Robotic Insertion of Cochlear Implants and Vestibular Function in Children

To analyze the impact of robotic-assisted electrode array insertion on vestibular function after cochlear implantation (CI) in children.

This single-center retrospective study included 80 ears from pediatric patients who underwent CI: 42 in the robotic-assisted group (2021-2024) and 38 in the manual group (2015-2020). All surgeries were performed by the same surgeon. Vestibular function was assessed preoperatively and postoperatively using objective tests, including cervical vestibular evoked myogenic potentials (cVEMP) and video head impulse test (vHIT). Subpopulations were defined based on the availability of complete vestibular data: 68 ears were included in the cVEMP analysis and 74 in the vHIT analysis. Statistical analysis was performed using the Fisher exact test and the Wilcoxon rank-sum test.

Overall mean age at CI was 56±51 months and post-CI vestibular assessment was performed at a mean delay of 18±13 months. In the robotic group, 100% of the sample (n=36) preserved saccular function (cVEMP), compared with 85% (n=27/32) in the manual group (P=0.02). vHIT analysis revealed no statistically significant differences between groups in canal function preservation; 92% (n=36/39) of the robotic group and 100% (n=35/35) of the manual group maintained normal canal responses postoperatively. Per-canal delta-gain analysis for vHIT showed no significant changes for any canal (anterior: P=0.75; lateral: P=0.06; posterior: P=0.92).

Robotic-assisted electrode array insertion had significantly higher post-CI cVEMP preservation compared with manual techniques after pediatric cochlear implantation. This may suggest that robotic slow electrode array insertion is less traumatic for the vestibule and helps preserve saccular function.