1. By Quinn Burton Presented on October 13, 2015

2.  the cochlear nerve is part of the vestibulocochlear nerve, a cranial nerve, located in the innner. This nerve carries auditory sensory information from the cochlea of the inner ear to the brain[2]. A deficiency, lack, or malformation of this nerve makes it difficult or impossible for an indivual to develop normal speech production and recognition. cochlear nerve defiency nearly 28 million americans and that number is projected to keep rising Cochlear/Audit ory Nerve Van Naarden K, Decoufle P, Caldwell K. Prevalence and characteristics of children with serious hearing impairment in metropolitan Atlanta, 1991-1993. Pediatrics. 1999 Mar. 103(3):570-5. [Medline].[Medline]

3.  1957, Dr. Djourno and Dr. Eyries found that by stimulating the auditory nerve of a deaf person with an electrified device, auditory activity occurred in the patient  This was a crucial observation and the framework for what would become the cochlear nerve implant Cochlear Implant Surgery <http://emedicine.medscape.com/article/857242- overview#a12

4.  The single channel set-up of the early devices have been replaced by multichannel set-ups, which allow for improved speech recognition  There are currently three FDA- approved, multichannel devices that are used in the U.S. Cochlear Implant Surgery <http://emedicine.medscape.com/article/857242- overview#a12 Nucleus 5 CIClarion 90K CICombi 40+

5.  Recently, Auditory Brainstem Implants (ABIs) are showing promise in treating cochlear nerve deficiency  Studies are now showing that ABIs can help the patient in the same way that cochlear implants but to a great degree of effectiveness and lower degree of risk in surgery Colletti, L., Colletti, G., Mandalà M., Colletti V., The Therapeutic Dilemma of Cochlear Nerve Deficiency, April 23, 2014

6.  Cochlear Implant  A small incisions made behind the ear, the posterior bone of the ear is exposed, the aerated bone is removed, implant is placed between skin and muscle around the former location of the aerated bone, another incision is made in the cochlear for the insertion in the cochlea. After the skin is closed, the procedure is complete and the patient begins healing. [1]  Auditory Brainstem Implant  A small incisions made behind the ear, the posterior bone of the ear is exposed, the 20 small disc electrodes of the ABI are inserted on the cochlear nucleus of the fourth ventricle. [1] Cochlear Implant Surgical Procedure http://www.vanderbilthealth.com/billwilkerson/280 94 http://www.vanderbilthealth.com/billwilkerson/280 94 [2] Cochlear implants and brain stem implants http://bmb.oxfordjournals.org/content/63/1/183.full http://bmb.oxfordjournals.org/content/63/1/183.full

7.  Cochlear Implant  Inner ear dysplasia- a common cavity deformity  Cochlear Obliteration- the cochlear lumen may become obliterated making implantation impossible  Chronic Middle ear and Mastoid Disease- An infection that occurs as a result of foreign objects in the ear  Auditory Brainstem Implantation  Most side effects occur post-surgery and can be easily fixed  They include: facial twitching, pain in the throat, face, or body.  Post- Surgery altering can fix these Cochlear implants and brain stem implants http://bmb.oxfordjournals.org/content/63/1/183.full http://bmb.oxfordjournals.org/content/63/1/183.full

8.  In a study, two groups of children with cochlear nerve deficiency were compared. One group had the cochlear implantation surgery and the other group had the ABI surgery.  Auditory performance was tested after the procedures were completed.  The group with cochlear implants scored O to 3 on the test. The group with ABIs scored 2 to 7.  The group with cochlear implants gained no ability for speech recognition while the group with ABIs did to a great degree.  The group with ABIs were so positively impacted that many of them were able to participate in mainstream education post surgery, a feat near impossible pre-surgery. This graph shows the improvement in auditory skills of ABI patients. This long-term improvement was not seen in cochlear implant patients [Colletti, L., Colletti, G., Mandalà M., Colletti V., The Therapeutic Dilemma of Cochlear Nerve Deficiency, April 23, 2014

9.  ABIs are a more effective, safer way of treating cochlear nerve deficiency.  The scientific community needs to focus on progression of this more effective method and spreading the use of this method  It allows for wonderful improvement in the quality of the patient’s lives and in their auditory skills [Colletti, L., Colletti, G., Mandalà M., Colletti V., The Therapeutic Dilemma of Cochlear Nerve Deficiency, April 23, 2014

10. Thank you for listening.