Hearing Implants

Middle ear implants provide an alternative for people with moderate to severe hearing loss who can’t wear hearing aids for medical reasons or who don’t derive enough benefit from them. See Who is a middle ear implant suitable for? for more details, below.

How does a middle ear implant work?

Rather than simply amplifying sound like a hearing aid, a middle ear implant (MEI) converts sound into mechanical vibrations that directly stimulate your middle ear, providing an enhanced signal to your inner ear so that even high-pitched tones can be heard well. This is different from a cochlear implant, designed for severe to profound hearing loss, which electrically stimulates the nerves in the inner ear.

The middle ear implant consists of two main components: the surgical implant, which is placed underneath the skin, and the externally worn audio processor, which is held directly over the implant by magnetic attraction and sits comfortably under your hair. Here’s what happens:

Source: MED-EL

  1. The audio processor converts sound into electrical signals.
  2. The signals are then transmitted through your skin to the implant.
  3. The implant then transmits the signals to a tiny part called a transducer.
  4. The transducer converts the signals into mechanical vibrations that stimulate movement of your middle ear structures – three little bones known as the ossicles.
  5.  The vibrations transmit the acoustic information to your inner ear and then to your brain, where it is interpreted as sound.
  6. The microphones inside the audio processor pick up sounds.

Can you get an active bone conduction implant on the NHS?

There are no NICE guidelines for middle ear implants. They are provided on the NHS in the following circumstances:

  • When someone has moderate to severe sensorineural hearing loss in both ears and can’t use hearing aids due to problems with the outer ear.
  • When someone has a mixed hearing loss and conventional hearing aids prove unsuitable for medical reasons, such as problems with the outer or middle ear, and they have tried a bone anchored hearing aid (BAHA) but experienced problems.
  • A full hearing and medical assessment will be made to determine whether you are suitable for surgery and likely to derive sufficient benefit from the middle ear implant.

Who is a middle ear implant suitable for?

  • People with moderate to severe sensorineural hearing loss , conductive hearing loss  or mixed hearing loss who are unable to benefit from conventional hearing aids for medical reasons. These may include outer ear abnormalities, recurrent infections, skin irritations or problems caused by the ear mould blocking the ear canal.
  • People with the above types of hearing loss who simply don’t derive enough benefit from hearing aids. This may be the case if you find your hearing aids just make noise louder rather than making speech clearer.
  • You must be aged five or over with a functioning auditory nerve.
cochlear implant pros and cons

Benefits of a middle ear implant system

  • Improved hearing quality and speech understanding, particularly in noisy surroundings. Users often describe sound as ‘natural’.
  • Reduced or no feedback (whistling) – This is because the microphone of the middle ear audio processor is farther away from the pinna than a hearing aid microphone. Hearing aids start whistling when sounds that leave the ear are picked back up by the microphone.
  • No plugging or blockage of the ear canal – This is an advantage for people who suffer from chronic ear canal inflammation and are prone to infections or irritation.
  • Discreet to wear – The audio processor is cable-free and can be concealed under longer hair.
  • Comfortable to wear.

Things to consider

  • Implant surgery is generally considered very safe but any type of surgery carries some degree of risk such as side effects from anaesthetic and post-operative infection. Ask your surgeon to explain how the risks and the benefits apply to you.
  • You may need to take the audio processor off for swimming or showering.
Information about cochlear implant risks

What to look for in a middle ear implant system?

  • Feel and appearance – Audio processors vary in size, weight and some have interchangeable covers in different colours and designs, allowing you to make a bold statement or to wear it discreetly.
  • Transcutaneous or percutaneous: Transcutaneous implants transmit sound signals through the intact skin to the implant. There are hardly any skin problems and they have a clear aesthetic advantage when the audio processor is not worn.  In percutaneous devices, the audio processor is attached to the skull bone via an abutment to a titanium screw in the non-intact skin.The skin around the screw must be cleaned thoroughly every day to avoid infections, which can occur with percutaneous devices.
  • MRI compatibility – It’s important to know whether your device is compatible with MRI scanners used for diagnostic medical tests, and to what degree.
  • Adaptive directional microphones – These help identify and filter out background noise.
  • Speech tracking – This identifies the direction from which speech is coming, sharpening the sound.
  • Wireless connectivity – Your audio processor can connect to your mobile phone, mp3 player or assistive listening device.
  • Suitability for children – Not all middle ear implants are suitable for children as some attach to the skull bones, which are still. However, others are independent of skull growth.
  • Intelligent sound adaptation – The audio processor can distinguish between different hearing environments and adjust automatically so you don’t have to keep making manual switches when you go from a quiet area to a noisy one, for example entering a restaurant.
  • Individual programs for specific environments such as background noise, TV or music.
  • Remote-control device – You can quickly and easily make manual adjustments, if necessary, without removing the audio processor.

Connect with a HearPeers mentor

to find out about their experiences with middle ear implants.


The contents of this website are for informational and educational purposes only and do not constitute medical advice. This website should not be used to diagnose or treat health conditions. You should contact a healthcare provider if you have healthcare related questions.