Small extracellular vesicles (sEVs), including exosomes, are enriched in multiomics information mirroring their parental cells. They have been investigated in health and disease and utilised in several applications from drug discovery to diagnostics. In disease diagnostics, sEVs can be sampled via a blood draw, enabling the convenient liquid biopsy of the tissue they originate from. However, few applications with sEVs have been translated into clinical practice. We developed a Nanoparticle EXOsome Sensing (NEXOS) technology, for the ultrasensitive and multi-dimensional detection of sEVs. NEXOS comprises two methods: a novel nanoelectronics method, E-NEXOS, and a high-throughput optical detection method, O-NEXOS. Both methods share the same steps for the immunocapture and antibody-labelling of sEVs and can be combined to derive differentiated detection parameters. As a proof of concept, we show the analytical detection and sensitivity of these methods in detecting pre-prepared cancer cell-derived CD9+CD81+ and CD9+HER2+ sEVs. Both sEV populations were diluted in PBS and spiked in processed plasma. We also provide a novel approach for the determination of target sEVs (TEVs), target epitopes in sEVs (TEPs), and epitopes per target sEV, as yet unseen from current and emerging technologies. Further, we demonstrate the higher sensitivity of O-NEXOS compared to the gold standard techniques, as well as demonstrating that E-NEXOS possesses commensurate sensitivity whilst only being powered by 36 nanogap-based sensors per nanochip. Finally, this manuscript lays the groundwork for a scalable electronics miniaturization of E-NEXOS nanochip with millions of nanogap-based sensors for the translation of NEXOS into standard clinical practice.