Until last decade, use of auditory brainstem implant (ABI) was restricted to adults and children with severe inner ear malformations and cochlear nerve aplasia did not have any option for hearing rehabilitation. Use of ABI opened a new era for this group of patients. In this review article, definite and probable indications of ABI for children are stated. Among probable indications, children with hypoplastic nerves constitute the most challenging group in decision making between cochlear implant (CI) and ABI. In these patients, radiological findings should be utilized together with preoperative and intraoperative audiological evaluation. However, none of these assessment methods offer enough data to enable correct choice between CI and ABI. Intracochlear electrical ABR (eABR) seems to a better indicator compared to preoperative electrophysiological tests. Commonly, CI is the first choice in these patients; if benefit with CI is not satisfactory during follow up, then ABI is utilized. Further definitive diagnostic tools are require in order to overcome this uncertainty. The ABI team must be experienced on pediatric CI patients, also an experienced pediatric neurosurgeon is indispensable to achieve success and to avoid complications. Age limit for ABI is similar to CI candidate children. Better language outcome is expected at younger ages, i.e., between 1 and 2 years. Preoperative radiological work up involves both high resolution computed tomography and magnetic resonance imaging. The side with less severe inner ear malformation or with more developed neural structures can be preferred. In preoperative audiological evaluation, subjective tests should always be included in test battery as well as objective ones. Rehabilitative assessment is focused on auditory perception skills, language and speech skills and learning abilities. Surgical method of choice is retrosigmoid approach in children. Intraoperative eABR measurements are important to determine correct position of electrode. Interindividual variability in language development and audiological outcome is prominent. Overall complication rate is in an acceptable range when surgery is performed with an experienced team. In conclusion, ABI can provide satisfactory audiological outcomes and language development to a certain extent is possible when every aspect of whole process is applied properly.
