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The Esteem Hearing Implant: An Invisible Hearing Aid Alternative

With a degree in biochemistry, Leah works for a small biotechnology company and enjoys writing about science.

Imagine the Possibilities

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.

How It Works

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.

Having Surgery

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 entire Esteem implant system.

The entire Esteem implant system.

29 Year Old Hears Voice for the First Time: Esteem Implant

Who Can Get The Esteem?

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).

Benefits of the Esteem

  • 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.

The Esteem Hearing Implant

What Are the Negatives?

  • 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.

Cost of the Esteem Implant

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.

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.

Lyric Hearing Aid: An Invisible Option Without Surgery

Phonak 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.

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Personal Accounts of the Esteem Device

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

© 2011 Leah Lefler


Chandra on January 20, 2017:

My mother is experiencing substantial hearing loss and my sister and I are looking into this alternative. It's costly. Like $30-40 per ear costly. Can someone confirm what they've spent or is the internet exaggerating?

Leah Lefler (author) from Western New York on November 10, 2012:

Thank you for the advice, Kevin. We have always used our FSA for our son's hearing aids (traditional acoustic aids) - he has a severe hearing loss and is being referred to a cochlear implant center for a "meet and greet" - if we decide to go that route, insurance will cover the implant as it is not considered a "hearing aid." The Esteem is, unfortunately, not covered by insurance and can be a real financial hardship to those who could benefit from the device.

I had never thought about deducting the cost of my son's hearing aid batteries from our taxes. He has significant health costs (definitely more than 10% of our income), so we will claim medical expenses as a deduction this year.

Kevin on November 08, 2012:

Do not fully rely on the tax savings calculation. The calculation defaults to the standard limitation on medical expenses. However, for those still in the working world, such medical expenses are likely fully deductible as "work-related-modifications." Consult your tax advisor.

BTW, I have always fully deducted the cost of my hearing aids and annually claim the cost of batteries.

Leah Lefler (author) from Western New York on May 23, 2012:

Hi Bonnie - the esteem (or another implantable middle ear device) may be an option for you. There are several options on the market: the Esteem is one option, but you must have a healthy middle ear to be considered a candidate. The Vibrant Soundbridge is another option, and you may be able to get insurance to cover it if your hearing aids aren't suitable due to conductive fluctuations. My son has a mixed hearing loss, for example, so he would never be considered a candidate for the Esteem. He would be a candidate for the Soundbridge, though. I would ask your audiologist about options at your next visit if your air-conduction hearing aids aren't working well for you. I would also see an ENT about the frequent "ear popping" you need to do. That sounds like middle ear fluid - sometimes adults need tubes placed because of Eustachian tube dysfunction - usually tubes are placed in children, but I know a few adults who have needed (and benefitted) from tubes, too.

Bonnie on May 23, 2012:

I have congenital nerve deafness. Is the implant an option for me? If not, is there another suggestion, as my main problem with any aid has been occlusion difficulties. I am constantly having to "pop" my ears to hear better.

Leah Lefler (author) from Western New York on January 25, 2012:

Grazie! I am glad the Esteem is working well for you, and I hope that you are free from colds for the rest of this year. Technology is amazing!

My son is four years old and was born with his hearing loss - his hearing aids help him a lot, but it would be nice if he could go swimming with them. I wish they would make more waterproof hearing aids!

IMPLANTED on January 25, 2012:

I'm glad to read your new answer. I'm from Italy. I'm 34 years old and i had my Esteem implant on september 2011 and now since that day i can ear better than first, but sometimes i must to take care about my ear from flues, cold, temperature changes, otherwise i will risk to have to face this feedback problems.

I worn a couple of earing aids too for ten ears but tired by them, i decided to have this new tecnology with so many satisfactions!!!

Whishes for your son and i hope that resolve this problem for a life-time

Leah Lefler (author) from Western New York on January 24, 2012:

Ah, that makes more sense! I was wondering with the "skin," but ear makes much more sense! I speak Spanish as well as English, and I know how hard it can be to translate things from your mother tongue - I often make horrible blunders, lol! I hope the feedback goes away. My son wears two hearing aids and he has a lot of feedback issues, but he has traditional hearing aids since he is a child. I love new technology like the Esteem since it means more options for him in the future - I really can't wait to see what the next ten years brings with regard to hearing technology!

IMPLANTED on January 24, 2012:

Hi Leahlefler, i'm sorry for my bad english, i meant:"i tried on my ear this result" but the symptoms sim like a trill or feedback in my ear. Now this situation is in the process of healing but in beginning i had this noises i my ear.... i just wanted to say i tried on my ear, not in my skin , i'm sorry again for my bad english ahahah we meet on the next post, bye bye

Leah Lefler (author) from Western New York on January 22, 2012:

Hi Implanted - Esteem recipients do have to have a healthy middle ear. People with chronic middle ear disease are NOT candidates. Children are not candidates for this particular device because of the requirements for stability and healthy middle ears. I am confused when you say you "tried it on your skin?" The Esteem is a direct-drive style device which is attached to a bone in the middle ear. It is not possible to try this device on the skin. The bone anchored hearing aids (a different technology) are possible to try on a headband, though.

IMPLANTED on January 22, 2012:


Leah Lefler (author) from Western New York on December 27, 2011:

Thanks, Jared. The Esteem is a great option for people who love to swim and have stable hearing losses. The lack of feedback and the "maintenance free" aspect are enticing. The battery does have to be replaced very occasionally, and the cost is definitely a big consideration.

Jared Mckay on April 17, 2011:

Good missive. Loss of Hearing is sometimes a scary experience as a lot of the elderly experience dimished hearing everyday. Thanks for bringing this matter to light.

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