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Torres R, Daoudi H, Gu W, Breil E, Ferrary E, Sterkers O, Nguyen Y, Mosnier I. Exploring Trauma Patterns and Contributing Factors With Slim Straight Electrode Array After Cochlear Implantation. Otolaryngol Head Neck Surg 2024; 171:521-529. [PMID: 38532540 DOI: 10.1002/ohn.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/09/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To assess trauma patterns associated with the insertion of lateral wall electrode arrays. The study focused on 3 categories-scala tympani (ST), intermediate, and scala vestibuli (SV)-to identify traumatic patterns and contributing factors. STUDY DESIGN Retrospective study. SETTING Data from 106 cochlear implant recipients at a tertiary otologic center. METHODS Demographic and surgical data were collected from recipients who underwent cochlear implantation manually and with RobOtol®. Measurements included cochlear dimensions, angular depth of insertion, and position of the first electrode. Three-dimensional reconstructions were used to analyze the electrode array location relative to the basilar membrane, categorized into ST, intermediate, and SV electrodes. Nontraumatic insertion was defined as all electrodes in the ST, while traumatic insertions had 1 or more electrodes in intermediate or SV locations. RESULTS Out of 106 cases, 44% had nontraumatic and 56% had traumatic insertions. Demographic and surgical characteristics showed no association with traumatic insertions. A deeper position of the first electrode, relative to the round window, was associated with traumatic insertions (P = .03). Three trauma patterns were observed: distal (facing the apical electrodes), proximal (facing the middle electrodes around 180°), and distal/proximal. CONCLUSION This study considers the intermediate position which could be associated with basilar membrane lesions. Risk zones for intracochlear trauma with lateral wall arrays were identified distally and proximally. Traumatic insertions were independently linked to deeper array placement. Future studies should explore whether gentler insertion, without insisting on further electrode array insertion depth, could reduce the trauma during cochlear implantation.
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Affiliation(s)
- Renato Torres
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
| | - Hannah Daoudi
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
| | - Wenxi Gu
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases (14DZ2260300), Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Eugénie Breil
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
| | - Evelyne Ferrary
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
| | - Olivier Sterkers
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
| | - Yann Nguyen
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
| | - Isabelle Mosnier
- Unité Fonctionnelle Implants Auditifs et Explorations Fonctionnelles, Service ORL, GHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP)/Sorbonne Université, Paris, France
- Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur/Inserm/Université Paris Cité, Paris, France
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Concheri S, Brotto D, Ariano M, Daloiso A, Di Pasquale Fiasca VM, Sorrentino F, Coppadoro B, Trevisi P, Zanoletti E, Franchella S. Intraoperative Measurement of Insertion Speed in Cochlear Implant Surgery: A Preliminary Experience with Cochlear SmartNav. Audiol Res 2024; 14:227-238. [PMID: 38525682 PMCID: PMC10961689 DOI: 10.3390/audiolres14020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVES The objectives were to present the real-time estimated values of cochlear implant (CI) electrode insertion speed (IS) during intraoperative sessions using the Cochlear Nucleus SmartNav System to assess whether this measure affected CI outcomes and to determine whether real-time feedback assists expert surgeons in achieving slow insertion. METHODS The IS was measured in 52 consecutive patients (65 implanted ears) using the CI632 electrode. The IS values were analyzed in relation to procedure repetition over time, NRT ratio, and CI audiological outcomes. RESULTS The average IS was 0.64 mm/s (SD = 0.24); minimum and maximum values were 0.23 and 1.24 mm/s, respectively. The IS significantly decreased with each array insertion by the operator (p = 0.006), and the mean decreased by 24% between the first and last third of procedures; however, this reduction fell within the error range of SmartNav for IS (+/-0.48 mm/s). No correlation was found between IS and the NRT ratio (p = 0.51), pure-tone audiometry (PTA) at CI activation (p = 0.506), and PTA (p = 0.94) or word recognition score (p = 0.231) at last evaluation. CONCLUSIONS The estimated IS reported by SmartNav did not result in a clinically significant reduction in insertion speed or an improvement in CI hearing outcomes. Real-time feedback of IS could potentially be used for training, but its effectiveness requires confirmation through additional studies and more accurate tools. Implementation of IS assessment in clinical practice will enable comparisons between measurement techniques and between manual and robot-assisted insertions. This will help define the optimal IS range to achieve better cochlear implant (CI) outcomes.
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Affiliation(s)
- Stefano Concheri
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Davide Brotto
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Marzia Ariano
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Antonio Daloiso
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | | | - Flavia Sorrentino
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Beatrice Coppadoro
- Pediatric Hematology Oncology Unit, Department of Woman’s and Child’s Health, Azienda Ospedale-Università di Padova, 35122 Padua, Italy
| | - Patrizia Trevisi
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Elisabetta Zanoletti
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
| | - Sebastiano Franchella
- Department of Neurosciences, Section of Otolaryngology, Azienda Ospedale-Università Padova, 35121 Padua, Italy
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Pai I, Connor S, Komninos C, Ourselin S, Bergeles C. The impact of the size and angle of the cochlear basal turn on translocation of a pre-curved mid-scala cochlear implant electrode. Sci Rep 2024; 14:1024. [PMID: 38200135 PMCID: PMC10781700 DOI: 10.1038/s41598-023-47133-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/09/2023] [Indexed: 01/12/2024] Open
Abstract
Scalar translocation is a severe form of intra-cochlear trauma during cochlear implant (CI) electrode insertion. This study explored the hypothesis that the dimensions of the cochlear basal turn and orientation of its inferior segment relative to surgically relevant anatomical structures influence the scalar translocation rates of a pre-curved CI electrode. In a cohort of 40 patients implanted with the Advanced Bionics Mid-Scala electrode array, the scalar translocation group (40%) had a significantly smaller mean distance A of the cochlear basal turn (p < 0.001) and wider horizontal angle between the inferior segment of the cochlear basal turn and the mastoid facial nerve (p = 0.040). A logistic regression model incorporating distance A (p = 0.003) and horizontal facial nerve angle (p = 0.017) explained 44.0-59.9% of the variance in scalar translocation and correctly classified 82.5% of cases. Every 1mm decrease in distance A was associated with a 99.2% increase in odds of translocation [95% confidence interval 80.3%, 100%], whilst every 1-degree increase in the horizontal facial nerve angle was associated with an 18.1% increase in odds of translocation [95% CI 3.0%, 35.5%]. The study findings provide an evidence-based argument for the development of a navigation system for optimal angulation of electrode insertion during CI surgery to reduce intra-cochlear trauma.
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Affiliation(s)
- Irumee Pai
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- St. Thomas' Hearing Implant Centre, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, 2nd Floor Lambeth Wing, London, SE1 7EH, UK.
| | - Steve Connor
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Radiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Charalampos Komninos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Christos Bergeles
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Derieppe A, Gendre A, Bourget-Aguilar K, Bordure P, Michel G. Comparative study of vestibular function preservation in manual versus robotic-assisted cochlear implantation. Cochlear Implants Int 2024; 25:23-27. [PMID: 37985652 DOI: 10.1080/14670100.2023.2271221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To compare vestibular outcomes in cochlear implant (CI) surgery, between robotic-assisted insertion of the electrodes versus manual insertion. METHODS We performed a monocentric retrospective study. From March 2021, the robotic system RobOtol© was used for all CI cases. We compared this robotic-assisted insertion group with a manual insertion group of patients who received a CI between July 2020 and March 2021. Primary objective was vestibular outcome. We used objective vestibular function tests: caloric testing, Vestibular Evoked Myogenic Potential (VEMP), and Video Head Impulse Test (VHIT). Secondary objectives were postoperative complications including patient-reported postoperative vertigo. RESULTS We found no statistically significant difference between the two groups in terms of caloric testing, VEMP or VHIT outcomes. In patient-reported outcomes, there was significantly more vertigo in the manual insertion group compared with robotic-assisted insertion. CONCLUSION It is hypothesized that a non-traumatic insertion would cause less vestibular dysfunction postoperatively. Larger prospective studies are required to determine whether robotic-assisted CI insertion has a significant impact on vestibular outcomes in CI surgery.
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Affiliation(s)
- Arthur Derieppe
- Service d'Oto-Rhino-Laryngologie et chirurgie cervico-faciale, CHU Nantes, Nantes, France
| | - Adrien Gendre
- Service d'Oto-Rhino-Laryngologie et chirurgie cervico-faciale, CHU Nantes, Nantes, France
- National Hearing Implant and Viani Research Center, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kinnie Bourget-Aguilar
- Service d'Oto-Rhino-Laryngologie et chirurgie cervico-faciale, CHU Nantes, Nantes, France
| | - Philippe Bordure
- Service d'Oto-Rhino-Laryngologie et chirurgie cervico-faciale, CHU Nantes, Nantes, France
| | - Guillaume Michel
- Service d'Oto-Rhino-Laryngologie et chirurgie cervico-faciale, CHU Nantes, Nantes, France
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Robot-Assisted Electrode Insertion in Cochlear Implantation Controlled by Intraoperative Electrocochleography-A Pilot Study. J Clin Med 2022; 11:jcm11237045. [PMID: 36498620 PMCID: PMC9737018 DOI: 10.3390/jcm11237045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Robotics in otology has been developing in many directions for more than two decades. Current clinical trials focus on more accurate stapes surgery, minimally invasive access to the cochlea and less traumatic insertion of cochlear implant (CI) electrode arrays. In this study we evaluated the use of the RobOtol® (Collin, Bagneux, France) otologic robot to insert CI electrodes into the inner ear with intraoperative ECochG analysis. This prospective, pilot study included two adult patients implanted with Advanced Bionics (Westinghouse PI, CA, USA) cochlear implant, with HiFocus™ Mid-Scala electrode array. The standard surgical approach was used. For both subjects, who had residual hearing in the implanted ear, intraoperative and postoperative ECochG was performed with the AIMTM system. The surgeries were uneventful. A credible ECochG response was obtained after complete electrode insertion in both cases. Preoperative BC thresholds compared to intraoperative estimated ECochG thresholds and 2-day postoperative BC thresholds had similar values at frequencies where all thresholds were measurable. The results of the ECochG performed one month after the surgery showed that in both patients the hearing residues were preserved for the selected frequencies. The RobOtol® surgical robot allows for the correct, safe and gentle insertion of the cochlear implant electrode inside the cochlea. The use of electrocochleography measurements during robotic cochlear implantation offers an additional opportunity to evaluate and modify the electrode array insertion on an ongoing basis, which may contribute to the preservation of residual hearing.
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Starovoyt A, Quirk BC, Putzeys T, Kerckhofs G, Nuyts J, Wouters J, McLaughlin RA, Verhaert N. An optically-guided cochlear implant sheath for real-time monitoring of electrode insertion into the human cochlea. Sci Rep 2022; 12:19234. [PMID: 36357503 PMCID: PMC9649659 DOI: 10.1038/s41598-022-23653-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022] Open
Abstract
In cochlear implant surgery, insertion of perimodiolar electrode arrays into the scala tympani can be complicated by trauma or even accidental translocation of the electrode array within the cochlea. In patients with partial hearing loss, cochlear trauma can not only negatively affect implant performance, but also reduce residual hearing function. These events have been related to suboptimal positioning of the cochlear implant electrode array with respect to critical cochlear walls of the scala tympani (modiolar wall, osseous spiral lamina and basilar membrane). Currently, the position of the electrode array in relation to these walls cannot be assessed during the insertion and the surgeon depends on tactile feedback, which is unreliable and often comes too late. This study presents an image-guided cochlear implant device with an integrated, fiber-optic imaging probe that provides real-time feedback using optical coherence tomography during insertion into the human cochlea. This novel device enables the surgeon to accurately detect and identify the cochlear walls ahead and to adjust the insertion trajectory, avoiding collision and trauma. The functionality of this prototype has been demonstrated in a series of insertion experiments, conducted by experienced cochlear implant surgeons on fresh-frozen human cadaveric cochleae.
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Affiliation(s)
- Anastasiya Starovoyt
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, ExpORL, KU Leuven, 3000 Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Neurosciences, Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium
| | - Bryden C. Quirk
- grid.1010.00000 0004 1936 7304Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005 Australia ,grid.1010.00000 0004 1936 7304Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, SA 5005 Australia
| | - Tristan Putzeys
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, ExpORL, KU Leuven, 3000 Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Neurosciences, Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Laboratory for Soft Matter and Biophysics, Department of Physics and Astronomy, KU Leuven, 3000 Leuven, Belgium
| | - Greet Kerckhofs
- grid.7942.80000 0001 2294 713XBiomechanics Laboratory, Institute of Mechanics, Materials, and Civil Engineering, UCLouvain, 1348 Louvain-La-Neuve, Belgium ,grid.5596.f0000 0001 0668 7884Department of Materials Science and Engineering, KU Leuven, 3000 Leuven, Belgium ,grid.7942.80000 0001 2294 713XInstitute of Experimental and Clinical Research, UCLouvain, 1200 Woluwé-Saint-Lambert, Belgium ,grid.5596.f0000 0001 0668 7884Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, 3000 Leuven, Belgium
| | - Johan Nuyts
- grid.5596.f0000 0001 0668 7884Department of Imaging and Pathology, Division of Nuclear Medicine, KU Leuven, 3000 Leuven, Belgium ,Nuclear Medicine and Molecular Imaging, Medical Imaging Research Center, 3000 Leuven, Belgium
| | - Jan Wouters
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, ExpORL, KU Leuven, 3000 Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Neurosciences, Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium
| | - Robert A. McLaughlin
- grid.1010.00000 0004 1936 7304Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005 Australia ,grid.1010.00000 0004 1936 7304Institute for Photonics and Advanced Sensing, The University of Adelaide, Adelaide, SA 5005 Australia ,grid.1012.20000 0004 1936 7910School of Engineering, University of Western Australia, Perth, WA 6009 Australia
| | - Nicolas Verhaert
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, ExpORL, KU Leuven, 3000 Leuven, Belgium ,grid.5596.f0000 0001 0668 7884Department of Neurosciences, Leuven Brain Institute, KU Leuven, 3000 Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals of Leuven, 3000 Leuven, Belgium
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Best Fit 3D Basilar Membrane Reconstruction to Routinely Assess the Scalar Position of the Electrode Array after Cochlear Implantation. J Clin Med 2022; 11:jcm11082075. [PMID: 35456169 PMCID: PMC9030636 DOI: 10.3390/jcm11082075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022] Open
Abstract
The scalar position of the electrode array is assumed to be associated with auditory performance after cochlear implantation. We propose a new method that can be routinely applied in clinical practice to assess the position of an electrode array. Ten basilar membrane templates were generated using micro-computed tomography (micro-CT), based on the dimensions of 100 cochleae. Five surgeons were blinded to determine the position of the electrode array in 30 cadaveric cochleae. The procedure consisted of selecting the appropriate template based on cochlear dimensions, merging the electrode array reconstruction with the template using four landmarks, determining the position of the array according to the template position, and comparing the results obtained to histology data. The time taken to analyze each implanted cochlea was approximately 12 min. We found that, according to histology, surgeons were in almost perfect agreement when determining an electrode translocated to the scala vestibuli with the perimodiolar MidScala array (Fleiss’ kappa (κ) = 0.82), and in moderate agreement when using the lateral wall EVO array (κ = 0.42). Our data indicate that an adapted basilar membrane template can be used as a rapid and reproducible method to assess the position of the electrode array after cochlear implantation.
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Robotics, automation, active electrode arrays, and new devices for cochlear implantation: A contemporary review. Hear Res 2022; 414:108425. [PMID: 34979455 DOI: 10.1016/j.heares.2021.108425] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 01/14/2023]
Abstract
In the last two decades, cochlear implant surgery has evolved into a minimally invasive, hearing preservation surgical technique. The devices used during surgery have benefited from technological advances that have allowed modification and possible improvement of the surgical technique. Robotics has recently gained popularity in otology as an effective tool to overcome the surgeon's limitations such as tremor, drift and accurate force control feedback in laboratory testing. Cochlear implantation benefits from robotic assistance in several steps during the surgical procedure: (i) during the approach to the middle ear by automated mastoidectomy and posterior tympanotomy or through a tunnel from the postauricular skin to the middle ear (i.e. direct cochlear access); (ii) a minimally invasive cochleostomy by a robot-assisted drilling tool; (iii) alignment of the correct insertion axis on the basal cochlear turn; (iv) insertion of the electrode array with a motorized insertion tool. In recent years, the development of bone-attached parallel robots and image-guided surgical robotic systems has allowed the first successful cochlear implantation procedures in patients via a single hole drilled tunnel. Several other robotic systems, new materials, sensing technologies applied to the electrodes, and smart devices have been developed, tested in experimental models and finally some have been used in patients with the aim of reducing trauma in cochleostomy, and permitting slow and more accurate insertion of the electrodes. Despite the promising results in laboratory tests in terms of minimal invasiveness, reduced trauma and better hearing preservation, so far, no clinical benefits on residual hearing preservation or better speech performance have been demonstrated. Before these devices can become the standard approach for cochlear implantation, several points still need to be addressed, primarily cost and duration of the procedure. One can hope that improvement in the cost/benefit ratio will expand the technology to every cochlear implantation procedure. Laboratory research and clinical studies on patients should continue with the aim of making intracochlear implant insertion an atraumatic and reversible gesture for total preservation of the inner ear structure and physiology.
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Torres R, Daoudi H, Lahlou G, Sterkers O, Ferrary E, Mosnier I, Nguyen Y. Restoration of High Frequency Auditory Perception After Robot-Assisted or Manual Cochlear Implantation in Profoundly Deaf Adults Improves Speech Recognition. Front Surg 2021; 8:729736. [PMID: 34568420 PMCID: PMC8461256 DOI: 10.3389/fsurg.2021.729736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Robot-assisted cochlear implantation has recently been implemented in clinical practice; however, its effect on hearing outcomes is unknown. The aim of this preliminary study was to evaluate hearing performance 1 year post-implantation whether the electrode array was inserted manually or assisted by a robot. Methods: Forty-two profoundly deaf adults were implanted either manually (n = 21) or assisted by a robot (RobOtol®, Collin, Bagneux, France) with three different electrode array types. Participants were paired by age, and electrode array type. The scalar position of the electrode array in the cochlea was assessed by 3D reconstruction from the pre- and post-implantation computed tomography. Pure-tone audiometry and speech perception in silence (percentage of disyllabic words at 60 dB) were tested on the implanted ear 1 year post-implantation in free-field conditions. The pure-tone average was calculated at 250–500–750 Hz, 500–1,000–2,000–3,000 Hz, and 3,000–4,000–8,000 Hz for low, mid, and high frequencies, respectively. Results: One year after cochlear implantation, restoration of the high-frequency thresholds was associated with better speech perception in silence, but not with low or mid frequencies (p < 0.0001; Adjusted R2 = 0.64, polynomial non-linear regression). Although array translocation was similar using either technique, the number of translocated electrodes was lower when the electrode arrays had been inserted with the assistance of the robot compared with manual insertion (p = 0.018; Fisher's exact test). Conclusion: The restoration of high-frequency thresholds (3,000–4,000–8,000 Hz) by cochlear implantation was associated with good speech perception in silence. The numbers of translocated electrodes were reduced after a robot-assisted insertion.
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Affiliation(s)
- Renato Torres
- Unité Fonctionnelle Implants Auditifs, Service Oto-Rhino-Laryngologie, AP-HP/Sorbonne Université, Paris, France.,Centre de Recherche en Audiologie Adulte, GHU Pitié-Salpêtrière/Fondation Pour l'Audition, AP-HP, Paris, France.,Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur, INSERM, Paris, France.,Departamento de Ciencias Fisiológicas, Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa, Peru
| | - Hannah Daoudi
- Unité Fonctionnelle Implants Auditifs, Service Oto-Rhino-Laryngologie, AP-HP/Sorbonne Université, Paris, France.,Centre de Recherche en Audiologie Adulte, GHU Pitié-Salpêtrière/Fondation Pour l'Audition, AP-HP, Paris, France.,Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur, INSERM, Paris, France
| | - Ghizlene Lahlou
- Unité Fonctionnelle Implants Auditifs, Service Oto-Rhino-Laryngologie, AP-HP/Sorbonne Université, Paris, France.,Centre de Recherche en Audiologie Adulte, GHU Pitié-Salpêtrière/Fondation Pour l'Audition, AP-HP, Paris, France.,Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur, INSERM, Paris, France
| | - Olivier Sterkers
- Unité Fonctionnelle Implants Auditifs, Service Oto-Rhino-Laryngologie, AP-HP/Sorbonne Université, Paris, France.,Centre de Recherche en Audiologie Adulte, GHU Pitié-Salpêtrière/Fondation Pour l'Audition, AP-HP, Paris, France.,Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur, INSERM, Paris, France
| | - Evelyne Ferrary
- Unité Fonctionnelle Implants Auditifs, Service Oto-Rhino-Laryngologie, AP-HP/Sorbonne Université, Paris, France.,Centre de Recherche en Audiologie Adulte, GHU Pitié-Salpêtrière/Fondation Pour l'Audition, AP-HP, Paris, France.,Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur, INSERM, Paris, France
| | - Isabelle Mosnier
- Unité Fonctionnelle Implants Auditifs, Service Oto-Rhino-Laryngologie, AP-HP/Sorbonne Université, Paris, France.,Centre de Recherche en Audiologie Adulte, GHU Pitié-Salpêtrière/Fondation Pour l'Audition, AP-HP, Paris, France.,Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur, INSERM, Paris, France
| | - Yann Nguyen
- Unité Fonctionnelle Implants Auditifs, Service Oto-Rhino-Laryngologie, AP-HP/Sorbonne Université, Paris, France.,Centre de Recherche en Audiologie Adulte, GHU Pitié-Salpêtrière/Fondation Pour l'Audition, AP-HP, Paris, France.,Technologies et Thérapie Génique Pour la Surdité, Institut de l'Audition, Institut Pasteur, INSERM, Paris, France
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