**Abstract**

The active middle ear implant (AMEI) may be considered, in selected cases, a valid alternative to conventional hearing aids (cHA) for rehabilitation of bilateral sensorineural hearing loss (SNHL). Since 2007, at the Implanting Centre of the University Hospital Sant'Andrea in Rome, 43 subjects underwent surgery for application of the Esteem®, after ascertaining by CT scan its feasibility for allocating its transducers within the mastoid space. The surgical procedure is longer than for the other AMEI, and the switch on of the device is usually performed 4–6 weeks after surgery. All the Esteem® implantees underwent a pre- and postoperative assessment via pure tone and speech audiometry with headset in a soundproof booth. Along with the recommended population with moderate-to-severe hearing loss, subjects also with a worse hearing loss (severe or severe-to-profound) were selected for this implant for different reasons. The auditory outcome in label and off-label implantees was analyzed. Complications included the need for a minor revision, due to middle ear fibrosis, or for an explant that was followed by ossicular reconstruction with return to a cHA (two subjects), cochlear implantation (five subjects) or no alternative solution (one case).

**Keywords:** Esteem, active middle ear implant, fully-implantable device, sensorineural hearing loss, hearing rehabilitation
