title: Implantable middle ear hearing devices: current state of technology and market challenges.
abstract: OBJECTIVE
  This review of implantable middle ear hearing devices is relevant to hearing professionals and otolaryngologists as an update of technological developments and the status of performance of current devices used in the United States. The 9th International Conference on Cochlear Implants and related Sciences was conducted 14-17 June in Vienna, Austria. Middle ear implantable devices were considered a 'hot topic', as two fully implantable devices are nearing European CE and FDA approval.
  
  
  RESULTS
  The main themes in this review focus on the fundamental technology applied to middle ear implantables, currently available devices, an overview of devices now off the US market and on challenges in improving performance and reliability. The necessary interplay with manufacturing devices which are more straightforward to surgically place and affordable enough to be accessed by the eligible population of people with hearing loss is discussed.
  
  
  CONCLUSIONS
  Indications for middle ear implantable hearing devices are expanding and the reliability of systems continues to improve. Solving problems related to affordability and access has made little progress in comparison, as evidenced by the poor performance of several 'technologically successful' manufacturers in the US market.
authors.affiliation: The Listen for Life Center at Virginia Mason, Section of Otolaryngology, Head and Neck Surgery, Virginia Mason Medical Center, Seattle, WA 98111-0900, USA. otoddb@vmmc.org
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Backous
authors.forename: William
authors.initials: W
authors.lastname: Duke
mesh_terms: D006310:Hearing Aids / Q000145:classification*; D034381:Hearing Loss / Q000601:surgery*; D006801:Humans; D009998:Ossicular Prosthesis; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000639:trends*; D014481:United States; D014486:United States Food and Drug Administration