Rehabilitation of patients with profound hearing loss deemed unsuitable for cochlear implants is challenging. An auditory brainstem implant (ABI) is a viable option for these patients. This paper evaluates auditory and speech perception outcome measures following ABI in 10 postmeningitic patients with bilateral profound hearing loss and a totally ossified cochlea. These patients had been deemed unsuitable for a cochlear implant. The authors recommend an extended retrolabrynthine approach over the conventional retro-sigmoid approach for placement of ABI, highlighting the advantage of less brain retraction. Pure tone averages and speech perception tests were compared before and after the ABI implant. Eight patients (80%) showed improvements in tonal audiometry and the word and vowel perception tests after an average follow-up of 3.3 years. Two patients recognised up to 40% of the closed-set sentences without lip-reading. Two patients had no auditory response. All eight patients with an auditory response used their ABI daily for more than eight hours a day and reported benefits in daily communication with the ABI. The authors report no postoperative intracranial complications with their technique.