Robotic‐Assisted Electrode Array Insertion Improves Stability of Acoustic Hearing Thresholds

ABSTRACT Objective(s) Robotic‐assisted electrode array (EA) insertion is a promising technique that may enhance preservation of residual acoustic hearing after cochlear implant (CI) surgery. The purpose of this study is to evaluate the impact of robotic‐assisted EA insertion on rates of delayed‐onset hearing loss (DOHL). Methods Sixty (Advanced Bionics [AB]: 30, MED‐EL: 30) adult patients underwent CI surgery with manual EA insertion and 29 (AB: 13, MED‐EL: 16) with robotic‐assisted insertion using the iotaSOFT system. The primary outcome variable was longitudinal change in low frequency pure‐tone average (LFPTA). DOHL was defined as a decrease in LFPTA of > 10 dB compared to previous best postoperative LFPTA. Results Twenty‐two (37%) out of the 60 subjects in the manual cohort and two (7%) out of the 29 subjects in the robotic‐assisted cohort had DOHL over the entire length of available follow‐up ( p = 0.002, Fisher's exact test, two‐tailed). When evaluating DOHL results for subjects who had LFPTA data at 12 months (±4 weeks) post initial activation, 11 (29%) out of the 38 (AB: 15, MED‐EL: 23) subjects in the manual cohort and zero (0%) out of the 18 (AB: 8, MED‐EL: 10) subjects in the robotic‐assisted cohort had DOHL ( p = 0.011, Fisher's exact test, two‐tailed). The number needed to treat was 4. Conclusion Robotic‐assisted EA insertion is associated with a clinically meaningful reduction in rates of DOHL. Preservation of residual acoustic hearing is a critical goal in CI surgery, and robotic‐assisted EA insertion contributes towards achieving this goal. Level of Evidence 3.