title: Carina® and Esteem®: a systematic review of fully implantable hearing devices.
abstract: OBJECTIVE
  To review the outcomes of the fully implantable middle ear devices Carina and Esteem regarding the treatment of hearing loss.
  
  
  METHODS
  PubMed, Embase, Scielo, and Cochrane Library databases were searched.
  
  
  METHODS
  Abstracts of 77 citations were screened, and 43 articles were selected for full review. From those, 22 studies and two literature reviews in English directly demonstrating the results of Carina and Esteem were included.
  
  
  METHODS
  There were a total of 244 patients ranging from 18 to 88 years. One hundred and 10 patients were implanted with Carina and with 134 Esteem. There were registered 92 males and 67 females. Five studies provided no information about patients' age or gender. From the data available, the follow-up ranged from 2 to 29.4 months.
  
  
  RESULTS
  The comparison of the results about word recognition is difficult as there was no standardization of measurement. The results were obtained from various sound intensities and different frequencies. The outcomes comparing to conventional HAs were conflicting. Nevertheless, all results comparing to unaided condition showed improvement and showed a subjective improvement of quality of life.
  
  
  CONCLUSIONS
  There are still some problems to be solved, mainly related to device functioning and price. Due to the relatively few publications available and small sample sizes, we must be careful in extrapolating these results to a broader population. Additionally, none of all these studies represented level high levels of evidence (i.e. randomized controlled trials).
authors.affiliation: Department of Otolaryngology, Hospital Central da Polícia Militar, Rio de Janeiro, Brazil.
authors.forename: Janaina Oliveira Bentivi
authors.initials: JO
authors.lastname: Pulcherio
authors.affiliation: Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Aline Gomes
authors.initials: AG
authors.lastname: Bittencourt
authors.affiliation: Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Patrick Rademaker
authors.initials: PR
authors.lastname: Burke
authors.affiliation: Department of Otolaryngology, Banco de Olhos de Sorocaba Hospital, São Paulo, Brazil.
authors.forename: Rafael da Costa
authors.initials: RC
authors.lastname: Monsanto
authors.affiliation: Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Rubens
authors.initials: R
authors.lastname: de Brito
authors.affiliation: Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Robinson Koji
authors.initials: RK
authors.lastname: Tsuji
authors.affiliation: Department of Otolaryngology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Ricardo Ferreira
authors.initials: RF
authors.lastname: Bento
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006310:Hearing Aids; D034381:Hearing Loss / Q000503:physiopathology / Q000628:therapy*; D006320:Hearing Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D009998:Ossicular Prosthesis; D011788:Quality of Life