Middle Ear Implants Offer Potential: New breed of devices may stimulate compliance, experts say

When the fully implantable Otologics Carina reaches the American market, CEO Bedoya estimated it will cost about $15,000, based on the company’s experience in Europe. Currently, implantation takes about 90 minutes, but the goal is to reduce this time to an hour.

MED-EL does not publish an estimated price for its Vibrant Soundbridge, in part, Franz said, because the cost of the surgery depends on the hospital. However, she said, Soundbridge is “in the same ballpark” as other MEIs and “much more expensive than a hearing aid.” Typically, the price of a pair of high-end hearing aids falls in the range of $5,000-$6,000.

As for the surgery, MED-EL provides some support training, but, Franz added, “It’s not a big stretch from what otologists already do. It’s similar to cochlear implant surgery.”

In the end, some of those interviewed believe that reimbursement will determine whether the MEI remains a niche product or goes mainstream. Currently, Medicare and most insurance companies in the U.S. do not cover either the device or the surgery. As a result, said Dr. Green, “The price-to-benefit ratio is outside the range of what most people can afford, so it really limits it to people who are wealthy. With the economy where it is, the average person doesn’t have the disposable income to pay for these.”

However, he added, “If it were covered by insurance, I think you’d have people lined up outside the clinics.”

Other factors may also be at play. One of these, said MED-EL’s Franz, is “lack of awareness that the technology is available.” While she thinks that otologists are generally knowledgeable about the devices, she sees a pressing need to get more information out to consumers and also to audiologists so that they will consider it as an option for their unsuccessful hearing aid patients.

Marshall Chasin, AuD, MSc, has frequently written about middle ear implants. Dr. Chasin, an audiologist who serves as coordinator of research at the Canadian Hearing Society in Toronto, sees a logistical problem standing in the way of maximum use of MEIs. Because of the complementary roles of the surgeon who implants the device and the audiologist who programs it, he noted, “there needs to be a well-defined interaction between the otolaryngologist and the audiologist. However, this is not always the case.”

Some Reservations

Despite the obvious attractions of a totally implantable system, some observers express reservations. Dr. Green noted that the concerns he has about MEIs in general—including their high cost, the possible need for repeated surgical procedures, and the risk of implanting someone whose hearing loss soon becomes too severe to he helped—are even more troubling with totally implantable devices, because the surgery is more complicated. Also, he noted, with the Esteem, replacing the battery requires additional surgery from time to time.