Esteem Hearing Implant Andrew Dunne


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  • Also called nerve deafness… most common form of deafness usually fixed with ordinary hearing aid Lack of microphone helps minimize background noises. Filtered out by the ear drum like in normal hearing Once depleted, battery is replaced in a minor outpatient surgical operation.
  • The Esteem device uses a piezoelectric sensor to monitor the eardrum and convert the signal into digital for processing. The processed information is then converted back into physical vibrations and applied to the stapes capitulum
  • Esteem Hearing Implant Andrew Dunne

    1. 1. Esteem Hearing Implant Andrew Dunne
    2. 2. What is Esteem? <ul><li>A totally implantable hearing system that is implanted under the skin behind the ear and within the middle ear space </li></ul><ul><li>For moderate and severe sensorineural hearing loss </li></ul><ul><ul><li>Sensorineural hearing loss -- Loss of hearing resulting from problems in the inner ear, the cochlear nerve, or in the brain. </li></ul></ul><ul><li>Has no microphone </li></ul><ul><ul><li>Uses the functioning eardrum to pick up vibrations </li></ul></ul><ul><ul><li>Adjusts vibrations to individual hearing needs </li></ul></ul><ul><li>Pacemaker like battery </li></ul><ul><ul><li>Needs replacement after 4.5 to 9 years of continuous use. </li></ul></ul><ul><ul><li>battery replaced in a minor outpatient surgical operation. </li></ul></ul>
    3. 3. Parts <ul><li>Two piezoelectric transducers implanted in the middle ear </li></ul><ul><ul><li>Sensor – surgically attached to incus </li></ul></ul><ul><ul><li>Driver – attached to stapes </li></ul></ul><ul><li>Sound Processor </li></ul><ul><ul><li>Implanted behind the ear in a boney well </li></ul></ul><ul><ul><li>Hold battery </li></ul></ul><ul><li>Personal Programmer </li></ul><ul><ul><li>Turns Esteem on/off </li></ul></ul><ul><ul><li>Select volume levels </li></ul></ul><ul><ul><li>Three program settings </li></ul></ul>
    4. 4. How it works I <ul><li>Sound travels down ear canal and vibrates eardrum </li></ul><ul><li>Sensor </li></ul><ul><li>Picks up vibrations from incus. </li></ul><ul><ul><li>Converts vibrations into electrical signals which are sent to the sound processor. </li></ul></ul><ul><li>Processor </li></ul><ul><ul><li>The digital signals are modified depending on patients individual needs </li></ul></ul><ul><ul><li>Determined by variety of hearing tests </li></ul></ul>
    5. 5. How it works II <ul><li>Driver </li></ul><ul><ul><li>Converts the new electrical signals into mechanical vibrations. </li></ul></ul><ul><ul><li>Transmits these signals to the stapes and the cochlea </li></ul></ul>Sound Processor Sensor Driver Incus and Stapes surgically separated to prevent feedback.
    6. 6. Study <ul><li>Study began in 2007 </li></ul><ul><li>Esteem implanted in 6 patients </li></ul><ul><ul><li>5 right ear, 1 left ear </li></ul></ul><ul><li>Hearing tests before, after surgery, after activation </li></ul><ul><li>Duration of surgical procedure varied </li></ul><ul><ul><li>First – 8h 10min </li></ul></ul><ul><ul><li>Last – 3h 50min </li></ul></ul><ul><ul><li>Average – 5h 45min </li></ul></ul><ul><li>Implant activated 2 months afterwards </li></ul>
    7. 7. Results <ul><li>3 of the 6 patients had implant activated. </li></ul><ul><ul><li>Reasons were not discussed </li></ul></ul><ul><li>Audiometric results </li></ul><ul><li>Mean (250-4000Hz) actual hearing gain as compared to preoperative hearing threshold </li></ul><ul><ul><li>Patient 1 – 26dB </li></ul></ul><ul><ul><li>Patient 2 – 9dB </li></ul></ul><ul><ul><li>Patient 3 – 11dB </li></ul></ul><ul><li>Mean actual hearing gain compared to postoperative hearing threshold </li></ul><ul><ul><li>Patient 1 – 65dB </li></ul></ul><ul><ul><li>Patient 2 – 41dB </li></ul></ul><ul><ul><li>Patient 3 – 61dB </li></ul></ul>
    8. 8. Issues / benefits <ul><li>Long surgical procedure with steep learning curve </li></ul><ul><li>Highly Invasive surgical procedure </li></ul><ul><li>Interruption of the ossicular chain </li></ul><ul><ul><li>Causes additional hearing loss initially </li></ul></ul><ul><li>Completely invisible to self and others </li></ul><ul><li>No acoustic feedback </li></ul><ul><li>Maintenance free </li></ul>
    9. 9. Approval <ul><li>Earned the CE mark of approval </li></ul><ul><li>FDA approved on March 17, 2010 </li></ul><ul><li>Direct cost to the recipient for device and implant surgery is approximately $30,000. Financing options are available. </li></ul>
    10. 10. References <ul><li>Barbara, M, Manni, V, & Monini, S. (2009). totally implantable middle ear device for rehabilitation of sensorineural hearing loss: preliminary experience with the esteem®, envoy. Acta Oto- laryngologica , 129 (4), 429-432. </li></ul><ul><li> </li></ul><ul><li> </li></ul>