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Remote intraoperative support during cochlear implantation
Levin S. , Kuzovkov V. , Sugarova S. , Pudov V. , Levina E. , Shaporova A.
Saint Petersburg ENT and Speech Research Institute, St.Petersburg, Russian Federation
Introduction: The Russian state cochlear implant (CI) program has grown from less than 100 surgeries in the
year 2000 to more than 1000 surgeries in the year 2013. With the increasing number of patients, specialists
need new methods of pre-operative examination, intra- and post-operative fitting, and CI testing. Usually
intraoperative testing is performed by the audiologist in the operating theater. In theater testing leads to
significant time loss. The audiologist cannot carry out other responsibilities while in theater. The primary
objective of this study was to compare the time needed by an audiologist to perform in-theater intra-operative
testing compared to the time needed to perform remote intra-operative testing.
Methods: 50 subjects were enrolled in this prospective, open label, 2-arm study. Remote testing was developed
and performed at our clinic. The operation room was equipped with a videoconference connection to connect intheater medical staff online with external staff. During the test session an audiologist had visual access to the
screen of the computer installed in the operation theater, the view from the microscope, and full control over the
CI testing procedure. Routine intra-operative tests: Impedance Field Telemetry (IFT), Auditory Nerve Response
Telemetry (ART), and the Evoked Stapedius Reflex Test (eSRT); were performed at surgery. The time taken to
perform the intra-operative tests was recorded. A questionnaire was administered to the remote expert and the
local host, and a different questionnaire was administered to the local expert after the test procedure.
Results: Using standard in-theater testing it took more time overall to perform intra-operative testing (Table 1). It
took less time to get to the operating theater and perform IFT with remote testing. eSRT and ART took longer
when performed remotely. According to the questionnaire administered the extra time taken by the standard
procedure was caused by connection interruptions. The overall time spent per patient was longer using standard
intra-operative testing because of the time taken to get between rooms.
Table 1.
Time to get to
Total (hh:mm:ss)
Standard testing
755 (00:12:35).
Remote testing
506 (00:08:26)
[Average time per patient (n=50) (seconds)]
Conclusion: Remote intra-operative testing session takes less time than a local intra- operative measurement