How does esteem implant work

The sound processor is connected to the two transducers, namely the sensor and the driver. The SP titanium case is housed in a temporal bone niche and receives the electrical signals from the sensor cemented to the incus body. After being processed, the signals are sent to the driver cemented to the stapes head, with a vibrational movement that generates the perilymphatic wave for cochlear stimulation Figure 2.

The two transducers connected to the sound processor 2 are then placed in contact with the ossicular chain: The sensor 1 to the incus body and the driver 3 to the stapes head.

Potential candidates were selected after a thorough audiometric assessment, which included pure tone and speech audiometry. Once the audiological clearance is given, a preliminary CT scan of the petrous bone is carried out to assess the feasibility of the procedure, in particular, if the space inside the mastoid cavity would be sufficient for housing the two transducers: the sensor on the incus body, by measuring the distance between the incus body and the sino-dural angle, and the driver on the stapes head, through a wide posterior tympanotomy, going posteriorly toward the sigmoid sinus region and lateral to the mastoid facial nerve course.

At this point, all the information regarding use, time of use, and performances with a cHA is taken and thoroughly evaluated by speech audiometry in quiet and noise as well as by specific questionnaires. The surgical procedure is performed under general anesthesia, with facial nerve monitoring and under hypotensive control all along the surgical steps, especially when cementing is taking place.

The main steps of the surgical procedure are summarized as follows: Identification of a flat, retro-auricular area in which a bony niche for the sound processor SP can be drilled. Accordingly, the skin incision is outlined and injected with vasoconstrictor solution.

A lazy-C retro-auricular incision, including skin and subcutaneous tissue, is carried out. After placement of self-retaining retractors, a large Palva flap is created and elevated with an anteriorly based pedicle.

The SP bone well is then drilled by using large 6—8 mm cutting and diamond burs, ending up by drilling two small holes on both sides for securing the SP to the skull at the end of surgery by nylon thread. An enlarged mastoidectomy is then drilled, completely exposing the presigmoid area, the sino-dural angle, and the inferior mastoid cell tip area. Posterior epitympanectomy is then carried out until getting the complete exposure of the incus body and the malleus head, with the incudomalleolar joint.

Posterior tympanotomy is then drilled, thinning out—but keeping intact—the posterior buttress; drilling is continued until a gross trapezoidal-shaped opening is obtained at the expense of the chorda tympani nerve, which needs to be severed in all cases to avoid its eventual contact with the driver transducer. The lateral aspect of the posterior tympanotomy will correspond to the fibrous tympanic annulus.

The superior corner of the posterior tympanotomy is drilled until obtaining an acute angle. The whole long process of the incus and the pyramidal eminence needs to be optimally visualized. After placing a soft insert microphone—connected to a laser Doppler vibrometer LDV System—into the external auditory canal, two small reflectors are placed on the incus body and on the posterior crus of stapes for allowing the assessment of the normal mobility of the intact ossicular chain [ 4 ].

LDV, mounted on a second microscope, checks first the intact chain movement, which should mandatorily give normal values before continuing the procedure. LDV is a very accurate G1 10 j4 Km , noncontact instrument that works by comparing the frequency of the emitted laser diode light with the frequency of the reflected light of the moving object Figure 4. Sound at dB SPL and a sweep of 50 frequencies ranging from to 8.

Separation of the incudostapedial joint is performed after gently removing the overlying mucosa. At this point, removal by scraping of the mucosa over the stapes head is accomplished after dying the area with methylene blue, and finally drying it with low-watt laser beam.

Both sensor and drivers transducers are then attached to the Glasscock stabilizers screwed on the posterior edge of the mastoidectomy cavity and are then placed on the incus body and on the precoated stapes head, respectively. Laser Doppler vibrometer LDV measurements are then performed, for testing both sensor and driver efficiency. The SP is then put in place and attached to the sensor and driver cables. The three percent with less than successful results were caused by infections and poor audiological performance.

The technology is very reliable with a failure rate of less than one percent. As you know, patient satisfaction rates are more subjective, and dependant on preoperative expectations. When considering options it's always helpful to learn what an experienced Esteem surgeon has to say! In people with sensorineural nerve-related hearing loss, the mechanics of the middle ear are functioning normally.

The Esteem is designed to leverage the natural mechanics of the middle ear. The surgical procedure takes place under general anesthesia and typically takes two to three hours.

The procedure is outpatient and so you can go home after surgery. All bench top testing done has shown an expected lifespan of at least 30 years that was the limit of the testing done, not the limit of the device lifespan. Many of our patients have it implanted for more than ten years.

Most of the components are based off of, or are similar to, pacemaker components — these products are built to last a long time in the human body. For approximately eight weeks after surgery the ear is healing and you will not be able to hear through the ear in which the Esteem is implanted.

The Esteem is designed to be retroactively compatible. Therefore as improvements such as software upgrades and improved battery life are made Esteem patients will get to take advantage of these upgrades when their battery is replaced. Curious about how the Esteem works? Watch the short video below to find out. See how the Esteem works! The Esteem battery and software are housed together in the Sound Processor piece which sits in the temporal bone.

This tissue can generally be removed; however,there are some people that will continue to re-grow this fibrotic tissue making it impractical to keep the device. As with any surgery, especially those done under general anesthesia, there are risks and potential complications that will be discussed in the surgeon's office.

In the surgical procedure, the surgeon must sometimes cut the chorda tympani, which is the nerve associated with taste. This can result in a taste disturbance that most patients describe as a metallic taste in their mouth. For most patients this goes away over time, but can linger or be permanent. The surgeon will be working in the area of the facial nerve and therefore facial nerve monitors are used during surgery to prevent injury.

If a person tends to swell a lot, this can put pressure on the facial nerve causing a numb or tingly sensation on that side of the face. Your surgeon will be able to give more details on the surgical procedure. The side-effects observed in the clinical study included:. It is important to remember that hearing is both a subjective and a quality of life issue that affects every aspect of an individual's life.

The patient is in the best position to decide how important addressing their hearing loss is to them and what risks the patient is willing to assume in the process. You can turn the device off and on, adjust the volume, and take advantage of three unique program settings. Is your hearing loss affecting the life you live? Would you like to throw your hearing aids in the ocean? Have you avoided wearing them entirely? If so, Esteem is likely a solution for you. It is designed to treat adults with the most common type of hearing loss — moderate to severe nerve-related sensorineural hearing loss.

With Esteem, you can work, play, and live as you could before hearing loss. Mark L. Nichols, a board certifed otolaryngologist, is specifically trained in the Esteem implant surgery. Call to schedule an appointment with Dr. Nichols to determine if you are a candidate for this hearing implant.