Ricerc@Sapienza

The active middle ear implant (AMEI) may be considered, in selected cases, a valid
alternative to conventional hearing aids (cHA) for rehabilitation of bilateral sensorineural
hearing loss (SNHL). The Esteem ® represents one of the two invisible solutions that can
be adopted at the present time, and it is the only one with FDA approval since 2010. Since
2007, at the Implanting Centre of the University Hospital Sant’Andrea in Rome, 43 sub-
jects underwent surgery for application of this device, after having ascertained by CT scan
its feasibility for allocating its transducers within the mastoid space. The surgical procedure
is longer than for the other AMEI and the switch on of the device is usually performed 4
to 6 weeks after surgery. All the Esteem ® implantees underwent a pre- and post-operative
assessment via pure tone and speech audiometry with headset in a soundproof booth. Along
with the recommended population with moderate-to-severe hearing loss, also subjects with
a worse hearing loss (severe or severe-to-profound) were selected for this implant for dif-
ferent reasons. The auditory outcome in label and off-label implantees were analyzed,
showing in some case a deterioration of the auditory threshold. Complications included the
need for a minor revision, due to middle ear fibrosis, or for an explant that was followed
by ossicular reconstruction with return to a cHA (2 subjects), cochlear implantation (5 sub-
jects) or no alternative solution (1 case).