**Question:** A child aged 3 years, presented with severe sensorineural deafness was prescribed hearing aids but showed no improvement. What is the next line of management-

A. Auditory brainstem implant (ABI)
B. Cochlear implant (CI)
C. Genetic counseling and further evaluation
D. Further hearing aid adjustments and auditory rehabilitation

**Correct Answer:** B. Cochlear implant (CI)

**Core Concept:**
Sensorineural deafness is a type of hearing loss caused by damage to the inner ear or the auditory nerve. In such cases, hearing aids may not be effective as they primarily amplify sounds rather than stimulating the damaged auditory neurons directly.

**Why the Correct Answer is Right:**
In cases of severe sensorineural deafness, especially when conventional hearing aids fail to provide improvement, the next appropriate step would be to consider a cochlear implant (CI). A CI is a surgically implanted electronic device that bypasses the damaged auditory neurons and directly stimulates the auditory nerve fibers, enabling the child to sense sound.

**Why Each Wrong Option is Incorrect:**
A. Auditory brainstem implant (ABI): ABI is a type of CI that only stimulates the brainstem, bypassing the damaged auditory nerve fibers and inner ear structures. This is less effective compared to cochlear implantation, which directly stimulates the auditory nerve fibers.
C. Genetic counseling and further evaluation: Although genetic counseling is important in cases of deafness, it is not the next line of management after hearing aids fail. Further evaluation should be conducted, but the primary management option is a cochlear implant.
D. Further hearing aid adjustments and auditory rehabilitation: Although auditory rehabilitation is crucial for children with deafness, it is insufficient as a management option when hearing aids fail to provide improvement. In such cases, a cochlear implant should be considered.

**Clinical Pearl:**
In cases of severe sensorineural deafness, a cochlear implant should be considered as the next line of management after hearing aids fail to provide improvement. Cochlear implantation provides direct stimulation of auditory nerve fibers, improving the child's ability to sense sound.