Common Misconceptions and Concerns with the Esteem®  Active Middle Ear Implant.

by Amy Pajula, on December 12, 2018

As a proud member of the hearing loss community, a hearing aid user for nearly three decades, and a happy bilateral Esteem® recipient, I am intimately familiar with the journey a person takes as they explore their hearing loss and the options available to them. I know the desire to find a better solution, one that works better for you and doesn’t seem to get in the way as much as it helps.  

After I became an Esteem® recipient, I became an Esteem® Counselor with Envoy Medical. I have worked with hundreds of other Esteem® recipients, and have probably talked to thousands of people with hearing loss looking for something more than a hearing aid.

Until recently, hearing aids were really the only treatment option for people diagnosed with sensorineural hearing loss. Over the last few decades, more technologies have come along for different types and levels of hearing loss. 

Active Middle Ear Implants are one of those relatively newer solutions for people with a certain level of sensorineural hearing loss. The Esteem® is the only fully implanted active middle ear implant FDA approved and commercially available in the United States.

The following are some common questions or concerns that I hear from people on looking into the Esteem® in the midst of their hearing loss journey.

Why not just get another hearing aid?

First, the Esteem® is only for those people who have tried a well-fit hearing aid for at least 30 days. If a hearing aid works for you, great! The Esteem® is something more and is geared towards people who have tried hearing aids and don’t get what they want out of them. They need something more.

Second, if you have tried hearing aids and are not satisfied, it is important to understand why. 

Is the hearing quality not what you had hoped? Are you having trouble hearing in background noise? Are you having trouble hearing in real-life situations? Are the hearing aids just a pain in the ear!?!?

Hearing aids have come a long way, but they are still hearing aids with limitations inherent to the technology.

There are many different types of hearing aids to explore all with different features and price points. A basic set of hearing aids with limited or no features may be found at your local audiologist for around a thousand dollars. A premium set of hearing aids with all the bells and whistles will set you back around nearly eight or nine thousand dollars. The average hearing aid user changes their hearing every three to five years (if it doesn’t get lost or break before then), and there are costs to maintenance and upkeep along with accessories to buy.

Can the device be adjusted?

The Esteem® is completely implanted, but can be adjusted using your personal programmer or remote.

After the ear has healed and your Esteem is activated (turned on), it is programmed to fit your specific hearing needs by the Esteem® Certified Audiologist. You will be given three different listening profiles and five volume steps within each profile on your personal programmer.

Should you want to change the volume or listening profile, you simply choose the program then hold the personal programmer up to your head and press transmit. The remote will “talk” to your implant through your hair and skin, and change to your desired settings or profile.  You can also adjust the volume level in each setting.

About half of Esteem® recipients don’t use the programmer. They “set it and forget it” and don’t make many changes. Others might prefer to change the profile when they are in a much louder environment and would prefer a setting designed to reduce background noise. Some reduce the volume at night if a spouse snores or if they prefer a quieter sound level.

How is the Device powered?

The Esteem® is powered by a lithium-ion battery. One important advantage to the Esteem® over hearing aids is the long battery life, which lasts an average of 5.3 years. Most hearing aids need their battery changed or charged frequently.

The Esteem® battery, sound processing strategy, and associated software are housed in the Sound Processor part of the system. The Sound Processor sits under the skin and slightly impeded in the bone of your skull. Number 2 in the picture Here .

When the battery is getting close to depletion, it will show a lower battery light on your personal programmer. The Sound Processor will need to be replaced in a simple outpatient surgical procedure that takes less than an hour.

What happens if a new and improved version becomes available?

We are always working on improving the Esteem®. The Esteem® is designed to be backwards compatible, so as improvements are made you will get to take advantage of those improvements at battery change. You can expect the battery life to get longer and the Esteem software to continue to improve.

What happens if your hearing loss declines over time?

There is no cure for sensorineural hearing loss, and there is not a solution that can stop or reverse the hearing loss process. Should your hearing loss continue to decline or progress, an Esteem® Certified Audiologist can test your hearing to observe the change and re-program the Esteem® to adjust for the changes in your hearing loss.  As we continue to improve the Esteem®, you will be able to utilize these improvements to further address a declining hearing loss.

If your hearing loss declines to a point in which the Esteem® can no longer provide the benefit you need, you will likely require a cochlear implant. You could choose the get the Esteem® removed and get a cochlear implant put in at this point.

What happens if there is a technological breakthrough?

Whenever you have a disease for which there is not a cure, it’s in your best interest to follow the latest and greatest research. If someday there is a breakthrough in which the hair cells in the cochlea could be regrown, you would still be able to take advantage of that.  The Esteem® is implanted on the middle ear bones, but leaves the cochlea (the nerve) intact.  


Image Amy

Hi, my name is Amy -  I have personally experienced the unique challenges of living with hearing loss as a teenager, a college student, a young professional, a new mother, and now the mother of two teenagers. I had significant challenges in each of those roles as I tried to manage my hearing loss and minimize the negative impact it had on my life. I stumbled upon the Esteem® at a low point in my hearing loss journey while trying to manage a stressful career, two active toddlers, and hearing aids that did not work with my lifestyle. I am now a bilateral Esteem® recipient and am thankful every day that I found this solution.   I understand the necessity of finding a hearing solution that enhances your life and look forward to educating you on the Esteem®.   I can be emailed directly at with ANY questions.  If a phone call is your preference, I can be reached at 651-361-8050.   I look forward to connecting with you!  

Topics:Esteemhearing losslive well with hearing lossAmy

About The Sounding Board. 

The Sounding Board is designed to help patients, friends and family,  navigate the full spectrum of hearing loss. By providing insight on everything from general hearing loss topics to the specific experiences of individuals regaining hearing health in innovative ways.

Subscribe to Sounding Board