The Robot that Restores Hearing: Emory Healthcare Performs First Robotic-Assisted Cochlear Implant in Georgia

Hearing loss can significantly impact a person's life, making it difficult to connect with loved ones and engage with the world. While hearing aids offer valuable assistance for many, some individuals experience such profound hearing loss that traditional amplification is no longer effective. For these patients, a cochlear implant can be a life-changing solution.

The devices—which are surgically implanted and rest over the ear and on the head—have been around for decades. But Emory Healthcare is at the forefront of improving cochlear implant procedures using new technology. In December 2024 we performed the first robotic-assisted cochlear implant surgery in the state of Georgia.

Rustin Kashani, MD, otolaryngologist at Emory Healthcare, advocated to bring this technology to Emory’s operating room. “Emory is receptive to new ideas and eager to incorporate innovations into patient care. When I suggested we bring in this technology, there was no hesitation,” he says. “From my department making it happen to the excitement of the clinical team in the operating room, everyone was in full support.”

Since then, Emory Healthcare’s Department of Otolaryngology has performed several robotic-assisted cochlear implants, and is collecting and contributing to data to both substantiate the benefits and further improve upon this technology.

“Patients are becoming increasingly savvy when it comes to their health, and many seek care at institutions that are on the cutting edge,” says Dr. Kashani. “Emory knows that and makes it a priority—it’s part of our reputation.” 

"The vast majority of patients with sensory hearing loss will benefit from hearing aids, where amplification will help deliver sound to the inner ear,” says Dr. Kashani. “However, some individuals will experience little to no improvement with hearing aids because the ability of the inner ear to process sound is compromised. This is a problem that can be uniquely addressed by cochlear implantation, which has the ability to restore hearing."

A cochlear implant is a small electronic device, with an internal element surgically inserted into the skull behind the ear and external components that hook over the ear and rest on the head.

Hearing aids make sound louder, turning up the volume of what someone is already hearing. For those experiencing significant hearing loss, the goal of a cochlear implant is to restore hearing by bypassing the body’s natural hearing process entirely.

"Normally, sound vibrations are picked up by the ear and travel through the hearing bones to the inner ear,” says Dr. Kashani. Those vibrations stimulate hair cells in the cochlea, a small fluid-filled and spiral-shaped organ within the inner ear. The cochlea helps convert sound vibrations into electric signals that travel along the hearing nerve to the brain, helping us recognize sounds. “A cochlear implant skips that entire process. It uses a microphone to pick up sound, converts it to a digital signal and sends it as tiny electrical impulses directly along the hearing nerve."

Patients may need a cochlear implant for various reasons, including:

• Severe to profound hearing loss, when it’s a struggle to hear below a certain decibel level and hearing aids no longer provide significant benefit
• Genetic factors
• History of infections or tumors affecting the ear, such as acoustic neuromas, that have damaged the inner ear 

Building on Emory Healthcare's expertise in robotic-assisted surgery across multiple disciplines, the Department of Otolaryngology prioritized the adoption of this technology. A key driver was its potential to significantly enhance the precision and safety of intricate procedures such as cochlear implants.

When working with an organ as delicate as the cochlea—which is only about 10 millimeters wide—precision matters.

"The amount of force that is potentially damaging to the cochlea is below what humans can perceive,” says Dr. Kashani. When the electrode is inserted by hand, the slightest movement can have a big impact. “Even the most skilled surgeons can inadvertently cause trauma due to subtle hand tremors or variations in speed and pressure."

It is important to minimize damage to the cochlea because many patients undergoing implantation still have a little bit of function that is still helpful. This native hearing, or “residual acoustic hearing,” translates into better outcomes for patients, from their ability to understand where sounds are coming from to their appreciation of music. “Using robotic technology allows us to preserve as much residual hearing as possible during implantation, beyond the abilities of a human surgeon,” says Dr. Kashani.

Robotic assistance offers several key advantages in cochlear implant surgery:

• Enhanced precision: The robot allows for controlled and consistent electrode insertion, minimizing the risk of trauma to the delicate structures within the cochlea.
  
• Consistent speed: Unlike manual insertion, the robot can insert the electrode at a very slow and uniform speed, as low as 0.1 millimeters per second, which studies suggest reduces damage.
  
• Reduced force: The robotic arm eliminates the subtle tremors of the human hand, leading to gentler electrode placement and minimizing pressure spikes.
  
• Greater control: Surgeons have increased control over the insertion process, with the ability to pause, adjust speed and even retract the electrode if needed.

Utilizing a robot in cochlear implant surgery helps to minimize the variability of human movement, ultimately reducing the risk of damage to the delicate cochlea. “We can control the speed so that it is constant and super slow," says Dr. Kashani.

This advancement is relatively new to the field, emerging in the last few years. “Now, Emory Healthcare is working to collect and contribute data to compare outcomes between manual and robotic insertions to prove that robotic insertion helps preserve function and leads to better outcomes,” says Dr. Kashani.

Cochlear implant procedures fall under otolaryngology, commonly known as ENT (ear, nose and throat) care. More specifically, they’re usually overseen by a neurotology specialist, a specialized area within otolaryngology that deals with the inner ear, auditory nerve and base of the skull. As part of our Department of Otolaryngology, Dr. Kashani and team regularly see patients experiencing hearing and balance issues.

A standard cochlear implant surgery is typically an outpatient procedure lasting about two hours, performed under general anesthesia. "We make an incision behind the ear and expose the bone underneath, called the mastoid bone," describes Dr. Kashani. "We then drill through this bone to access the cochlea, which is located in the space behind the eardrum."

Through a tiny opening, the surgeon carefully inserts the electrode into the cochlea. The device itself is placed under the skin behind the ear.

After the procedure, cochlear implant recipients must be patient—their hearing isn’t instantly fixed. Patients usually wait about three to four weeks for the area to heal before the implant is activated. From there, they will go through a series of visits with their care team to assess performance and adjust to their implant.

Adults adapting to cochlear implants are not like viral videos of children getting hearing aids and hearing for the first time, warns Dr. Kashani. “You’ve known what hearing was like your whole life—and this new way of hearing has a learning curve,” he says. “The initial sound can have a digital quality, and it takes time for the brain to adapt. However, within a few months, or even weeks, most patients become very comfortable with their implant.”

Emory Healthcare's adoption of robotic-assisted cochlear implant surgery underscores our commitment to providing pioneering care and improving the lives of our patients. This innovative approach offers a glimpse into the advancement of health care, where technology plays an increasingly vital role in enhancing precision, safety and, ultimately, patient outcomes.

Learn more about otolaryngology and ENT care at Emory and call 404-778-3381 to make an appointment.