Abstract
Intratympanic steroid injections are commonly employed in treating ear diseases, such as sudden sensorineural hearing loss or Meniere's disease through drug delivery via the middle ear. Whilst being an effective treatment, the procedure has to be performed by a trained surgeon to avoid delicate regions in the patient's anatomy and is considered painful despite the use of topical anaesthesia. In this letter we introduce a fluid-driven soft robotic system which aims at increasing patient-comfort during the injection by counteracting unwanted needle motion, reducing the cognitive load of the clinician by autonomously identifying sensitive regions in the ear and de-risking the procedure by steering the needle towards the desired injection site. A design comprising of six embedded fluidic actuators is presented, which allow for translation and rotation of the needle as well as adaptive stiffening in the coupling between needle and ear canal. The system's steering-capabilities are investigated and the differential kinematics derived to demonstrate trajectory tracking in Cartesian space. A vision system is developed which enables tracking of anatomical landmarks on the tympanic membrane and thus locating the desired needle insertion site. The integrated system shows the ability to provide a safe guide for the inserted needle towards a desired target direction while significantly reducing needle motion. The proposed tracking algorithm is able to identify the desired needle insertion site and could be employed to avoid delicate anatomical regions.
Highlights
T HE World Health organisation estimates that hearing loss affects 500 million people worldwide, with far reaching social, educational and economic consequences where sensorineural hearing loss makes up around 90% of this burden [1]
In this work we propose a soft robotic system that assists in intratympanic needle guidance by beirngaacbtilveetloy steer inside a lumen to guide a needle towards a r desired point of injection on the tympanic membrane; compensate hand motion of the operating surgeon by providing actively controllable mechanical coupling between r needle and the patient’s ear canal; autonomously identify a desired site for intratympanic injection according to anatomical priors
As part of intratympanic steroid injections the patient is placed in a supine position and topical anaesthetic is applied to the tympanic membrane under otoscope guidance
Summary
T HE World Health organisation estimates that hearing loss affects 500 million people worldwide, with far reaching social, educational and economic consequences where sensorineural hearing loss makes up around 90% of this burden [1]. Intratympanic injection of steroids is a first-line treatment option for both sudden sensorineural hearing loss and Meniere’s disease [2], [3] This delivery method is the focus for development of novel therapeutics. Drugs delivered in this way can bypass the blood-perilymph barrier and deliver higher local concentration for drugs that have narrow therapeutic window or serious side effects. Interest in this field has been increasing rapidly, with an ever-increasing number of therapeutic development programmes around the world progressing along the translational pathway. Restorative and regenerative therapeutics are underway with several being in advanced stages of clinical trials [4]
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