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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 AIM TM 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.

The goal of this study is to assess speech comprehension and listening effort by means of pupillometry, in patients with bone-anchored hearing system (BAHS). The study was performed prospectively in a group of 21 hearing-impaired adults, unilaterally implanted with BAHS Ponto. Listening effort was compared in patients wearing two sound processors (Oticon Medical AB, Askim, Sweden): Ponto 3 SuperPower (P3SP) and Ponto Pro (PP). Every patient was invited to two visits, separated by a 3-month break. The first session was to establish the noise level needed to obtain 95% correct sentence recall in the hearing in noise test (HINT), when speech is presented at 70 dB SPL. During the second session, pupillometry, with the use of the above-mentioned conditions, was performed. The mean HINT scores obtained during the second visit were 96.3% for PP and 97.7% for P3SP ( p = 0.9863). In pupillometry, no significant differences were found for average PPD (peak pupil dilation; p = 0.3247), average peak pupil dilation timing ( p = 0.527) and for pupil dilation growth curves with both processors. The findings of this study suggest that BAHS users allocate similar listening effort with PP and P3SP when processing speech-in-noise at a sound pressure level not saturating Ponto Pro and at a fixed performance level of 95%. This finding applies to the patients who meet the qualification criteria for bone conduction devices and have BC in situ threshold average below 45 dB HL.

Background: The aim of the study was to describe our initial experience with the high-definition three-dimensional (3D) exoscope for middle ear surgery versus the operating microscope., Methods: The study included 60 randomly chosen patients diagnosed with otosclerosis ( n = 30) or chronic otitis media ( n = 30) with a clinical indication for surgery. The primary measurement was the subjective estimation of quality of the visibility of the operating field provided by the 3D exoscope-VITOM-3D (Karl Storz, Tuttlingen, Germany) in comparison to the operating microscope., Results: All procedures, except for two (3.3%) converted to the microscope, were successfully completed using a 3D exoscope. In both stapedotomy and tympanoplasty, the exoscope was superior to the microscope during more superficial portions of the procedures. By contrast, in deeper areas of the middle ear, the exoscope provided significantly worse visibility, but usually not suboptimal. Both intraoperative bleeding and the narrow surgical field substantially reduced the visibility with the 3D exoscope in comparison to the microscope., Conclusions: Overall, our study shows that the 3D exoscope offers excellent, highly magnified, and well-illuminated high-definition images of the surgical field. However, our experience revealed several important limitations of this system, including decreased depth perception in deep areas of the tympanic cavity and reduced visibility in a difficult surgical field, with subsequent need to switch to an operating microscope in select cases.

Background: The aim of this paper is to analyze the results of virtual reality (VR) antromastoidectomy simulation training and the transferability of the obtained skills to real temporal bone surgery., Methods: The study was conducted prospectively on a group of 10 physicians, and was composed of five VR simulation training sessions followed by live temporal bone surgery. The quality of performance was evaluated with a Task-Based Checklist (TBC) prepared by John Hopkins Hospital. Additionally, during every VR session, the number and type of mistakes (complications) were noted., Results: The quality of performance measured by the TBC increased significantly during consecutive VR sessions. The mean scores for the first and fifth sessions were 1.84 and 4.27, respectively ( p < 0.001). Furthermore, the number of mistakes in consecutive VR sessions was gradually reduced from 11 to 0. During supervised surgery, all the participants were able to perform at least part of an antromastoidectomy, and the mean TBC score was 3.57. There was a significant strong positive correlation between the individual results of the fifth VR session and the individual results of supervised surgery in the operating room (r p = 0.89, p = 0.001)., Conclusions: Virtual reality for temporal bone training makes it possible to acquire surgical skills in a safe environment before performing supervised surgery. Furthermore, the individual final score of virtual antromastoidectomy training allows a prediction of the quality of performance in real surgery.