[Update on Active Middle Ear and Transcutaneous Bone Conduction Hearing Systems].

The recent years have observed technical developments and improvements and have led to an almost all-over coverage for hearing impaired persons by means of non-invasive hearing aids and implantable hearing systems. Thus, persons with hearing disabilities can enjoy an almost normal life and be part of working and social active communities. However, some patients either do no benefit satisfactorily from conventional hearing aids or cannot wear them due to inflammatory reactions and chronic infections of the external auditory canal or due to anatomical reasons. For these patients, various (semi-) implantable middle ear and bone conduction systems are available. The common active principle of the devices considered here is the mechanic stimulation at the ossicular chain or other middle ear structures (active middle ear implants), at the skull (bone-anchored hearing devices), or of the cochlea itself (direct acoustic stimulation). Given the audiological indication criteria and the anatomical conditions were carefully considered, patients who failed surgical hearing rehabilitation or do not benefit from conventional hearing aids, may achieve significant better speech understanding and tremendous improvement in quality of life by implantable hearing devices.