Auditory brainstem implant (ABI) technology attempts to restore hearing in deaf patients caused by bilateral cochlear nerve injury through the direct stimulation of the brainstem, but many aspects of the related mechanisms remain unknown. The unresolved issues can be grouped into three topics: which patients are the best candidates; which type of electrode should be used; and how to improve restored hearing. We evaluated our experience with 11 cases of ABI placement. We found that if at least seven of eleven electrodes of the MED-EL ABI are effectively placed in a patient with no deformation of the fourth ventricle, open set sentence recognition of approximately 20% and closed set word recognition of approximately 65% can be achieved only with the ABI. Appropriate selection of patients for ABI placement can lead to good outcomes. Further investigation is required regarding patient selection criteria and methods of surgery for effective ABI placement.