Patients with moderate to severe sensorineural hearing loss may be good candidates for an implantable middle ear device. These devices simulate natural hearing with greater clarity than hearing aids, and have the added bonus of leaving the ear canal open. In addition, feedback and background noise are virtually eliminated.

Several types of devices can be considered implantable hearing devices.
These include:

  • Cochlear implants
  • Hybrid cochlear implants
  • Bone-anchored hearing devices
  • Middle-ear implantable devices
Dr. Shohet was the first Orange-County based surgeon to implant middle ear devices. In addition, Shohet Ear Associates is one of only eight sites worldwide and six in the United States engaged in clinical trials of a totally implantable hearing aid.

Dr. Shohet was the first Orange-County based surgeon to implant middle ear devices. In addition, Shohet Ear Associates is one of only eight sites worldwide and six in the United States engaged in clinical trials of a totally implantable hearing aid.

Cochlear Implants

Patients with severe to profound hearing loss in both ears may benefit from a cochlear implant.

This device allows patients to actually hear sound and improve their communication. A cochlear implant provides sound perception by means of an electrode surgically implanted into the cochlea. A sophisticated combination of a microphone, processor and transmitter is worn outside the ear. The device sends hearing sensations to the implant, which in turn transmits these signals to the auditory nerve of the brain. The signals are then interpreted as sound. Cochlear implants are usually performed  on an outpatient basis. The implants are programmed in our office by a clinical audiologist.

Hybrid Cochlear Implants

A new FDA-approved device has recently come onto the market and brings together the best of two different technologies to preserve and enhance low-frequency hearing while restoring access to high-frequency hearing.

The Cochlear ™ Nucleus® Hybrid Implant System is the first and only solution to incorporate hybrid hearing to help people hear again. It is composed of a hearing aid portion to address the lower frequencies and a cochlear implant to address the higher frequencies of hearing.

For people with mild to moderate hearing loss in the low frequencies, hearing aids offer acoustic amplification to send sounds through the normal hearing pathway. The cochlear implant component of the hybrid device addresses severe to profound hearing loss or deafness and bypasses the cause of hearing loss to send electronic sound signals directly to the brain. When combined, these signals allow a full spectrum of sound.

The Cochlear Nucleus Hybrid is an implanted device that amplifies low-pitched sounds by sending them down the normal pathway of hearing. At the same time, the device’s sound processor converts high-frequency sounds to digital signals and sends them to the hearing implant. These signals combine with the amplified low-pitched sounds and turn into the full spectrum of sound that the wearer hears.

The Cochlear Nucleus Hybrid is implanted during a simple outpatient procedure.

Shohet Ear Associates was among the first practices in California to offer this innovative technology, which greatly enhances speech recognition, sound quality, and quality of life.

Bone Anchored Hearing Aids (BAHA)

Bone-anchored hearing devices are used primarily for conductive hearing loss or single-sided deafness. They are popular for hearing rehabilitation in patients with congenital ear malformations or refractory chronic ear disease. A titanium fixture is implanted in the postauricular area. An external sound processor is attached to the abutment at will. A microphone in the processor, which vibrates the bone in the skull by means of the fixture, picks up sound. The sound is transmitted directly to the inner ear on the side with conductive hearing loss or better sensorineural hearing than the other.

Implantable Middle-Ear Hearing Devices

Implantable middle-ear hearing devices were developed to treat conductive and sensorineural hearing loss. These devices improved fidelity by directly stimulating the hearing bones, and they improve comfort by allowing the ear canal to remain open. In addition, most implantable middle-ear devices almost completely eliminate feedback, one of the most annoying adverse effects of conventional aids.

Piezoelectric

Piezoelectric devices operate by passing an electric current into a piezoceramic crystal, which changes its volume and thereby produce a vibratory signal.

One promising piezoelectric device is the Envoy Esteem System—a totally implantable hearing aid. This device uses the eardrum as the microphone, taking advantage of the natural acoustics of the ear canal without obstruction, interference, or any external devices. The input signals are identical to those received by a person with normal hearing. This mechanical signal is detected from a piezoelectric transducer at the head of the sensor and converted to an electrical signal by using existing transducer technology. The electrical signal is amplified, filtered, and converted back to a vibratory signal. The vibratory signal is then delivered by means of a piezoelectric transducer to the inner ear.

An audiologist programs the implant using a device called the commander. After the device is programmed, patients are given a personal programmer that allows them to turn the device on or off, to adjust the volume, and to remotely modify background noise filters.

To learn more about the Envoy Esteem, visit the Envoy Medical website.

Esteem Hearing Aid

Envoy Medical has produced the world’s first FDA approved totally implantable hearing device specifically engineered to help improve the hearing of adults diagnosed with moderate to severe sensorineural hearing loss. It is called the “Esteem” and it is a breakthrough in technology that actually utilizes your own eardrum as the sound collection mechanism rather than using a synthetic microphone. The results are truly amazing in terms of sound clarity, quality and ease of use.

Because the Esteem is a true implant, it’s invisible. There are no external components and nothing is inserted in your ear canal. Unlike hearing aids, you never put it on or take it off, you can’t lose it, you don’t clean it and as a result, you rarely have to think about it.

Earlens Hearing Aid

The Earlens Hearing Aid uses light and a small lens placed on your eardrum to directly activate your natural hearing system. The result is rich, complete sound. In a clinical study, the vast majority of people reported that Earlens made it easier to understand people in noisy environments and participate in group situations.* In the same study, 95% of users were satisfied with the sound quality of Earlens.* The light-driven hearing technology that Earlens uses also eliminates the major source of whistling that troubles conventional hearing aids.

Shohet Ear Associates is one of only eight sites worldwide and six in the United States engaged in clinical trials of the Envoy System.

Electromagnetic

Electromagnetic hearing devices function by passing an electric current into a coil, which creates a magnetic flux that drives an adjacent magnet. The small magnet is attached to one of the vibratory structures of the middle ear. So far, however, these devices are only partially implantable and still require an externally worn device to house the electric coil. The major disadvantage is that power is decreased by increased distance between the coil and the magnet—so they must be positioned closely. A slight shift of coil position in the external ear results in unpredictable or insufficient power output. In addition, the anatomy of the middle ear space restricts the size of the magnet or coil.

The Soundbridge is the first U.S. Food and Drug Administration (FDA) approved implantable middle ear hearing device to treat sensorineural hearing loss. People who participated in the Soundbridge clinical trial reported improved sound clarity, better fit and comfort, increased gain (loudness of sound), and fewer maintenance issues than they experienced with hearing aids. Soundbridge is a proven, safe and effective treatment that leaves the ear canal completely open.

Candidates for Soundbridge include adults who have moderate-to- severe sensorineural hearing loss and desire an alternative to a traditional hearing aid. It uses technology that directly drives the ossicular chain (middle ear bones), bypassing the ear canal and tympanic membrane (eardrum). It consists of two major components: 1) the implanted component, and 2) the externally-worn receiver, which is approximately the size of a quarter. Unlike a hearing aid, which simply amplifies sound, the Soundbridge consists of a prosthetic driver which mechanically vibrates the bones in the middle ear without surgically altering the structures of the middle ear.

For more information, log on to http://www.medel.com/vibrant-soundbridge

Study participants reported statistically significant improvement in their ability to hear and communicate while using the Soundbridge in a variety of difficult listening situations, such as: improved ability to hear familiar talkers, increased ease of communication, better performance in environments with high levels of reverberation or background noise, less distortion of sound,better performance when other listening cues were reduced, and fewer uncomfortable or unpleasant sounds.

Soundbridge Hearing Aid

The Vibrant® Soundbridge® is an FDA approved, direct-drive, semi-implantable middle ear device intended to provide a level of useful sound perception to individuals with a moderate-to-severe sensorineural hearing loss. The Soundbridge converts sound into mechanical energy that is directly transferred to the middle ear bone (auditory ossicles). Direct-drive means that the implant converts sound energy directly into mechanical energy to directly drive the inner ear.

MAXUM Hearing Aid

MAXUM uses an advanced sound processor which sends electric signals to a transceiver coil. These signals are transferred by electromagnetic energy across the eardrum to the MAXUM implant which causes the ossicles to vibrate, thereby directly stimulating the cochlea (inner ear). Direct cochlear stimulation provides cleaner, crisper sound quality and more amplification without feedback. This also allows for improved audibility and speech understanding.

Vibrant Soundbridge Hearing Aid

The Vibrant® Soundbridge® is an FDA approved, direct-drive, semi-implantable middle ear device intended to provide a level of useful sound perception to individuals with a moderate-to-severe sensorineural hearing loss. The Soundbridge converts sound into mechanical energy that is directly transferred to the middle ear bone (auditory ossicles). Direct-drive means that the implant converts sound energy directly into mechanical energy to directly drive the inner ear.

In 2000, Dr. Shohet was the first surgeon to implant the Soundbridge in Orange County (then called the Symphonix Soundbridge). Since then, he has implanted many patients with significant success including one patient who is now wearing one in both ears.

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