Minimally invasive, robot assisted cochlear implantation

Cochlear implants allow the restoration of hearing function in patients with severe to profound sensorineural hearing loss through the direct stimulation of the auditory nerve by an electrode array inserted into the inner ear. Typically, access to the cochlea is gained through the performance of a mastoidectomy, which involves the removal of a large portion of the mastoid bone, allowing the surgeon to visualize and protect vital structures within the mastoid during milling. Once access to the cochlea has been achieved, the surgeon may insert the electrode through the round window, or alternatively through an artificial access called a cochleostomy. Recent advances in image guided robotics have allowed dramatic changes in the performance of both stages of this procedure. Recent work at the University of Bern has seen the realization of a robotic system designed specifically for minimally invasive cochlear implantation. The system enables significantly reduced invasiveness by removing the need for a mastoidectomy, replacing this with a direct tunnel approach known as direct cochlear access (DCA). Meanwhile, work at Brunel University has focused on improving the safety and accuracy of inner ear access through the cochleostomy. This work describes both of these systems individually and discusses the implications and opportunities associated with the combination of these devices.