Surgical treatment of sensorineural hearing loss: an ethical dilemma in the 21st century

Almost 70 years after Shea's first successful stapedectomy, this operation remains the gold standard for otosclerosis, providing excellent outcomes with minimal risk. In contrast, the situation is quite different for sensorineural hearing loss. The development of new middle ear active implants, such as the Vibrant Soundbridge, now provide hearing outcomes comparable to conventional hearing aids, with very low surgical risk and added acoustic benefits. However, their clinical adoption is still limited, often influenced more by economic and ethical dilemmas than by scientific evidence. In some public healthcare systems, active middle ear implants for sensorineural hearing loss are fully funded, while conventional hearing aids are not. This creates an inequity that leaves many patients unable to access non-surgical hearing solutions. This article reflects on that paradox and argues that, as technology continues to evolve, one principle must remain clear: the patient's right to hear should always take precedence over financial or bureaucratic constraints.