Diagnostic auditory brainstem response (ABR) testing allows for early identification of severe hearing loss, but definitive treatment such as cochlear implantation (CI) is often delayed due to a variety of auditory, medical, and social factors. This study characterizes the clinical significance of bilateral “no response” (NR) ABR in terms of ultimate hearing intervention outcome. Bilateral NR ABR is highly predictive of progression to CI. CI should be tentatively recommended assuming confirmatory behavioral audiometric testing. Amplification trials, counseling, and auditory-based intervention therapy should commence but not delay surgical intervention, as it does not appear to change the eventual clinical course.