The Esteem fully-implantable middle ear device

The active middle ear implant (AMEI) may be considered, in selected cases, a valid alternative to conventional hearing aids (cHA) for rehabilitation of bilateral sensorineural hearing loss (SNHL). The Esteem ® represents one of the two invisible solutions that can be adopted at the present time, and it is the only one with FDA approval since 2010. Since 2007, at the Implanting Centre of the University Hospital Sant’Andrea in Rome, 43 sub- jects underwent surgery for application of this device, after having ascertained by CT scan its feasibility for allocating its transducers within the mastoid space. The surgical procedure is longer than for the other AMEI and the switch on of the device is usually performed 4 to 6 weeks after surgery. All the Esteem ® implantees underwent a pre- and post-operative assessment via pure tone and speech audiometry with headset in a soundproof booth. Along with the recommended population with moderate-to-severe hearing loss, also subjects with a worse hearing loss (severe or severe-to-profound) were selected for this implant for dif- ferent reasons. The auditory outcome in label and off-label implantees were analyzed, showing in some case a deterioration of the auditory threshold. Complications included the need for a minor revision, due to middle ear fibrosis, or for an explant that was followed by ossicular reconstruction with return to a cHA (2 subjects), cochlear implantation (5 sub- jects) or no alternative solution (1 case).