Envoy Medical has developed a middle ear implant that utilizes the natural eardrum, middle ear bones, a receiver, and a transducer to send amplified signals to the cochlea (inner ear).
How We Hear
- Naturally, hearing starts off with sound entering the earcanal as acoustic energy. This sound then vibrates the eardrum which transduces the acoustic energy into mechanical energy.
- The eardrum then puts into motion a series of very small bones in the middle ear: the malleus, incus, and stapes (aka hammer, anvil, & stirrup).
- The stapes footplate then pumps the fluids of the cochlea (inner ear) like a hydraulic system. The waves of fluid movement then stimulate thousands of hair cells called stereocilia.
- The stereocilia then convert that hydraulic energy into electrical impulses which are then sent along the auditory nerve, via the brainstem, to the auditory cortex where meaning to sound is achieved.
The Esteem does not utilize conventional microphone, amplifier, and speaker components. Instead, it relies on the natural eardrum to act as the microphone. The vibrations are then sent through a processing/amplifying process and the stapes bone is directly stimulated and its vibration enhanced. The battery is said to last up to 9 years.
This technology, which is not available to the general public yet; however Envoy Medical claims that this product can fit approximately 80% of all individuals with sensorineural hearing loss. The process requires surgery of the implant and estimated costs are around $25,000. Envoy states that they will not pursue the insurance companies for coverage because they do not want the insurance companies to delegate how much reimbursement this device should receive.
One of the advantages I currently see in the Esteem over current technologies is that it uses the natural eardrum to pick up sound information and does not have to rely on the fidelity of a microphone.
However, a sensorineural hearing loss is a sensorineural hearing loss is a sensorineural hearing loss! Due to damaged sensory cells, nerve degeneration in the inner ear and beyond, sensorineural hearing loss adds a distortive component to all sound coming into the inner ear. My criticism is this: how is a middle ear implant going to significantly outperform a traditional hearing aid for individuals with sensorineural hearing loss when the problem is not the outer or middle ear…. it’s the inner ear! Either way, the distortion is still going to be there!
For individuals with certain middle ear/outer ear related issues, this product will most likely outperform a traditional hearing aid. Because it is bypassing what the hearing aid cannot.
Envoy Medical’s Esteem product definitely provides some interesting ideas into the hearing solutions industry. Is it worth pursuing? I would wait… see the results… and then wait until there’s a second or third generation of the product. The launch of a new product is often accompanied by problems and issues. Just look at the start of the cochlear implant industry and the meningitis scare… whew! Glad that’s over….
Here are some questions that I still have regarding this product.
Is there a digital processor?
Does it use compression/expansion for loud and soft sounds? I would like to know a little more about the processor.
Does it have to be explanted if the batteries run out?
3 out of 100 patients had to be explanted… seems like quite a lot…that’s 1 out of every 33 patients had to have surgery again to explant… what’s the comparison w/ other middle ear surgeries?