Purpose of review-Treatment of auditory dysfunction is dependent on inner ear drug delivery, with microtechnologies playing an increasingly important role in cochlear access and pharmacokinetic profile control. This review examines recent developments in the field relevant to both clinical and animal research environments.Recent findings-Micropump technologies are being developed that provide dynamic control of flow rates with refillable reservoirs to enable timed delivery of a series of multiple agents for protection or regeneration therapies. These micropumps can be combined with cochlear implants with integral catheters or used independently with cochleostomy or RWM delivery modalities for therapy development in animal models. Sustained release of steroids with coated cochlear implants remains an active area of research with first-time-in-human demonstration of reduced electrode impedances. Advanced coatings containing neurotrophin producing cells have enhanced spiral ganglion neuron survival in animal models, and have proven safe in a human study. Microneedles have emerged as a novel method for controlled microperforation of the round window membrane with significant enhancement in permeability, which can be combined with emerging matrix formulations that optimize biological interaction and drug release kinetics.Summary-Microsystem technologies and associated fabrication techniques are providing enhanced and more controlled access to the inner ear for advanced drug delivery approaches, alone and in conjunction with cochlear implants.