This issue concentrates on the advancement in techniques within the field of implant otology starting with cochlear implantation. Here it is sub-divided into indications, candidacy (including full pre-operative testing and investigations), surgical technique and outcomes for both adults and children. The surgical section is further divided into the relevant surgical steps one progresses through. Of particular note, the authors explain the positioning of the ideal incision and the considerations with regard to avoiding post-operative wound complications. The merits of cochleostomy and insertion via the round window are discussed in detail but the extended round window technique is also described as a third option for electrode access. The article clearly has a central theme with regard to hearing preservation and the techniques adopted to optimise this. In particular, ‘soft surgery’ principles to minimise trauma and prevent contamination into the cochlear to preserve residual hearing are explained. The speed of electrode insertion with relevance to hearing preservation was also discussed. Issues regarding securing the device (especially in children where bony wells are less feasible) and the various techniques used were described. Complications that have been encountered in drilling the well down to the dura (CSF leaks and subdural haematomas) have been identified within the literature such that this technique is no longer favoured. Finally, the need for Pneumococcal vaccinations is emphasised to prevent meningitis in implant patients. These topics were all supported by current available evidence, which in the most part pertained to case series and cohorts rather than randomised trials. They also drew on their own experience at the Johns Hopkins School of Medicine, Baltimore. The reader is therefore reminded that the techniques described are based on personal preference with at best level IIb supporting evidence in some situations. However, a useful overview of the differing options in insertion techniques.