Hearing Preservation in Cochlear Implantation: A Case Report on Integrating Robotic-assisted Electrode Insertion with Early Activation

This case report presents an 11-year-old girl with prelingual bilateral sensorineural hearing loss who underwent cochlear implant surgery using a modified method combining robotic-assisted electrode insertion with early activation to preserve residual hearing and structure. The robotic system enabled controlled, ultra-slow electrode insertion at 0.1 mm/s, minimizing intracochlear trauma and ensuring precise electrode positioning within the scala tympani. Intraoperative electrocochleography monitoring revealed stable cochlear function throughout the procedure. Early activation of the audio processor was performed on the first postoperative day, demonstrating stable electrode impedance and resulting in improved auditory performance at 1-month follow-up. Hearing preservation was quantified at 72.5%, classified as partial preservation, indicating significant retention of residual acoustic hearing. This report highlights the clinical feasibility and safety of combining robotic-assisted insertion, hearing preservation techniques, and early activation to optimize cochlear implantation outcomes. Further studies with larger cohorts and long-term follow-up are warranted to validate these promising results.