Impact of Robotic Cochlear Implantation on Hearing Performance in Noise

Not Applicable

Not yet recruiting

• Conditions: Severe to Profound Hearing Loss
• Interventions: Procedure: Conventional manual surgery; Procedure: Surgery with RobOtol®

• Registration Number: NCT06248398
• Lead Sponsor: Assistance Publique - Hôpitaux de Paris

Brief Summary

The purpose of this study is to compare two methods of cochlear implantation : conventional manual insertion versus robot-assisted in order to verify whether robotic insertion provides better performance in the noisy environment.

To do this, we will compare the two methods of insertion of the electrode holder, on 140 patients candidates for cochlear implantation randomized in two groups (70 conventional surgery versus 70 robot-assisted surgery). All patients will be recruited during 17 months, in our Ear, nose and throat (ENT) Department of the Pitié-Salpêtrière hospital group, the first center for adult patients established in France (on average 180 patients/year).

Patient will be followed for 9 months with clinical evaluation, imaging, audiometric, listening effort and quality of life assessments. These evaluations will be carried out preoperatively and postoperatively at 3 months and 6 months post-activation of the cochlear implant.

Detailed Description

In the case of severe (70 to 90dB loss) and profound (\>90dB loss) hearing loss, when conventional hearing aids no longer provide sufficient benefit, cochlear implantation remains the only possible solution for hearing rehabilitation. In implanted patients, a clear improvement in communication in silence is observed, but almost all patients have difficulty understanding speech in noisy environments. Cochlear implantation involves inserting an electrode holder into the cochlea during a surgical procedure under general anesthesia. The insertion of the electrode holder must be as minimally traumatic as possible in order to preserve the cochlear structures and avoid post-operative fibrosis that could impact the auditory outcomes.

The conventional method of this surgery is the manual insertion of the electrode holder. In recent years, robotic assistance, the RobOtol®, has been developed with the aim of avoiding the jerks of the surgeon's hand and improving the precision of the insertion. RobOtol® has had its CE marking since 2016 and is used in several hospitals in France and abroad.

Study Timeline

• Study First Submitted: 2023-12-08
• Status Verified: 2024-01
• Study Start: 2024-02
• Study First Submitted QC: 2024-02-05
• Last Update Submitted: 2024-02-05
• Study First Posted: 2024-02-08
• Last Update Posted: 2024-02-08
• Primary Completion: 2025-04
• Study Completion: 2025-04

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 140

Inclusion Criteria

• Adult patient ≥ 18 years old
• Patient with an indication for uni- or bilateral, simultaneous or sequential cochlear implantation according to HAS criteria: severe to profound moderate hearing loss with intelligibility ≤ 50% for Fournier's disyllabic words, in free field, at 60 dB with adapted hearing aids
• Patient able to understand the information note and give written consent
• Affiliation to a French social security system

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Exclusion Criteria

• Patient who does not speak French
• Etiologies of deafness known to be of bad prognosis (auditory neuropathy, congenital profound deafness, immediate post-meningitis profound deafness, vestibular schwannoma on the side of the ear to be implanted)
• Impossibility of testing the effect of the cochlear implant alone on hearing results (cochlear implantation in the context of unilateral deafness or fluctuating deafness)
• Cochlear implantation requiring the use of a perimodiolar electrode holder.
• Pregnant and breastfeeding women
• Patients wearing electronic devices, in direct connection with the brain or nervous system
• Patient included in another interventional study (Jardé 1)
• Patient under legal protection (guardianship or curatorship) or deprived of liberty

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Control arm	Conventional manual surgery	Patient having conventional manual cochlear implantation surgery.
Experimental arm	Surgery with RobOtol®	Patient having cochlear implantation surgery with RobOtol®.

Primary Outcome Measures

Name	Time	Method
Auditory performance in noise with the cochlear implant	At 6 months post-implantation	Evolution of the intelligibility score (Variation of the percentage of words understood) for monosyllabic Lafon words presented at 60 dB SPL with a signal-to-noise ratio of 10 dB (SNR10) between the preoperative score and the score at 6 months post-implantation

Secondary Outcome Measures

Name	Time	Method
Hearing performance in noise under ecological conditions after robotic cochlear implantation compared to conventional manual cochlear implantation	At 3 and 6 months post-implantation	Evolution of the intelligibility score (Variation of the percentage of words understood) for Fr-Bio words presented at 60 dB SPL with a signal-to-noise ratio of 10 dB (SNR10) between the preoperative score and the score at 3 months and at 6 months post-implantation. The noise will be an ecological noise (restaurant or street noise) using the Immersion® system.
Hearing performance in silence after robotic cochlear implantation compared to conventional manual cochlear implantation for phonemes	At 3 and 6 months post-implantation	Evolution of the intelligibility score (Variation of the percentage of phonemes understood) for monosyllabic Lafon words presented at 60 dB SPL in quiet between the preoperative score and the score at 3 months and at 6 months post-implantation.
Hearing performance in noise after robotic cochlear implantation compared to conventional manual cochlear implantation for phonemes	At 3 and 6 months post-implantation	Evolution of the intelligibility score (Variation of the percentage of words and phonemes understood) for monosyllabic Lafon words presented at 60 dB SPL with a signal-to-noise ratio of 10 dB (SNR10) between the preoperative score and the score at 3 months and at 6 months post-implantation.
The subjective benefit on quality of life after robotic cochlear implantation compared to conventional manual cochlear implantation	At 3 and 6 months post-implantation	Evolution of the Patient's Related Outcomes Measures using the questionnaire concerning the quality of life with the Cochlear Implant Quality of Life (CIQOL)
The position of the electrode array in the cochlea during manual and robotic insertions	At day one post -implantation	the position of each electrode will be analyzed blindly on the post-operative CT-scan.
The presence of postoperative vertigo in case of robotic cochlear implantation compared to manual implantation	At 7 days, 3 months and 6 months post-implantation	Evaluation of vertigo with the Dizziness Handicap Inventory (DHI) questionnaire
Hearing performance in silence after robotic cochlear implantation compared to conventional manual cochlear implantation for words	At 3 and 6 months post-implantation	Evolution of the intelligibility score (Variation of the percentage of words understood) for monosyllabic Lafon words presented at 60 dB SPL in quiet between the preoperative score and the score at 3 months and at 6 months post-implantation.
The subjective benefit on tinnitus after robotic cochlear implantation compared to conventional manual cochlear implantation	At 3 and 6 months post-implantation	Evolution of the Patient's Related Outcomes Measures using questionnaire concerning the tinnitus with the Tinnitus Handicap Inventory (THI)
The impact of a translocation on auditory performance in silence and in noise	At 3 and 6 months post-implantation	Auditory scores measured at 3 and 6 months after implantation will be correlated to the presence of a translocation of the electrode array assessed on the post-operative CT scan.
The effort of listening in silence and in noise after manual and robotic insertions assessed with the Speech, Spatial and Qualities of Hearing Scale (SSQ)	At 3 and 6 months post-implantation	The effort of listening will be analyzed with SSQ scale
The effort of listening in silence and in noise after manual and robotic insertions assessed with a visual analog scale	At 3 and 6 months post-implantation	The effort of listening will be analyzed after each audiologic test with a visual analog scale, using which the patient will rate from 0 to 10 the effort made to understand the words presented (Bräcker et al., 2019)
The preservation of residual hearing after cochlear implantation in cases with residual hearing before surgery	At 30 days, 3 months and 6 months post-implantation	Evolution of auditory thresholds measured with tonal audiometry between preoperative and postoperative measurements on the operated ear.

Trial Locations

Locations (1)

Groupe Hospitalier Pitié-Salpêtrière; 🇫🇷 Paris, France