About Prof. Wu Hao
Prof. Wu Hao is a world-class otologist at the Eye & ENT Hospital of Fudan University, specialising in cochlear implantation, auditory brainstem implants (ABI), and complex middle ear surgery. His team performed China's first paediatric ABI surgery in 2019, developed China's first domestically produced ABI system — now in multicentre clinical trials — and has raised the ABI surgical success rate from the international average of 60% to 92% through innovations in electrode design, 3D positioning technology, and intraoperative auditory evoked potential monitoring. His operative standards are incorporated into China's audiology clinical guidelines, and his research has been published in Cell Research and other leading journals.
Case Overview
Xiao Ming (pseudonym), a 26-month-old boy, was brought to Prof. Wu's clinic after failing newborn hearing screening. High-resolution CT and MRI confirmed bilateral cochlear aplasia — the cochleae were absent bilaterally, making cochlear implantation anatomically impossible. Auditory brainstem response testing confirmed no measurable hearing at any frequency; language development was absent. Prof. Wu's team assessed him as a candidate for ABI — the only available hearing restoration pathway. Surgery was performed at 26 months: the 16-channel electrode array was implanted at the cochlear nucleus under intraoperative AEP guidance, with 3D positioning ridge technology ensuring placement accuracy within 0.5 mm. Intraoperative AEP confirmed robust cochlear nucleus activation across all 16 channels. At device activation six weeks postoperatively, Xiao Ming responded to environmental sounds for the first time. At two-year follow-up, he was vocalising consistently, responding to his name, and producing two-word phrases — approaching age-appropriate norms for children with ABI. His parents reflected: "We were told he would never hear. Prof. Wu's team gave him a world with sound. Watching him respond to his name for the first time — there are no words for that moment. He is talking now. He is catching up. We could not have imagined this two years ago."
Diagnostic Workup
Newborn hearing screening: bilateral refer on automated ABR. Diagnostic ABR at 3 months: no response at 90 dB nHL bilaterally. CT temporal bones: bilateral cochlear aplasia; internal auditory canals present; facial nerve anatomy normal. MRI temporal bones and posterior fossa: cochlear nerves present bilaterally (hypoplastic); brainstem and cochlear nuclei structurally normal. Genetic testing: GJB2 negative; comprehensive deafness gene panel negative — malformation classified as sporadic. Multidisciplinary assessment confirmed bilateral cochlear aplasia precluding CI, intact cochlear nuclei, and ABI candidacy. Developmental assessment: no vocalisation; no sound response; language age equivalent zero months at 22 months chronological age.
Prof. Wu's pre-operative assessment: Bilateral cochlear aplasia is an absolute contraindication to cochlear implantation. MRI confirms the cochlear nuclei are structurally present and the brainstem anatomy is suitable for ABI. At 26 months, the auditory cortex retains neuroplasticity — the window for meaningful auditory development is open, but it will not remain open indefinitely.
Treatment Strategy and Course
Diagnosis: Bilateral cochlear aplasia — CI anatomically impossible; ABI the only hearing restoration pathway; cochlear nuclei intact; neuroplasticity window open at 26 months.
Treatment principle: ABI with 16-channel electrode array, 3D positioning ridge technology, and intraoperative AEP guidance — precise cochlear nucleus stimulation to initiate auditory pathway development and enable language acquisition.
- Surgery: Retrosigmoid craniotomy; cochlear nucleus identified under neuronavigation; 3D positioning ridge electrode placed with <0.5 mm accuracy; robust AEP confirmed across all 16 channels before closure
- Stimulation strategy: Layered stimulation protocol — differentiated pulse parameters for distinct cochlear nucleus functional subregions, maximising sound coding complexity
- Activation and rehabilitation: Sound awareness confirmed at first activation (6 weeks); intensive auditory-verbal therapy commenced; weekly sessions for 12 months with parent-implemented home programme
- Two-year follow-up: Consistent vocalisation; reliable name response; two-word phrases emerging; language approaching ABI age-appropriate norms; no device or neurological complications
Prof. Wu's clinical reflection: At 26 months, this child had never heard a sound. At two years post-implant, he is producing two-word phrases. That trajectory — from silence to language — is what ABI makes possible when the electrode is placed precisely and rehabilitation begins immediately. The 3D positioning ridge and intraoperative AEP are not refinements — they are the difference between an electrode that activates the cochlear nucleus and one that does not.
Expert Commentary — Prof. Wu Hao
1. ABI Indication and Patient Selection
Approximately 8% of congenitally deaf children have cochlear malformations or cochlear nerve aplasia precluding CI. For these children, ABI — which bypasses the cochlea entirely by directly stimulating the cochlear nucleus — is the only available hearing restoration pathway. Candidate selection requires high-resolution CT and MRI to confirm cochlear anatomy, cochlear nerve status, and cochlear nucleus integrity. Optimal outcomes are achieved when ABI is performed within the neuroplasticity window — ideally before age three — when the auditory cortex retains the capacity for experience-dependent reorganisation underlying language acquisition.
2. 3D Positioning Ridge and Intraoperative AEP: Technical Innovations
The cochlear nucleus occupies a small, anatomically variable region of the lateral recess of the fourth ventricle; electrode misplacement by even 1–2 mm results in non-auditory stimulation rather than hearing. Prof. Wu's 3D positioning ridge — a surface structure conforming to the lateral recess contours — constrains electrode placement to within 0.5 mm of the target. Intraoperative AEP recording provides real-time electrophysiological confirmation of cochlear nucleus activation across all 16 channels, enabling dynamic adjustment before closure. Together, these innovations raised the surgical success rate from 60% (international average) to 92%, with non-auditory stimulation complications reduced to 2.5%.
3. Domestic ABI System: Breaking the Technology Monopoly
Prior to Prof. Wu's programme, ABI in China depended on imported European devices at costs beyond reach for most families. His team developed China's first domestic ABI system — incorporating the 16-channel array, 3D positioning ridge, and optimised stimulation processor — through a medical-engineering collaboration and patent licensing pathway. The system has completed multicentre registered clinical trials; all implanted patients recovered effective hearing with significant speech perception improvement. The domestic system reduces treatment cost by more than 50%, breaking the foreign technology monopoly that had restricted ABI access across China and Asia.
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Xiao Ming's family throughout their pathway at the Eye & ENT Hospital of Fudan University, providing priority consultation coordination with Prof. Wu's otology and audiology team, bilingual interpretation across all diagnostic, surgical, and rehabilitation consultations, coordination of CT, MRI, ABR, genetic testing, and developmental assessment with bilingual results communication, bilingual surgical consent, and ongoing rehabilitation scheduling.
For international patients with children who have failed cochlear implant candidacy assessment, or adults with hearing loss not amenable to conventional restoration — Prof. Wu Hao's team offers access to one of Asia's most advanced ABI programmes. CMCS ensures that expertise is accessible, in the patient's language, with every step coordinated clearly.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
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