A first: Complex auditory implant surgery at PGI

Tribune News Service

Naina Mishra

Chandigarh, August 29

The Post Graduate Institute of Medical Education and Research here has performed its first auditory brainstem implant (ABI) surgery on a two and a half-year-old patient.

An implant is a boon for those with hearing loss who can’t benefit from a hearing aid or cochlear implant surgery due to abnormalities of the cochlea or cochlear nerve. This is most commonly due to a missing or very small hearing nerve or severely abnormal inner ear (cochlea). The child was born without a cochlea or auditory nerves since the birth. Dr Naresh Panda, Head of the Department of Otolaryngology, PGIMER, said: “In the cochlear implants, the rehabilitation takes around six months whereas in case of the ABI, the rehabilitation is a little longer as the child gradually picks up hearing. However, the ABI procedure is costlier (Rs 16 lakh) than the cochlear implant (Rs 5 lakh).”

The Department of ENT, PGIMER, carries out around 20 to 25 cochlear implant surgeries every year. The ABI is done in those patients in whom the cochlea (spiral-shaped bone found in the inner ear and contains the sensory organ of hearing) and auditory nerves are absent on both sides. In cochlear implants, the auditory nerve is stimulated by the implanted electrodes whereas in ABI, the cochlear nucleus present in the brainstem (bottom part of your brain) is stimulated. The hearing outcomes are better with cochlear implants compared to the ABI.

Dr Panda said, “The department has been running a successful cochlear implant programme for the past 19 years. However, the ABI is indicated in those patients in whom the cochlea and the cochlear nerve are either absent or not functioning well.”

Explaining the complex surgery, he said: “In adults, ABI surgery is performed on individuals after removing bilateral acoustic neuromas in whom both the auditory nerves may not be functional. The ABI bypasses the cochlea and cochlear nerve, and the implant is placed in the brainstem.”

This surgery was performed by a team comprising Dr Naresh Panda (ENT), Dr Pravin Salunke (neurosurgery), Dr Sanjay Munjal, Dr Parul Sud (audiology) and Dr Nidhi Panda and Dr Babita Ghai (anaesthesia) from the PGIMER, under the supervision of Prof Mohan Kameshwaram, Prof MC Vasudevan and Prof Ranjith Rajeswaran from Chennai. Dr Kameshwaram and Dr Vasudevan have a vast experience in performing ABI surgeries in the country.

Boon for hearing loss patients

• Auditory brainstem implant (ABI) is done in patients lacking cochlea (spiral bone containing sensory organ of hearing) and auditory nerves, and uses technology similar to a cochlear implant
• The difference is where and what electrodes stimulate. With cochlear implant, electrodes stimulate auditory nerve in cochlea, while ABI’s electrodes are placed directly on brainstem (bottom part of brain)
• Cochlear implant generally provides better quality sound, but it can’t be used in all situations. The ABI procedure is also costlier (Rs 16 lakh) than the cochlear implant (Rs 5 lakh)

In cochlear implants, rehabilitation takes around six months, while in case of the ABI, it is a little longer as the child gradually picks up hearing — Dr Naresh Panda, Head, Department of Otolaryngology, PGIMER

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