Active middle ear implants (AMEIs) have been available for a number of years and yet most radiologists have never heard of them. Some bear a striking resemblance to cochlear implants whereas others are more similar to conventional hearing aids. The aims of this review are to provide an introduction as to the types of implants available, how they work and when they are indicated. Also, to highlight important pre-operative imaging features that can influence surgery and to consider the role of imaging in the post-operative setting. As patient choice increases, it becomes more likely that radiologists will encounter these devices in daily practice and knowledge of them may prove useful.