Cochlear implants (CIs) are commonly used for profound bilateral hearing loss. They have specific national guidance for their insertion, however patients with a substantial residual acoustic hearing are potential CI candidates. Preservation of this residual hearing can be sought with improving surgical technique and technology. Higher electrode array insertion speeds lead to significantly higher forces and the suggestion is that low and stable speeds minimise the degree of trauma. In this paper, the robot RobOtol® inserted a MED-El Flex 24-electrode array in adult patients with a severe to profound hearing loss. The robot implanted five patients and was compared to 17 patients who underwent manual manipulation. The conventional CI surgical approach was utilised by a single surgeon. On view of the round window membrane via a posterior tympanotomy, the robot was introduced and inserted the array. Video recordings were used to calculate the speed of insertion. The speed of insertion was 0.88+/-0.12mm/s for the robot and 2.48mm/s for manual insertion. They utilised pure tone audiogram (PTA) and cone beam CT for evaluation measures. In the robot arm, all five electrode arrays were completely inserted. There was comparable PTA mean loss 13.6dB (robot) and 16.53dB (manual), but a lower degree of >20dB loss per patient 1/5 (robot) and 5/17 (manual). Intracochlear trauma was graded using Eshraghi’s Classification and revealed Grade 0 insertion trauma for robot assistance compared to 10/17 Grade 1 trauma (Scored 0 no trauma to 4 severe trauma). This study is a feasibility study, but there is a suggestion that robotic insertion may minimise traumatic effect and therefore help preserve residual hearing function.
Robotic insertion of electrode array in cochlear implantation
Reviewed by Aaron Ferguson
The Use of a Robot to Insert an Electrode Array of Cochlear Implants in the Cochlea: A Feasibility Study and Preliminary Results.
Aaron SJ Ferguson
Department of Otolaryngology, Ninewells Hospital, UK.View Full Profile