Fluidic soft robot for needle guidance and motion compensation for intratympanic steroid injections

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1. The World Health organization estimates that hearing loss affects 500 million people worldwide. Delivery of drugs to the inner ear via the surgical approach offers the optimum delivery of drugs to the cochlea. However, it poses risks, such as further reduction in hearing due to the highly invasiveness. Therefore, in most cases administration of drugs through diffusion to the inner ear from the middle ear is the preferred option, which is done in the intratympanic injection of steroids, where flushing of steroids to the middle ear through the ear drum is done, with uncertainty of the treatment's efficiency. This is currently performed by trained ear, nose, and throat (ENT) surgeons as the procedure could induce pain to the patient and pose the risk of inducing permanent hearing loss, vertigo, or tinnitus, if the inner or middle ear is damaged. In recent years, the emergence of technologies for diagnosis and treatment through natural orifices has been exponentially growing. However, the morphology of the ear orifice presents a major challenge for its adoption in this field due to its small dimension, fragility, and highly non-uniform shape. To provide a first steppingstone towards inner ear drug delivery, a fluidic soft robot for needle guidance and motion compensation has been introduced for intratympanic steroid injections. The design constitutes of a camera and six integrated fluidic actuators that is capable in stabilising, translating and rotating of a given needle within a lumen. This system indeed could provide needle guidance towards desired target while reducing needle motion. However, whilst it shows the capability to aid in drug delivery into the middle ear cavity, the current design inherits several limitations which prevent it from targeted delivery directly to the cochlea. 2. Further research needs to be undertaken to better understand state-of-the-art drug delivery mechanisms, develop means for efficient monitoring of the delivery and integrate this with bespoke soft robotic system. 3. As part of this project, I will develop new, realistic and sensorized phantoms which can provide quantitative assessment of today's manual delivery and determine the efficacy of local drug delivery to the inner ear. As current state-of-the-art endoscope systems are incapable of visualizing the middle ear cavity through the ear drum, which is crucial in determining the efficacy of drug delivery to the inner ear, I will research new means of imaging the ear anatomy, for example by using endoscopic vision paired with near-infrared or narrow-band imaging. The gained understanding of the procedure and the derived imaging methodologies will be incorporated in a soft robotic platform inspired by to aid in delivery and monitoring the efficacy of the delivery whilst ensuring patient safety and comfort and greatly de-risking the procedure. 4. This interdisciplinary research track combines aspects from biomedical engineering, medical imaging and image computing and soft robotics, which could pave the way for democratizing drug delivery to the inner ear. Furthering the understanding of current clinical practices could aid in developing new delivery protocols and provide training for ENT surgeons or other clinical staff which could lead to the more widespread adoption of treatment for inner ear pathologies. Novel imaging capabilities for visualizing the middle ear cavity to assess drug delivery to the inner ear are of paramount importance in drug discovery and assessment for treating inner ear pathologies. Finally, the integration with a soft robotic system could greatly de-risk and de-skill such drug delivery protocols with the potential to enable other ENT procedures. These are all alligned with EPSRC' strategy and research area on transforming health and healthcare, improving quality of life through innovative technological solutions.5. WEISS and UCL EAR institute.