OBJECTIVE: To present long-term results with a semi-implantable middle ear implant, the Vibrant Soundbridge (VSB), and analyze pre- and post-operative results of audiologic tests. STUDY DESIGN: Retrospective chart review with additional patient interview and audiologic testing. SETTING: One tertiary referral center. SUBJECTS: Twenty patients who met the selection criteria of the manufacturer were evaluated at least two years after implantation. INTERVENTIONS: Monaural Implantation of the VSB in 20 patients, in two of these 20 patients implantation of the second ear in a second stage. RESULTS: Assessment of benefit and satisfaction using the standardized International Outcome Inventory for Hearing Aids, the Glasgow Benefit Inventory, and Visual Analogue Scales in all patients. Fifteen patients agreed to undergo audiologic testing at follow-up including pure-tone- and speech audiometry in silence and noise. The majority of patients (13/20) reported to be satisfied or very satisfied with the VSB. Aided speech perception was comparable between the VSB and the hearing aid preoperatively. When compared to the preoperative audiograms, residual hearing from 0.5-4 kHz was significantly worse in the operated ear with 8 dB (Wilcoxon signed rank test p < 0.001) but only 2.6 dB in the non-operated ear (Wilcoxon signed rank test, p > 0.05). Major surgical complications did not occur. Permanent alteration in taste occurred in three patients and revision surgery was necessary in another three patients. CONCLUSION: Satisfaction with the VSB was not superior to conventional hearing aids in subjective and in audiometric terms. Because of its impact on residual hearing and the requirement of implantation middle ear surgery, implantation of the VSB should be limited to patients with relevant side effects of hearing aids, e.g., severe chronic otitis externa.