To evaluate the long-term outcomes of the first 5 infants and 9 children with congenital aural atresia (CAA) who had undergone hearing rehabilitation using the MED-EL Vibrant Soundbridge with intraoperative assistance of electrocochleo- graphy (ECoG) for optimal fitting of the floating mass transducer (FMT) on the round window (RW) membrane. Infants and children with moderate-to-severe con- ductive or mixed hearing loss, not suitable or unwilling to accept Bone-Anchored Hearing Aids and who would not tolerate tra- ditional bone and air conduction hearing aids, obtain substan- tial benefit with the FMT-RW implantation procedure. Intraoperative ECoG is of significant help in achieving the best FMT-RW fitting.