title: Apparent cochlear nerve aplasia: to implant or not to implant?
abstract: OBJECTIVE
  To describe the imaging findings and clinical outcomes of children with apparent cochlear nerve aplasia undergoing cochlear implantation.
  
  
  METHODS
  Retrospective case review.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Three patients with imaging findings consistent with absent cochlear nerve canal on diagnostic imaging and questionable audiometric responses on testing who underwent promontory stimulation and subsequent cochlear implantation.
  
  
  METHODS
  Magnetic resonance imaging and computed tomography, audiologic assessment, and cochlear implantation.
  
  
  METHODS
  Audiologic performance after cochlear implantation.
  
  
  RESULTS
  Three patients were identified to have hearing loss on newborn hearing screening and underwent auditory brainstem response testing revealing absent brainstem responses. ASSR testing was inconclusive when performed. Imaging in all cases identified 1 ear with a small internal auditory canal with 2 nerves present, one of which seems to enter the vestibule in each case and the other is assumed to be the functioning facial nerve. There was a bony plate present over the entrance to the cochlea in 2 of the 3 patients. Over time, 2 of the families reported responses to auditory stimuli with amplification. Promontory stimulation testing showed reproducible responses to electrical stimuli in the ears in question. After cochlear implantation, all 3 patients have shown responses to auditory stimuli.
  
  
  CONCLUSIONS
  The absence of a visible cochlear nerve or cochlear nerve canal on radiologic imaging does not preclude auditory innervation of the cochlea. Cochlear implantation can be a viable option for patients with apparent cochlear nerve aplasia who have undergone appropriate testing. Electronically evoked auditory brainstem response is critical in the evaluation of this patient group.
authors.affiliation: Division of Otolaryngology, Head and Neck Surgery, University of Utah, Salt Lake City, Utah 84132, U.S.A. sklbse@gmail.com
authors.forename: Frank M
authors.initials: FM
authors.lastname: Warren
authors.forename: Richard H
authors.initials: RH
authors.lastname: Wiggins
authors.forename: Cache
authors.initials: C
authors.lastname: Pitt
authors.forename: H Ric
authors.initials: HR
authors.lastname: Harnsberger
authors.forename: Clough
authors.initials: C
authors.lastname: Shelton
mesh_terms: D000015:Abnormalities, Multiple / Q000473:pathology; D001299:Audiometry; D002675:Child, Preschool; D019929:Cochlear Implantation; D003054:Cochlear Implants; D003056:Cochlear Nerve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D016057:Evoked Potentials, Auditory, Brain Stem / Q000502:physiology; D005260:Female; D006320:Hearing Tests; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed