Implantable Hearing Aids Research Articles

Middle Ear Active Implant Indications, Comparative Audiometric Results from Different Approaches, and Coupling with the Vibrant Soundbridge®: A Single Center Experience over More Than 20 Years.

Middle ear active implants, such as the Vibrant Soundbridge (VSB), offer an alternative to reconstructive surgery and other implantable hearing aid systems for patients with conductive, mixed, or sensorineural hearing loss. The primary objective of this work is to describe the auditory results obtained with VSB in our patient cohort, measuring the auditory gain in terms of average tonal thresholds and spoken word discrimination at 65 dB. Secondly, auditory gain differences between different types of hearing loss, coupling to the ossicular chain compared to round and oval windows, and the impact of open versus more conservative surgical approaches, were analyzed. A cross-sectional observational study, with retrospective data collection, was conducted at a tertiary care center. Clinical and audiometric data pre- and post-implantation were included, from patients who underwent VSB device placement surgery between 2001 and 2024. 55 patients with an average age of 62.58 ± 17.83 years and a slight preference in terms of the female gender (52.72%) were included in the study. The average gain in the PTA for all types of hearing loss was 41.56 ± 22.63 dB, while for sensorineural hearing loss (SNHL) the gain was 31.04 ± 8.80 dB. For mixed-conductive hearing loss (C-MHL) a gain of 42.96 ± 17.70 was achieved, notably, in terms of absolute values, at frequencies of 4000 and 6000 Hz, with gains reaching 49.25 ± 20.26 dB at 4 K and 51.16 ± 17.48 dB at 6 K. In terms of spoken word discrimination, for all types of hearing loss, an improvement of 75.20 ± 10.11% was achieved. However, patients with C-MHL exhibited an approximately 13% higher gain compared to those with SNHL (69.32 ± 24.58% vs. 57.79 ± 15.28%). No significant differences in auditory gain were found between open and closed surgical techniques, nor in the proportion of adverse effects, when comparing one technique with the other. The VSB is effective in improving hearing in patients with mixed, conductive, and sensorineural hearing loss, with significant gains at high frequencies, especially through the round window membrane approach. The choice of surgical technique should consider the patient's anatomical characteristics and specific needs in order to optimize auditory outcomes and minimize postoperative complications.

Up-to-date knowledge of implantable hearing aids

Background: Although remarkable progress has been made in conventional hearing aids, patients with hearing loss are still reluctant to use them due to cosmetic or functional reasons, such as the feedback phenomenon or the occlusion effect. In the late 20th century, implantable hearing aids were developed and used as an alternative.Current Concepts: Several devices have been developed, with three currently available on the international market (Vibrant Soundbridge [Med-El Corporation], MAXUM [SOUNDTEC Inc.], and Esteem [Envoy Medical Corporation]). Electromagnetic and piezoelectric transduction systems enable the devices to transmit external sounds to the internal auditory system, enabling sounds to be heard without amplifying the sound source. Although not an implantable hearing aid, Earlens (Earlens Corporation), which attaches to the eardrum and transmits sound, has also been developed and is commercially available. This manuscript briefly describes these devices, evaluates their benefits and limitations, and considers future research directions in the field of implantable hearing aids.Discussion and Conclusion: Implantable or attachable hearing aids are innovative technologies that compensate for the shortcomings of conventional hearing aids while providing comparable or better results. The demand for them is expected to continue to increase in the future owing to the continued increase in the population with hearing loss and the trend toward quality of life and external beauty.

Very Early Loading of a Bone-Anchored Hearing System Is Safe.

To investigate the feasibility of early sound processor loading with two separate bone-anchored hearing aid implants 1 to 2 weeks after implantation. Secondary endpoints included registration of any postoperative complications, skin reactions, and any adverse events. Prospective, nonrandomized, noncontrolled, multicenter clinical trial. Tertiary referral center. Sixty adult patients, eligible for bone-anchored hearing aid surgery, were enrolled. Implantation of the bone-anchored hearing aid implants were done using minimally invasive surgery with tissue preservation. Implant stability quotient (ISQ) values were recorded using resonance frequency analysis. Follow-ups were scheduled 5 to 12 days, 4 to 8 weeks, 6 months, and 12 months postoperatively. Differences between the lowest ISQ values (ISQ low) over time were analyzed by paired-samples t test with a significance level of 0.05. Skin and soft tissue reactions were assessed according to Holger's classification. Loading time of the Ponto Wide implant was 11.6 ± 1.4 days (SD) in average (median, 12 d; range, 7-19 d). Loading of the Ponto BHX implant was done 9.7 ± 3.5 days (SD) postoperatively (median, 9 d; range, 5-19 d). The implant stability increased significantly during the 12-month study period with both implants. One Ponto BHX implant was lost. Skin and soft tissue reactions were few in both groups. Across all planned follow-up visits, no skin and soft tissue reactions were observed in 86% (Ponto BHX implant) and 85% (Ponto Wide implant). Very early loading of sound processors after percutaneous bone-anchored hearing system surgery is safe already 1 to 2 weeks postoperatively.

Multichannel multimodal piezoelectric middle ear implant concept based on MEMS technology for next-generation fully implantable cochlear implant applications

This paper introduces a unique multimode, multichannel piezoelectric vibration sensor for the next-generation fully implantable cochlear implant (FICI) systems. The sensor, which can be implanted on the middle ear chain to collect and filter the ambient sound in eight frequency bands, comprises an array of 4 M-shape multimode and 11 single cantilevers. Finite element (FE) analysis indicates a 2.05-fold improvement in capturing frequency information for the multimodal sensor compared to its single-mode counterpart. Under an acoustic excitation at 100 dB SPL, the sensor, mounted on an artificial tympanic membrane, yielded a peak output voltage of 546.16 mVpp and a peak sensitivity of 285.28 mVpp/Pa at 1613 Hz. The extrapolated acoustic results indicated a dynamic frequency range between 300 Hz and 6 kHz, even at 30 dB SPL. Furthermore, a lightweight titanium coupler, employing a two-sided clipping structure with a maximum wall thickness of 70 μm, is micromachined for surgical attachment of the transducer to the middle ear chain. A commercial accelerometer, implanted on the incus short process (SP) of a cadaver using the titanium coupler, successfully recorded 0.1 g for 100 dB SPL at 500 Hz, revealing the potential feasibility of the coupler for vibration sensor implantation. Moreover, the presented anatomically accurate FE model of the middle ear, exhibiting a high correlation coefficient (R2) of 0.97 with the cadaveric experiment, suggests an efficient numerical approach for evaluating the implantation of middle ear prostheses. In this regard, the study holds great promise for clinical application in the field of implantable hearing aids.

Surgical Outcomes of Modified Technique for Transcutaneous Bone Conduction Hearing Aid Implantation.

To detail a modified surgical technique for implantation of the Osia 2 Bone Conduction Hearing Aid (BCHA) system and to assess intra- and postoperative outcomes of this technique. A retrospective review was performed for cases undergoing implantation of an Osia 2 BCHA at a tertiary academic medical center. Modifications were made to the surgical procedure including: horizontal or curvilinear incisions, placement of the osseointegrated screw slightly superior to the plane of the external auditory canal, and double layer wound closure. Data regarding outcomes including demographics, incision type, surgical time, drilling requirements, and complications were collected using the electronic medical record. A total of twenty-eight cases were evaluated with 57.1% and 42.9% utilizing horizontal and curved incisions, respectively. The median age for recipients was 43.1 years with six pediatric cases included in the study. Median operative time was 58 min (43-126 min). The majority of cases required minimal (60.7%) or no drilling (28.6%) with a significant increase in operative time for those requiring moderate drilling versus minimal to no drilling (F = 8.02, p = 0.002). There were no intraoperative complications. One (3.6%) postoperative seroma occurred which resolved with conservative management. The proposed modified surgical technique is a safe and effective method for implantation of the transcutaneous BCHA system with a low complication rate. Keys include incision design, implant placement, and two-layered closure to minimize wound tension. These modifications can improve ease of the procedure and reduce operative time. These techniques also appear to be applicable to the pediatric population. 3 Laryngoscope, 134:2401-2404, 2024.

Influence of Bone Conduction Hearing Device Implantation on Health-Related Quality of Life for Patients with and without Tinnitus.

(1) Background: Tinnitus, often related to hearing loss, is an addressable public health concern affecting health-related quality of life (HRQoL). This study aimed to explore the influence of bone conduction hearing aid (BCHA) implantation on HRQoL and hearing disability in patients with hearing loss suffering from tinnitus. (2) Methods: Data were collected from an international hearing implant registry. Health Utilities Index Mark 3 (HUI-3), Spatial and Qualities of Hearing- 49 Questionnaire (SSQ) and self-reported tinnitus burden data for adult patients implanted with a BCHA (n = 42) who provided baseline as well as follow-up data 1-year post-implantation were extracted from the registry. Wilcoxon signed rank tests and paired samples t-tests were used to analyse outcomes data. (3) Results: Patients, with or without tinnitus, demonstrated clinically important mean improvements in HUI-3 multi-attribute utility scores, HUI-3 hearing attribute and SSQ scores. Hearing loss patients with tinnitus presented with a lower HRQoL than patients without tinnitus. (4) Conclusions: These findings demonstrate the importance of hearing rehabilitation in improving the quality of life and hearing disability of patients with or without tinnitus and in providing tinnitus relief in some patients with hearing loss and tinnitus.

Hearing Aid System Response Improvement

This study was conducted to understand the response of hearing aids to different inputs and propose a novel technique to significantly improve performance of hearing aid implants. The motivation behind this study is to represent behavior of hearing aid system with simple input-output relation rather than complicated models. This representation offered a better understanding of the system and inspired an innovation to improve the hearing aid implants. A model of a hearing aid system called cochlear transplants is generated and used to simulate the system response. Using multiple methods, simplified input-output relations are derived. Results from these methods are compared and conclusions are drawn regarding which method is best for this application. One of the methods used resulted in 69.7 % error measure reduction compared to the benchmark method. This method was later used to produce a simplified model, which was then used as the basis for analysis of different configurations. A qualitative comparison of model was made, and significant improvement of cochlear transplants was achieved.

O perspectivă logopedică asupra tranziției către școlaritate a copilului cu implant cohlear

Cochlear implant (CI) is a medical procedure originally developed in the United States. In Romania, it is part of the national programme for the treatment of deafness with implantable hearing aids managed by the National Health Insurance House. Successful implantation transforms the child with hearing loss into a hearing but not a speaking child. Only with systematic support and guidance will the child become a speaker. It is risky to assume that the development of the child with CI follows the same milestones and has to overcome the same challenges as the typical child. In fact, successful integration into mainstream school must be considered a separate objective, which will be prepared and actively pursued during the child's pre-school years by the child's educational partners (family - teachers - speech therapist). Spontaneous development is not guaranteed; moreover, there is a risk of losing the child's development potential. This is why the preparation of the family, the child with CI, the teachers and even the school as a physical environment is essential for a successful start at school. This paper aims to provide a brief contextualisation of cochlear implantation and also answers some pressing questions for an optimal transition to schooling. It considers building and strengthening the self-image of the child with CI, developing personal autonomy, training and developing conversational skills, investigating options related to school choice, getting to know the school and future teachers, forming and developing the prerequisites for schooling, pragmatic suggestions for involving the family in school activities, but also for involving teachers in the school integration of the child with CI.

Surgical results of transcutaneous bone-anchored hearing aid comparing the C-shaped and linear incision techniques.

The aim of the study is to compare the operative time and postoperative complication outcomes for bone-anchored hearing aid (BAHA) implants using two different techniques: the C-shaped incision technique and the linear incision technique. An analysis was carried out of 38 patients implanted with transcutaneous BAHAs during a 4-year period in a single otolaryngology department. The implantation was carried out under general anesthesia. Operative time was significant lower with the linear technique compared to the C-shaped technique (76.55min, SD 16.75 vs. 93.17min, SD 19.82; p = 0.007). There was no difference in postoperative complications between the two techniques. The use of linear incision for transcutaneous BAHA system implantation is associated with a reduced surgery time compared to the C-shaped technique, with no increase in postoperative complications.

Functional and patient-reported outcomes of bone-anchored hearing aids (BAHA): A prospective case series study

ObjectiveThe purpose of this study was to evaluate the functional and patient-reported outcomes, and their correlation, after percutaneous bone-anchored hearing aid (BAHA) implantation. MethodsA prospective study was conducted between January 2018 and December 2020 in a tertiary care center. All adult patients who were implanted with a percutaneous BAHA device during this evaluation period were included in the study. Complete auditory function and patients reported outcome measures (PROMs) were assessed in the preoperative period and 6 months after the implant activation. The PROMs included a generic form (Medical Outcome Study 36 Short Form Healthy Survey (MOS SF-36)), and three disease-specific forms (Hearing Handicap Inventory (HHI), Satisfaction with Amplification in Daily Life Scale (SADLS), and Tinnitus Handicap Inventory (THI)). ResultsTwenty-two patients with an average age of 53 years were included in the study. The overall functional gain with the BAHA in sound-field pure tone average (PTA) was 29 dB, with no statistically significant differences according to surgical indication (F(3,18) = 2.319, p = 0.110). The greater the preoperative air-bone gap, the greater the functional gain obtained (r = 0.505, p < 0.05). In the PROMs, we found a significant improvement in HHI scores (p < 0.005) and a significant increase in overall SADLS scores (p < 0.05) with the use of percutaneous BAHA devices. We did not verify any statistically significant correlation between functional and PROMs results. ConclusionsThe BAHA is a safe and effective alternative hearing rehabilitation option in selected patients. The PROMs results prove patient's overall satisfaction.

Treatments for hearing loss in osteogenesis imperfecta: a systematic review and meta-analysis on their efficacy

About 70% of people with osteogenesis imperfecta (OI) experience hearing loss. There is no cure for OI, and therapies to ameliorate hearing loss rely on conventional treatments for auditory impairments in the general population. The success rate of these treatments in the OI population with poor collagenous tissues is still unclear. Here, we conduct a systematic review and meta-analysis on the efficacy of treatments addressing hearing loss in OI. This study conforms to the reporting standards of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Data sources include published articles in Medline via PubMed, Web of Science, Scopus, and Embase, from their inception to November 2020. Studies included individuals with OI undergoing a hearing loss treatment, having pre- and postoperative objective assessment of hearing function at a specified follow-up length. Our search identified 1144 articles, of which 67 were reviewed at full-text screening. A random-effects meta-analysis was conducted on the selected articles (n = 12) of people with OI that underwent stapes surgery. Success was assessed as the proportion of ears with a postoperative Air–Bone Gap (ABG) ≤ 10 dB. A systematic review was conducted on the remaining articles (n = 13) reporting on other treatments. No meta-analysis was conducted on the latter due to the low number of articles on the topic and the nature of single case studies. The meta-analysis shows that stapes surgeries have a low success rate of 59.08 (95% CI 45.87 to 71.66) in the OI population. The systematic review revealed that cochlear implants, bone-anchored hearing aids, and other implantable hearing aids proved to be feasible, although challenging, in the OI population, with only 2 unsuccessful cases among the 16 reviewed single cases. This analysis of published data on OI shows poor clinical outcomes for the procedures addressing hearing loss. Further studies on hearing loss treatments for OI people are needed. Notably, the mechanisms of hearing loss in OI need to be determined to develop successful and possibly non-invasive treatment strategies.

Is there an unmet medical need for improved hearing restoration?

Hearing impairment, the most prevalent sensory deficit, affects more than 466 million people worldwide (WHO). We presently lack causative treatment for the most common form, sensorineural hearing impairment; hearing aids and cochlear implants (CI) remain the only means of hearing restoration. We engaged with CI users to learn about their expectations and their willingness to collaborate with health care professionals on establishing novel therapies. We summarize upcoming CI innovations, gene therapies, and regenerative approaches and evaluate the chances for clinical translation of these novel strategies. We conclude that there remains an unmet medical need for improving hearing restoration and that we are likely to witness the clinical translation of gene therapy and major CI innovations within this decade.

Results and Quality of Life after Implantation of Active Middle Ear Implants.

The provision of implantable hearing aids represents an area with high development and innovation potential. On the one hand, this review article provides an overview of current indication criteria for the treatment with active middle ear implants. On the other hand, outcome parameters as well as functional results after implantation of active middle ear implants are demonstrated and discussed. The focus is mainly placed on audiological results as well as the subjective health status. "Patient Reported Outcome Measures" (PROMs) have become an integral part of the evaluation of hearing implant treatment. Due to low evidence level criteria, the study situation regarding audiological as well as subjective outcome parameters is not satisfactory. The lack of an international consensus on accepted outcome parameters makes a meta-analytical analysis of results immensely difficult. In the studies published to date, patients with sensorineural hearing loss and patients with conductive or mixed hearing loss offered better speech recognition after implantation of an active middle ear implant compared to conventional hearing aids. Current analyses show a significant improvement in general as well as hearing-specific quality of life after implantation of an active middle ear implant. To date, no validated, hearing-specific quality-of-life measurement instruments exist for assessing the success of fitting in children. Especially in children with complex malformations of the outer ear and the middle ear, excellent audiological results were shown. However, these results need to be substantiated by quality-of-life measurements in future.

Otological complications in inversa type recessive dystrophic epidermolysis bullosa.

The rare inversa subtype of recessive dystrophic epidermolysis bullosa (RDEB-I) is characterized by predominant intertriginous skin blistering and marked mucosal involvement. Specific recessive missense mutations in the collagen VII triple helix are implicated in the disease. To date, otological complications have been reported infrequently in this patient group. We conducted an observational, retrospective, double institution case record review of patients with RDEB-I who presented with otological complications between January 2000 and June 2020. Diagnosis was established on the basis of clinical features, family history and mutation analysis of the COL7A1 gene. In total, 11 (44%) of 25 patients with RDEB-I in our database (2 paediatric, 9 adult; mean age 40.9 years, range 8-72 years) experienced otological complications. Of these 11 patients, 10 (90.9%) had recurrent otitis externa, 7 (63.6%) had meatal stenosis and 7 (63.6%) had recurrent blistering of the external auditory canals. All 11 patients reported hearing difficulties, with conductive hearing loss confirmed by audiology testing in 6 (54.5%) of these. Of the 11 patients, 3 (27.3%) went on to have implantable hearing aids [2 bone-anchored hearing aids (BAHA) and 1 middle ear implant (MEI)] fitted with favourable outcome, while a fourth paediatric patient presented with a cholesteatoma that was surgically managed. We observed a higher prevalence of otological morbidity in RDEB-I than previously reported, and present the first case of cholesteatoma in epidermolysis bullosa (EB). Our data indicate that BAHA and MEI are safe and effective treatment options for hearing loss in EB. Clinicians should be vigilant in screening for ear symptoms in RDEB-I and consider early referral to an Ear, Nose and Throat specialist.

A New Type of Wireless Transmission Based on Digital Direct Modulation for Use in Partially Implantable Hearing Aids.

In this study, we developed a new type of wireless transmission system for use in partially implantable hearing aids. This system was designed for miniaturization and low distortion, and features direct digital modulation. The sigma-delta output, which has a high SNR due to oversampling and noise shaping technology, is used as the data signal and is transmitted using a wireless transmission system to the implant unit through OOK without restoration as an audio signal, thus eliminating the need for additional circuits (i.e., LPF and a reference voltage supply circuit) and improving the ease of implantation and reliability of the circuit. We selected a carrier frequency of 27 MHz after analysis of carrier attenuation by human tissue, and designed the communication coil with reference to both the geometry and required communication distance. Circuit design and simulation for wireless transmission were performed using Multisim 13.0. The system was fabricated based on the circuit design; the size of the device board was 13 mm × 13 mm, the size of the implanted part was 9 mm × 9 mm, the diameter of the transmitting/receiving coil was 26 mm, and the thicknesses of these coils were 0.5 and 0.3 mm, respectively. The difference (error) between the detected and simulation waveforms was about 5%, and was thought to be due to the tolerances of the fabricated communication coil and elements (resistors, capacitors, etc.) used in the circuit configuration of the system. The number of windings was reduced more than 9-fold compared to the communication coil described by Taghavi et al. The measured THD was <1% in the frequency band from 100 Hz to 10 kHz, thus easily meeting the standard specification for hearing aids.

Examining the Relationship Between Speech Recognition and a Spectral-Temporal Test With a Mixed Group of Hearing Aid and Cochlear Implant Users.

Purpose Audiology clinics have a need for a nonlinguistic test for assessing speech scores for patients using hearing aids or cochlear implants. One such test, the Spectral-Temporally Modulated Ripple Test Lite for computeRless Measurement (SLRM), has been developed for use in clinics, but it, as well as the related Spectral-Temporally Modulated Ripple Test, has primarily been assessed with cochlear implant users. The main goal of this study was to examine the relationship between SLRM and the Arizona Biomedical Institute Sentence Test (AzBio) for a mixed group of hearing aid and cochlear implant users. Method Adult hearing aid users and cochlear implant users were tested with SLRM, AzBio in quiet, and AzBio in multitalker babble with a +8 dB signal-to-noise ratio. Results SLRM scores correlated with both AzBio recognition scores in quiet and in noise. Conclusions The results indicated that there is a significant relationship between SLRM and AzBio scores when testing a mixed group of cochlear implant and hearing aid users. This suggests that SLRM may be a useful nonlinguistic test for use with individuals with a variety of hearing devices.

Coupling of active middle ear implants-biomechanical aspects

Active middle ear implants or implantable hearing aids are used to treat sensorineural or combined hearing loss. Their coupling to the middle ear structures has alarge impact on the success of rehabilitation. Practical issues such as the coupling site, influence of middle ear status, and forward and backward excitation of the inner ear are discussed in the context of biomechanics. For this purpose, experimental studies, model simulations, and current literature data are evaluated. The explanations are intended to contribute to abetter understanding of certain procedures in hearing rehabilitation with active implants.

Evaluation of Vibrant® Soundbridge™ positioning and results with laser doppler vibrometry and the finite element model.

The etiology of hearing loss originates from genetic factors and includes several other events including infections, working or living environment, as well as several endocrine and metabolic disorders. The Vibrant® Soundbridge™ (VSB) is an implantable hearing aid whose floating mass transducer (FMT) is attached to the long process of the incus. The device is used for pure sensorineural hearing loss with an intact middle ear. Variations in the manner of attachment may occur. Knowledge of the impact of such variations on the overall device performance may guide towards optimal transducer attachment during surgery. A mechanical modelling of the ear was first reported by von Békésy and indicated that the tympanic membrane (TM) moves as a stiff plate, and that the mallear and incudal ligaments act as a rotation axis for the ossicular chain at low frequencies. Experimental investigations and simulations with the model yield the same main results. The first fitting situation, where the FMT floats freely in the middle ear, provides by far the worst possible results. Contact to the stapes supra-structure of the FMT is necessary for optimal performance of the FMT. The mastoid specimen preserves its acoustic properties that have been shown to be similar to those in the vital human ear, under these conditions. Properly coupling the electromagnetic transducer to the ossicles can be difficult and it requires a certain degree of experience. A finite-element model (FEM) is useful for functional evaluation of the VSB since it enables easy modelling of the complicated middle ear structures and simulation of their dynamic behavior which makes it easy to understand it in detail without experiments.

Bioinstructive Micro-Nanotextured Zirconia Ceramic Interfaces for Guiding and Stimulating an Osteogenic Response In Vitro.

Osseous implantology’s material requirements include a lack of potential for inducing allergic disorders and providing both functional and esthetic features for the patient’s benefit. Despite being bioinert, Zirconia ceramics have become a candidate of interest to be used as an alternative to titanium dental and cochlear bone-anchored hearing aid (BAHA) implants, implying the need for endowing the surface with biologically instructive properties by changing basic parameters such as surface texture. Within this context, we propose anisotropic and isotropic patterns (linear microgroove arrays, and superimposed crossline microgroove arrays, respectively) textured in zirconia substrates, as bioinstructive interfaces to guide the cytoskeletal organization of human mesenchymal stem cells (hMSCs). The designed textured micro-nano interfaces with either steep ridges and microgratings or curved edges, and nanoroughened walls obtained by direct femtosecond laser texturing are used to evaluate the hMSC response parameters and osteogenic differentiation to each topography. Our results show parallel micro line anisotropic surfaces are able to guide cell growth only for the steep surfaces, while the curved ones reduce the initial response and show the lowest osteogenic response. An improved osteogenic phenotype of hMSCs is obtained when grown onto isotropic grid/pillar-like patterns, showing an improved cell coverage and Ca/P ratio, with direct implications for BAHA prosthetic development, or other future applications in regenerating bone defects.

Implantable Hearing Aids: Where are we in 2020?

Beginning in the late 20th century, implantable hearing aids were developed and used as an alternative for individuals who were unable to tolerate conventional hearing aids. Since that time, several devices have been developed, with four currently remaining on the international market (Med‐el Vibrant Soundbridge, Envoy Esteem, Ototronix MAXUM, and Cochlear Carina). This review will briefly examine the history of middle ear implant development, describe current available devices, evaluate the benefits and limits of the technology, and consider the future directions of research in the field of implantable hearing aids.