Middle Ear Implants (MEI) have emerged as a viable alternative for individuals who gain minimal benefit from traditional amplification and are not candidates for cochlear implantation. Through a historical lens, the development of MEIs has evolved from early experiments in the 1930s. MEIs function by converting acoustic energy into vibrations that stimulate the ossicles, overcoming impedance mismatch challenges. The Vibrant Sound Bridge (VSB) and Esteem are currently notable active MEIs in the market, each with distinct mechanisms and candidacy criteria. Selection for these devices requires thorough audiological and radiological evaluations, ensuring appropriateness for conductive, mixed, or sensorineural hearing loss.