ObjectiveThe indications of the Vibrant Soundbridge (VSB), presently limited to the patients with sensorineural hearing loss (HL) and normal middle ear function, have been extended to include patients with mixed HL due to congenital or acquired ossicular chain defects. The FMT of the VSB placed onto the RW, round window implant (RWI), has allowed optimal amplification in patients with moderate‐to‐severe mixed HL who, at present, do not have good options for adequate functional rehabiliation.Methods27 patients were unsuitable candidates for air and bone conductive hearing aids (BCHAs and ACHAs) and osseointegrative implants (BAHAs) and were treated with RWI. The patients were subdivided in 3 groups in relation to the etiologies and the performed surgeries. The first group includes 15 adults with unsuccessful OPLs (9 canal‐wall‐up (CWU) and 6 canal‐wall‐down (CWD) tympanoplasty); the second group includes 8 adult patients with CSOM, operated on dry radical or modified RCs; and the third group includes 4 patients, 2 children aged 1‐ and 10‐years‐old, and 2 adults with severe congenital malformations of the auricle combined with atresia of the outer ear canal and malformations of the ossicular chain. RWI surgeries will be illustrated in detail for each group.ResultsSignificant improvements were observed in puretone threshold and speech understanding after surgery and at different follow‐ups (12–24 months), with no complications.ConclusionsThe post‐operative results suggest that RWI offers a viable treatment option for patients with severe mixed HL, regardless of the etiology of HL and previous surgeries.