Restoration of High Frequency Auditory Perception After Robot-Assisted or Manual Cochlear Implantation in Profoundly Deaf Adults Improves Speech Recognition

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.

Suitable Electrode Choice for Robotic-Assisted Cochlear Implant Surgery: A Systematic Literature Review of Manual Electrode Insertion Adverse Events

“…Robotic systems, such as HEARO®, Rosa®, which drill a narrow tunnel (direct cochlear access) from the cortex to the cochlea, need an alternate solution for stabilizing the electrode. EM has not been reported in the limited series of patients operated on who have had robotic insertions ( 12 – 15 , 17 , 18 ). Although the narrow tunnel approach itself provides some stabilization and the absence of coiled excess electrode lead in the mastoid cavity minimizes the EMs, caution is needed in fixing the electrode in the tunnel, which might be accomplished, for example with bone paté.…”

“…Cadaveric temporal bone experiments show that, in particular, the occurrence of ESD is decreased in motorized co-axial insertion with a slow steady speed ( 102 ). Yet, even in the limited series of RACIS, ESD has been reported with pre-shaped electrodes ( 17 ). With straight electrodes, RACIS can better manage co-axial insertion into the ST, minimizing damage to the scalar walls.…”

“…It includes an automated insertion tool for the electrode ( 16 ). Recent reports in a series of patients demonstrate the clinical feasibility and effectiveness of these robotic systems in accommodating various CI electrode variants ( 14 , 15 , 17 , 18 ).…”

“…These include electrode tip fold over (ETFO) ( 19 ), electrode array scalar deviation (ESD) ( 20 ), and electrode array migration (EM) or slippage ( 21 ). A recent report on the application of RACIS also included one of the electrode-related complications mentioned above ( 17 ). Electrode variants that are currently available can be classified as either pre-shaped or straight electrode types ( 22 ).…”

A new method of preoperative assessment of correct electrode array alignment based on post-operative measurements in a cochlear implanted cohort

“…Preserving residual hearing and developing a less traumatic insertion of the electrode array have been main goals for many institutions, which could potentially be achieved using robotic surgery [20][21][22]. There is limited knowledge on post-robotic insertion hearing outcomes, but recent studies have shown that the robot itself is able to decrease the involuntary movements such as tremor; creates a smooth insertion and the translocated electrodes were decreased in comparison to manual insertion with reduced intracochlear damage, however, navigation and preoperative planning are still under refinement.…”