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Position Statement: Active Middle Ear Implants

Position Statement: Active Middle Ear Implants

The American Academy of Otolaryngology-Head and Neck Surgery considers active middle ear implants as appropriate treatment for adults with moderate to severe hearing loss when performed by a qualified otolaryngologist-head and neck surgeon. Based on available literature demonstrating that clinically selected adults receive substantial benefit, implanting active middle ear implants is accepted medical practice in those who benefit from amplification but are unable to benefit from the amplification provided by conventional hearing aids. Use of active middle ear implants, which have been Food and Drug Administration (FDA)-approved for these indications, should adhere to the restrictions and guidelines specified by the appropriate governing agency, such as the Food and Drug Administration in the United States and other similar regulatory agencies in countries other than the United States.

Adopted 9/13/1986
Revised 2/4/1989
Submitted for Review 4/13/1995
Submitted for Review 3/1/1998
Reaffirmed 3/1/1998
Revised 12/5/2009
Revised 12/8/2012
Revised 1/8/2013
Drafted 3/11/2016
Reviewed 9/17/2016


  1. Boeheim K, Pok SM, Schloegel M, Filzmoser P. Active middle ear implant compared with open‐fit hearing aid in sloping high‐frequency sensorineural hearing loss. Otol Neurotol. 2010 Apr;31(3):424‐9. PubMed PMID: 20042907.
  2. Butler CL, Thavaneswaran P, Lee IH. Efficacy of the active middle‐ear implant in patients with sensorineural hearing loss. J Laryngol Otol. 2013 Jul;127 Suppl 2:S8‐16. PubMed PMID: 23790515.
  3. Edfeldt L, Strömbäck K, Grendin J, Bunne M, Harder H, Peebo M, Eeg‐Olofsson M, Petersson CM, Konradsson K. Evaluation of cost‐utility in middle ear implantation in the ‘Nordic School’: a multicenter study in Sweden and Norway. Acta Otolaryngol. 2014 Jan;134(1):19‐25. PubMed PMID: 24256038.
  4. Ihler F, Bewarder J, Blum J, Matthias C, Canis M. Long‐term functional outcome and satisfaction of patients with an active middle ear implant for sensorineural hearing loss compared to a matched population with conventional hearing aids. Eur Arch Otorhinolaryngol. 2014 Dec;271(12):3161‐9. PubMed PMID: 24248731.
  5. Snik AF, van Duijnhoven NT, Mylanus EA, Cremers CW. Estimated cost‐effectiveness of active middle‐ear implantation in hearing‐impaired patients with severe external otitis. Arch Otolaryngol Head Neck Surg. 2006 Nov;132(11):1210‐5. PubMed PMID: 17116816.
  6. Wagner F, Todt I, Wagner J, Ernst A. Indications and candidacy for active middle ear implants. Adv Otorhinolaryngol. 2010;69:20‐6. PubMed PMID: 20610910.
  7. Zwartenkot JW, Hashemi J, Cremers CW, Mulder JJ, Snik AF. Active middle ear implantation for patients with sensorineural hearing loss and external otitis: long‐term outcome in patient satisfaction. Otol Neurotol. 2013 Jul;34(5):855‐61. PubMed PMID: 23739560.

Important Disclaimer Notice (Updated 7/31/14)

Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.

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