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BackTable / ENT / Article
The iotaMotion Story: Improving Cochlear Implant Surgery
Julia Casazza • Mar 5, 2024 • 36 hits
Cochlear implantation (CI) can restore hearing in patients who do not benefit from hearing aids. Despite clear clinical benefits, CI technology is far from perfect; often, trauma during surgery can damage cochlear structures, causing patients to lose any residual hearing they may have. With a desire to solve this issue, Dr. Marlan Hansen and Dr. Chris Kaufman, otolaryngologists at the University of Iowa, developed iotaMotion’s iotaSOFT robot: a first-of-its-kind robotic CI insertion system. Dr. Hansen and Dr. Kaufman recently sat down with BackTable to share their story.
This article features excerpts from the BackTable ENT Podcast. We’ve provided the highlight reel in this article, and you can listen to the full podcast below.
The BackTable ENT Brief
• Hearing preservation approaches to cochlear implant (CI) surgery aim to minimize cochlear trauma during the operation. Hearing preservation approaches allow patients to benefit from bimodal hearing after surgery which involves the simultaneous use of a hearing aid and cochlear implant.
• The iotaMotion iotaSOFT robot improves control over CI electrode insertion. Relative to a human hand, insertions are smoother and steadier, which translates to less cochlear trauma during surgery.
• Fewer than 5% of the patients who could benefit from CIs have them. One of the top reasons cited for not pursuing surgery is fear of losing existing hearing in lower frequencies.
• Surgeon entrepreneurs face unique challenges due to the rigors of their professional lives and the need to avoid conflicts of interest in bringing new technology to market.
Table of Contents
(1) iotaMotion: A Technology-Based Solution to Hearing Preservation During Cochlear Implantation
(2) Increasing CI Uptake Through Technological Innovation
(3) From the OR to the Company Office: Commercializing Intellectual Property
iotaMotion: A Technology-Based Solution to Hearing Preservation During Cochlear Implantation
“Hearing preservation” approaches to cochlear implant surgery minimize surgical trauma to preserve existing hearing. Interested in expanding the surgical toolkit for hearing preservation strategies, Dr. Hansen pondered how he could better control electrode insertion during surgery. Even among patients with no measurable hearing on an audiogram, surgery can harm the remaining cochlear function. Working alongside fellow ENT Dr. Kaufman, he set out to develop a robot capable of CI insertion, in order to produce consistent results and preserve residual cochlear function. Thus, iotaMotion was born.
[Dr. Marlan Hansen]
The issue is you're putting in a pretty big piece of equipment into a very small, delicate space. It really has become quite evident that any trauma you cause has deleterious effects. It became even more heightened in the era now, for the past 20 years at Iowa, we have been working on this idea that it's better to preserve whatever residual hearing you have in the ear. It became almost imperative to come up with ways to be more smooth, more steady, less traumatic, more precise, and also to make that so that everybody could do it.
Because what I could see is that there were a handful of centers that would really try and do any structure or function preservation by putting in the cochlear implant. Most places wasn't even on their radar screen to do that. You had to have something that you could have every surgeon use and use at a high level. Then some of it actually has to do with what happens if the patient loses hearing or has a change in their hearing status after you put the implant in? Can you adapt it so that you can personalize where the electrode is to optimize it for that individual patient's hearing?
I think in a big scheme, to make it a short answer, one, better structure, better function, preservation, more consistent results, and more consistent results across a wide experience range of surgeons.
…
[Dr. Marlan Hansen]
We're talking about all patients who receive a cochlear implant because even those where there isn't measurable hearing, there's still structure and function in that cochlear that's important to preserve. There's lots of data now that show that if you damage those delicate little structures in the inner ear, you're probably not only causing scarring and fibrosis, but the nerve itself that you're trying to stimulate is injured and just the overall benefit from the electrode is diminished.
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Increasing CI Uptake Through Technological Innovation
iotaMotion aims to alleviate the burden of severe hearing loss by increasing the attractiveness of CIs as a therapeutic option. Fewer than 5% of patients who could benefit from CIs have them. Thus, even small increases in uptake could have great public health and commercial benefits. Among patients considering CIs, one of the biggest reasons cited for not pursuing surgery is the risk of losing residual hearing. iotaMotion addresses this concern by reducing cochlear injury during implant insertion, thus increasing the odds of successful hearing preservation.
[Dr. Chris Kaufmann]
The goal really, I think for me when it started was just the low penetration rate of cochlear implant themselves. You probably know it. Less than 5% of people who are eligible actually get them, which just blew my mind as a resident and new to the field of ENT. I think it's just a matter of asking questions of why is that? As I dug deeper and deeper and deeper and looked at all the different barriers and all the different pain points. One was fear of hearing loss which we were addressing but really it was the standardization of the insertion process itself.
Like you said, it's a very complex, very-- We probably picked the most challenging procedure to apply robotics to, but there was your micron-level insertion. The structures are sub-millimeter. It's beyond the abilities of what a surgeon, the human can do. That's where I put the two together and said this is where robotics really has a true clinical benefit in robotics with the true need here, that surgeons can't go submicron speeds. They can't go submicron precision, but let's make something that fits in the current approach, doesn't add cost, doesn't add significant time.
It's compatible with multiple different electrode arrays across the different implant manufacturers so that we provide access to the most number of patients and potentially improve that penetration rate so we can treat a big public health problem of hearing loss with cochlear implants.
From the OR to the Company Office: Commercializing Intellectual Property
Surgeon entrepreneurs face a distinct challenge: how can one simultaneously excel at clinical and business operations? The experience of iotaMotion’s founders suggests solutions to this problem. Since Dr. Hansen and Dr. Kaufman developed the technology behind their company at the University of Iowa, they negotiated with the University of Iowa Foundation to license their intellectual property. As a result, the University of Iowa owns a portion of the company and has a say in its operations. When it comes to daily operations, Dr. Hansen advises carving out specific time in one’s schedule to manage company or clinical duties. Where possible, maintaining separate workspaces helps preserve the firewall between clinical and business judgment.
[Dr. Marlan Hansen]
The initial IP that went in on this was filed by the university as is university policy. We filed it through the university, and then they strongly recommended and we agreed that that was a good strategy is to form a small startup company and license that IP from them. In fact, that's one of the main reasons to do it, is the university's not going to commercialize a robotic device. If they want to see the IP move forward, if we want to see the IP move forward, it really does require commercialization-type effort.
We negotiated the licensing agreement for the IP through the university's foundation. That's basically how it happened, is they filed some of the initial IP. We negotiated with them what the terms of the licensing agreement for that IP would be. They still have a little bit of say in how the company goes and a little bit of stuff. They have a percentage of the company as a consequence of that.
[Dr. Eric Gantwerker]
I'm sure. How about as the company has grown and your role within the company versus as a clinician? I myself, am a part-time clinician. I'm 60% clinical and 40% working for a technology company, and that's a constant battle of trying to divide myself 30 times into multiple areas. How have you managed working with a company as well as practicing and active clinician?
[Dr. Marlan Hansen]
The university has really strong guidance around this. We have a conflict of interest policies and things that we do, and we truly try to make sure it's clean between-- The university is very supportive. Our initial office for the little small startup company was actually in university space for these little incubator-type scenarios. We started there and we just keep it separate. I make sure that my time is separate. We try and make sure that-- in fact, all the way through we have made sure that university work is done with university things and resources and time and iotaMotion work and resources are used to develop iotaMotion things.
Podcast Contributors
Dr. Marlan Hansen
Dr. Marlan Hanen is a clinician-scientist trained in neurotology/skull base surgery and cell and molecular biology. He is a Department Chair of Otolaryngology and a Professor of Neurosurgery and Molecular Physiology & Biophysics at the University of Iowa.
Dr. Christopher Kaufmann
Dr. Christopher Kaufmann was an Otolaryngology Head & Neck Surgery resident and NIH research fellow at the University of Iowa prior to leaving surgical training to join iotaMotion full time to lead product portfolio strategy and technology development.
Dr. Eric Gantwerker
Eric Gantwerker is a Pediatric Otolaryngologist at Cohen Children's Hospital at Northwell Health/Hofstra, Associate Professor of Otolaryngology at Zucker School of Medicine at Hofstra/Northwell, and Vice President, Medical Director at Level Ex.
Cite This Podcast
BackTable, LLC (Producer). (2023, January 10). Ep. 84 – Your Implant Robot: The Future of Robotic Assisted Surgery [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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