The University of Arizona
Department of Surgery

Envoy Esteem (Totally Implantable Hearing Aid)

The Envoy Esteem is the world's first FDA-approved totally implantable hearing device. Implanted under the skin behind the ear and in the middle ear space, the Esteem is completely invisible. This allows the Esteem to overcome many of the limitations of conventional hearing aids, including the discomfort of wearing something in the ear, wax buildup, infection and acoustic feedback. Because there are no external components to remove, the Esteem can be worn 24/7, including in the shower and at night.

The Envoy Esteem uses the ear canal and ear drum to collect sound, which gives a more natural sound quality than conventional hearing aids can offer.  Based on pacemaker technology, the Esteem has a non-rechargeable battery with a life span of five to nine years. When the battery is depleted, the sound processor and battery are replaced during a short surgical procedure.



The Esteem is activated at least eight weeks post-surgery per Envoy's recommendations in order to allow time for the surgery incision to heal.

Abraham Jacob, MD, director of the UA Ear Institute, is the only surgeon in the Southwest - and one of only about 15 surgeons in the United States - that are approved to implant the Esteem.

Candidacy Criteria:

  • Adults with stable bilateral moderate to severe sensorineural hearing loss
  • No conductive hearing loss
  • Reasonably good speech discrimination scores (40 percent or greater in unaided condition)
  • No external or internal anatomical abnormalities that may restrict surgery (determined by physical examination of the ear and temporal bone CT scan)
  • Minimum 30 days experience with appropriately fit conventional hearing aids
  • Medical/cardiac clearance to ensure you are healthy enough to undergo surgery

Pricing Information:

The Esteem is currently not covered by any insurance plans. Each individual implant center determines costs based on regional factors. The MSRP has been suggested to be about $45,000. Our initial estimated out-of-pocket costs are $35,294 but pricing may change in the future based on the program's financial solvency.

The letters below provide a detailed breakdown of costs for the following:

  1. Candidacy evaluation and Esteem surgery
  2. Battery change (typically needed every 5-9 years)

For more information, please see:

Frequently Asked Questions about Esteem - UA Ear Institute

Description of Surgical Risks - UA Ear Institute

Envoy Esteem company website