The Esteem Hearing Implant: An Invisible Hearing Aid Alternative

Traditional, acoustic hearing aids have come a long way. Still, there are many limitations to traditional hearing aids: the use of a microphone and speaker system creates feedback and distortion, earmolds must constantly be replaced, and hearing aids are not waterproof.

Enter the Envoy Esteem Hearing Implant: for adults with moderate to severe sensorineural hearing loss, the Esteem offers a wonderful hearing aid alternative. The Esteem is entirely implanted, invisible, waterproof, and uses the ear's natural eardrum to produce sound.

The Esteem is not a hearing aid: it is an implantable device. All components of the Esteem are implanted: a sensor picks up vibrations from the eardrum and middle ear bones, then an implanted sound processor processes and amplifies the sound according to individual needs. The amplified signals are sent to the driver, attached to the Stapes bone in the middle ear: the Stapes vibrates against the oval window, and sends the amplified sound directly to the inner ear (cochlea).

Each person who receives an Esteem implant will also receive a personal programmer: a remote control for turning the implant on and off, for adjusting up to three unique programs, and for selecting volume.

The Esteem implant requires surgery to the mastoid bone and an extended facial recess procedure to access the middle ear bones. While all surgeries have risks (primarily from anesthesia), the type of ear surgery used for implanting the Esteem is very safe. The surgery is brief, and most patients are released from the hospital on the same day.  The recovery is very fast, and the small incision (behind the ear) is not noticeable after healing. Implant recipients must wait a period of time (usually six to eight weeks) before the Esteem Implant is "activated," or turned on.

The Esteem is not advisable for all people with hearing loss. Currently, candidates for the procedure must be:

1. Over the age of 18: children may not get this device.
2. Have a moderate to severe sensorineural hearing loss: mild hearing losses and conductive hearing losses are not eligible for the Esteem.
3. Have a stable hearing loss: progressive or fluctuating hearing losses are not eligible.
4. Have a medically healthy middle ear: the eardrum, middle ear bones, and anatomy must all be normal.
5. Unaided speech discrimination score >40%.
6. Adequate space for the Esteem implant (determined by high resolution CT scan).
   

• Natural sound, as the eardrum provides the sound via a direct-drive mechanism.
• Completely invisible, as all parts of the Esteem are implanted.
• The Esteem is waterproof.
  
• No feedback, as there is no microphone.
• No maintenance, as the Esteem has a battery life of 4.5-9 years.

• Every 4.5-9 years, the Esteem battery will have to be replaced. This requires a minor, outpatient procedure, using local anesthesia.
• A sensitivity to silicone rubber, stainless steel, titanium, gold, or polyurethane will cause a reaction to this device.
• Implant recipients must avoid head trauma, so contact sports are not advised.
• Implant recipients may not have magnetic resonance imaging (MRI) performed.
• Recipients may not dive to a depth of more than 30 feet of water or otherwise expose the implant to high pressures.
• The Esteem may not function with all mobile phone devices.
• The Esteem may set of metal detectors at airports: an ID card is provided for recipients to show to security agents.
• The Stapes or cochlea may be damaged during removal or revision surgeries.
  

The cost of the Esteem middle ear implant is high: the estimated expense is about $30,000 for all of the required tests, the implantation surgery, the implant, and the follow-up appointments. The Esteem implant is not covered by medical insurance in most cases, so the recipient usually has to find a way to foot the bill.

If a person elects to have two implants placed, the cost would be approximately $60,000. Esteem candidates should also plan to save money for the battery replacement surgeries, which will not be covered by insurance.

It is possible for an Esteem recipient to borrow money from a 401(k) plan penalty-free to pay for the implant. If the cost of receiving the Esteem implant exceeds 7.5% of the candidate's gross annual income, a penalty-free withdrawal from a 401(k) retirement fund is allowed.

In addition, medical expenses exceeding 7.5% of an individual's gross income qualify for a tax deduction. Be aware, however, that the amount of money received in a tax deduction will come nowhere near the cost of the implant procedure. An estimated guide to the tax savings can be found here: Potential Tax Savings for the Esteem Middle Ear Implant.

A medical flex-spending plan (Flexible Spending Account or Health Savings Account) is another alternative to financing the Esteem Implant. This type of plan allows the individual to pay for the procedure with pre-taxed income, and will generally save more money than filing for a deduction.

InSound Medical manufactures the Lyric hearing aid, an invisible, "shower proof" hearing aid that sits deep inside the ear canal and is entirely invisible to the outside world. The Lyric hearing aid requires absolutely no surgery and remains in the ear, maintenance free, for up to four months. The Lyric hearing aid is purchased on an annual subscription basis, which covers all replacements for the year. Every 120 days, the Lyric recipient returns to the audiologist or physician to have the Lyric replaced in a ten-minute office procedure. The Lyric is a good solution for individuals with mild-moderate hearing losses desiring a maintenance free, invisible hearing aid that doesn't require surgery. The biggest negative is the price: an annual subscription for the Lyric hearing aid costs about $3,000.