Paediatric Auditory Brainstem Implantation: Patient Selection, Surgical Challenges and Management of Complications

Paediatric auditory brainstem implantation (ABI) represents one of the most technically demanding and ethically complex interventions in contemporary otology and neurotology. While ABI has become an established option for children with profound deafness who are not candidates for cochlear implantation, its use—particularly in non-tumour paediatric indications—continues to evolve, with significant international variation in patient selection, surgical technique, outcome reporting and complication management.

This panel discussion aims to provide a comprehensive, experience-driven overview of current paediatric ABI practice, bringing together international experts to critically examine areas of consensus and controversy. The session will focus on three inter-related domains: patient selection, surgical and peri-operative challenges, and the prevention and management of complications.

The first part of the discussion will address patient selection and candidacy assessment. Key topics will include radiological and anatomical criteria, neurodevelopmental considerations, timing of implantation, counselling of families, and the role of multidisciplinary decision-making. Particular attention will be given to borderline cases, expanding indications beyond tumour-related deafness, and balancing potential auditory benefit against surgical risk in children with complex additional needs.

The second component will explore surgical challenges unique to paediatric ABI. Panellists will discuss approaches to the lateral recess of the fourth ventricle, intra-operative neurophysiological monitoring, electrode placement and fixation, and strategies to minimise neurological morbidity. Differences in surgical philosophy, learning curves, and institutional experience will be highlighted, with an emphasis on practical lessons learned from high-volume international centres.

The final section will focus on complications and outcome optimisation. Topics will include cerebrospinal fluid leak, lower cranial nerve dysfunction, device migration or malfunction, non-auditory stimulation, and long-term rehabilitation challenges. The panel will also address how complications are reported, communicated to families, and incorporated into governance, audit and international registries, as well as the need for standardised outcome measures.

The session will be highly interactive, incorporating case-based discussion and audience participation. It is intended for otologists, neurotologists, paediatric ENT surgeons, audiologists and senior trainees, and aims to stimulate informed debate, share best practice, and identify priorities for future collaboration and consensus development in paediatric auditory brainstem implantation.