Surgery to implant a device regarded as the first invisible hearing aid is now being performed in Tucson.

The University of Arizona Medical Center surgeon who has performed the procedure twice this year expects to eventually do four surgeries per month. The devices are for people with moderate to severe hearing loss.

"This is the future. No one wants a device hanging on their ear when they are trying to run," said Dr. Abraham Jacob, who is director of the UA Ear Institute and an associate professor in the UA surgery department's division of otolaryngology. Jacob came to Tucson from Ohio State last year to help build the hospital's ear, nose and throat program.

About half of people age 65 and older have some form of hearing loss, he said.

"Sixty-five-year-olds run now. That was maybe not an issue a generation ago. But now 50 is the new 40, right? So people don't want to be limited," Jacob said.

Regular hearing aids can be limited by discomfort, wax buildup and infection; they can't be worn in the shower or at night; and they often squeal and can be embarrassing.

"Glasses are now stylish; people want to wear them. Hearing aids, for whatever reason, are not," Jacob said. "These kinds of devices are an entire paradigm shift in how people rehabilitate hearing loss. It's invisible; it's on all the time if you want it to be. It's like Lasik versus glasses."

The Esteem device, which was approved by the U.S. Food and Drug Administration in 2010, costs $35,000 apiece and no insurers in Arizona and nearly none nationwide cover it. Jacob said one insurer in Alabama is covering it, and the surgeon doing the implants in that region is inundated with patients. The devices are made by the Minnesota-based Envoy Medical Corp.

Not everyone is a candidate. For the Esteem device, a patient's standardized word recognition score for hearing certain words in a sound booth must be 40 percent or higher, Jacob said. Some patients have too much hearing loss for qualify. The device is not for children.

The two patients who have had the surgery already indicate that the devices could fuel medical tourism to Tucson. The first patient, 53-year-old LoriAnn Harnish, is from Scottsdale. The second was a man from Canada. Each had the device implanted in one ear. The surgery wound must have time to heal - typically eight weeks - before the device can be remotely activated.

"They are the first and only FDA-approved, completely implantable hearing aid system," Jacob said. "We have candidates currently being evaluated from Arizona, New Mexico and Montana."

Jacob stressed the Esteem is not a replacement for the more commonly known cochlear implant, which has an external component behind the ear that transmits to an internal device in the inner ear.

 "A cochlear implant is for a person who has severe to profound hearing loss who wears hearing aids and doesn't get benefit from them," he said. "Esteem is for patients who currently wear hearing aids - that's a lot more people."

Currently cochlear implants are covered by most insurance, including Medicare. The UA Medical Center has been doing cochlear implants since last year.

The Esteem surgery can be lengthy - at least four hours, compared with 90 minutes for the cochlear, and surgery always comes with risks. Also, the batteries need to be replaced every five to nine years, Jacob said.

Harnish, the Scottsdale resident, had 65 percent hearing loss in both ears. She developed hearing loss from a high fever when she was 5 years old. UA officials say that she is the first person in the Southwest to receive the Esteem and that she hopes to get her second ear done within the next year.

"Hearing is a huge issue because it is tied to cognitive recall," Jacob said. "It is our most-processed sense, meaning brain processing. And because hearing loss is tied to cognitive decline, social isolation and things like that, you know this is a big deal for the aging population."

Contact reporter Stephanie Innes at or 573-4134.