Introduction: The Esteem is a totally implantable hearing system that uses piezoelectric technology. It is indicated in case of moderate to severe stable sensorineural hearing loss with a minimum discrimination score of 60% and a middle ear which is anatomically and functionally intact. Its two components (sensor and driver) are positioned and fixed in the mastoid cavity and coupled respectively to the incus body and capitulum with cement. Study Design: Retrospective study. Settings: Tertiary referral center. Materials and Methods: Pure-tone average (PTA) gain in the implanted ear was calculated at 1, 2, and 4 KHz, word recognition score (WRS) gain at 50 dB SPL, and average WRS (AWRS) gain at 40, 55, and 70 dB SPL. WRS was also evaluated in silence and noise. All patients were asked to fill in the abbreviated profile of hearing aid benefit (APHAB) questionnaire pre- and postoperatively as well as an Esteem questionnaire. Results: Thirteen patients received implants between May 2008 and April 2010. Five minor complications occurred (1 temporary partial facial palsy, 1 secondary healing difficulty, and 3 revision surgeries for poor and deteriorating functional results and progressive gain loss after use of a heart defibrillator). Two patients (15%) suffered major complications and their implants had to be removed 4 months postoperatively because of a Staphylococcus aureus wound infection. One patient underwent reimplantation 6 months later. Mean PTA gain was 25 ± 11 dB, mean WRS gain at 50 dB SPL was 64 ± 33%, and mean AWRS gain was 40 ± 20%. WRS in silence and with a signal-noise ratio of 10, 0, and –5 dB was 91 ± 11, 85 ± 14, 71 ± 19, and 64 ± 30%, respectively. The APHAB questionnaire revealed 84% of satisfaction improvement compared to the previous classic hearing aid. Conclusion: The totally implantable hearing device Esteem 2 can offer good functional and satisfaction results. Careful selection of patients is required, however, based on hearing tests, exclusion of middle ear ventilation problems, and CAT-scan middle ear anatomy. Specific surgical training and experience are also needed. The implant is safe and only associated with classic auditory implant complications.

Keywords:
Hearing implant, Esteem, Results, Complications, Satisfaction
1.
Barbara M, Biagini M, Monini S: The totally implantable middle ear device ‘Esteem’ for rehabilitation of severe sensorineural hearing loss. Acta Otolaryngol 2011;131:399–404.
2.
Cunningham CD, Slattery WH, Luxford WM: Postoperative infection in cochlear implant patients. Otolaryngol Head Neck Surg 2004;131:109–114.
3.
Huber A, Sequeria D, Decraemer WF, et al: The effects of complex stapes motion on the response of the cochlea. Otol Neurotol 2008;29:1187–1192.
4.
Jenkins H, Atkins J, Horlbeck D, Hoffer M, Balough B, Alexiades G, Garvis W: Otologics fully implantable hearing system: phase I trial 1-year results. Otol Neurotol 2008;29:534–541.
5.
Kraus E, Shohet JA, Catalano PJ: Envoy Esteem totally implantable hearing system: phase 2 trial, 1-year hearing results. Head Neck Surg 2011;145:100–109.
6.
Martin C, Deveze A, Richard C, et al: European results with totally implantable Carina placed on the round window: 2-year follow-up. Otol Neurotol 2009;30:1196–1203.
7.
Schmuziger N, Schimma, F, à Wengen D, Patscheke J, Probst R: Long-term assessment after implantation of the vibrant soundbridge device. Otol Neurotol 2006;27:183–188.
© 2012 S. Karger AG, Basel
2012
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