The vestibular implant: A probe in orbit around the human balance system

Fornos, Angelica Pérez; Cavuscens, Samuel; Ranieri, Maurizio; Berg, Raymond van de; Stokroos, Robert J.; Kingma, Herman; Guyot, Jean-Philippe; Guinand, Nils

doi:10.3233/ves-170604

Cited by 41 publications

(29 citation statements)

References 66 publications

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“…While beyond the scope of the current paper, recent studies have suggested vestibular implantation as a promising procedure to restore vestibular function in patients with disabling bilateral vestibular deficits . Vestibular implants consist of an array of electrodes that is introduced by an extralabyrinthine or intralabyrinthine surgical approach to electrically stimulating the ampullary nerves .…”

Section: Discussionmentioning

confidence: 99%

Histopathological changes to the peripheral vestibular system following meningitic labyrinthitis

Pauna

Knoll

Lubner

et al. 2020

Laryngoscope Investig Oto

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Objective: While cochlear ossification is a common sequela of meningitic labyrinthitis, less is known about the effects of meningitis on the peripheral vestibular end organs. Herein, we investigate histopathologic changes in the peripheral vestibular system and cochlea in patients with a history of meningitic labyrinthitis. Methods: Temporal bone (TB) specimens from patients with a history of meningitis were evaluated and compared to age-matched controls. Specimens were evaluated by light microscopy and assessed for qualitative changes, including the presence of vestibular and/or cochlear endolymphatic hydrops, presence and location of inflammatory cells, new bone formation, and labyrinthitis ossificans; and quantitative changes, including Scarpa's ganglion neuron (ScGN) and spiral ganglion neuron (SGN) counts.Results: Fifteen TBs from 10 individuals met inclusion and exclusion criteria. Presence of inflammatory cells and fibrous tissue was found in 5 TBs. Of these, evidence of labyrinthitis ossificans was found in 2 TBs. In the peripheral vestibular system, mild to severe degeneration of the vestibular membranous labyrinth was identified in 60% of cases (n = 9 TBs). There was a 21.2% decrease (range, 3%-64%) in the mean total count of ScGN in patients with meningitis, compared to age-matched controls. In the cochlea, there was a 45% decrease (range, 25.3%-80.9%) in the mean total count of SGN compared to age-matched controls (n = 14 TBs). Conclusions: Otopathologic analysis of TBs from patients with a history of meningitic labyrinthitis demonstrated distinct peripheral vestibular changes. Future research may help to delineate potential mechanisms for the observed otopathologic changes following meningitis. Level of Evidence: N/A K E Y W O R D S meningitis, otopathology, Scarpa ganglion neurons, spiral ganglion neurons, temporal bone, vestibular changes

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Section: Discussionmentioning

confidence: 99%

Histopathological changes to the peripheral vestibular system following meningitic labyrinthitis

Pauna

Knoll

Lubner

et al. 2020

Laryngoscope Investig Oto

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“…Additionally, Perez Fornos et al [29,30] suggest that VOR restoration can improve the stabilization abilities with a VI. Vestibular implants are devices designed to rehabilitate patients suffering from a dysfunction of VOR that impairs gaze stabilization and results in an abnormal loss of visual acuity in dynamic situations.…”

Section: Discussionmentioning

confidence: 99%

Vestibular Response to Electrical Stimulation of the Otolith Organs. Implications in the Development of A Vestibular Implant for the Improvement of the Sensation of Gravitoinertial Accelerations

Miguel¹,

González²,

Macías³

2017

Int Adv Otol

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OBJECTIVE:Electrical stimulation of the utricular and saccular portions of the vestibular nerve improves stability in patients suffering from vestibular dysfunction. The main objective of this study was to evaluate a new technique, vestibular response telemetry (VRT), for measuring the electrically evoked vestibular compound action potential (saccular and utricular) after stimulating the otolith organ (saccular and utricular) in adults. This study used evidence that the otolith organ can be electrically stimulated in order to develop a new vestibular implant design to improve the sensation of gravitoinertial acceleration. MATERIALS and METHODS:Four adult patients were evaluated by using a variety of measurement procedures with novel VRT software. VRT values were obtained by stimulating with three full-band Nucleus CI24RE (ST) electrodes. Specific stimuli were used. Simultaneously, electrical ocular vestibular evoked myogenic potentials (eoVEMPs) were recorded in the contralateral side. RESULTS:Electrically evoked compound action potentials were obtained in 10 of the 12 electrodes tested, and eoVEMPs were recorded when VRT was present. In addition to the validation of this technique, a set of default clinical test parameters was established. The VRT response morphology consisted of a biphasic waveform with an initial negative peak (N1) followed by a positive peak (P1), and latencies were typically 400 μs for N1 and 800 μs for P1. The consequences for the development of a vestibular implant for the improvement of gravitoinertial acceleration sensation are also presented. CONCLUSION:The VRT measurement technique has been shown to be a useful tool to record neural response on the otolith organ, and thus it is a convenient tool to evaluate whether the implanted electrodes provide a neural response or not. This can be used for the early development of vestibular implants to improve gravitoinertial acceleration sensation.

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“…Stimulation of SCC afferents has been shown to restore VOR by inducing canal-specific eye movements, with modulation of amplitude or frequency causing a proportional effect on the velocity and direction of the movement [21]. In order to restore bi-directional eye movements using unilateral stimulation, an artificial 'spontaneous' impulse firing rate (as close as possible to the 90 spikes per second firing rate produced in a healthy vestibular system) must be induced in each vestibular nerve [22]. This can then be either up-or downregulated, in response to specific movements to elicit eye movements in different directions [21].…”

Section: Vestibular Implantsmentioning

confidence: 99%

Finding a Balance: A Systematic Review of the Biomechanical Effects of Vestibular Prostheses on Stability in Humans

Haxby

Akrami

Zamani

2020

JFMK

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The vestibular system is located in the inner ear and is responsible for maintaining balance in humans. Bilateral vestibular dysfunction (BVD) is a disorder that adversely affects vestibular function. This results in symptoms such as postural imbalance and vertigo, increasing the incidence of falls and worsening quality of life. Current therapeutic options are often ineffective, with a focus on symptom management. Artificial stimulation of the vestibular system, via a vestibular prosthesis, is a technique being explored to restore vestibular function. This review systematically searched for literature that reported the effect of artificial vestibular stimulation on human behaviours related to balance, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) technique. A total of 21 papers matched the inclusion criteria of the literature search conducted using the PubMed and Web of Science databases (February 2019). The populations for these studies included both healthy adults and patients with BVD. In every paper, artificial vestibular stimulation caused an improvement in certain behaviours related to balance, although the extent of the effect varied greatly. Various behaviours were measured such as the vestibulo-ocular reflex, postural sway and certain gait characteristics. Two classes of prosthesis were evaluated and both showed a significant improvement in at least one aspect of balance-related behaviour in every paper included. No adverse effects were reported for prostheses using noisy galvanic vestibular stimulation, however, prosthetic implantation sometimes caused hearing or vestibular loss. Significant heterogeneity in methodology, study population and disease aetiology were observed. The present study confirms the feasibility of vestibular implants in humans for restoring balance in controlled conditions, but more research needs to be conducted to determine their effects on balance in non-clinical settings.

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The vestibular implant: A probe in orbit around the human balance system

Cited by 41 publications

References 66 publications

Histopathological changes to the peripheral vestibular system following meningitic labyrinthitis

Histopathological changes to the peripheral vestibular system following meningitic labyrinthitis

Vestibular Response to Electrical Stimulation of the Otolith Organs. Implications in the Development of A Vestibular Implant for the Improvement of the Sensation of Gravitoinertial Accelerations

Finding a Balance: A Systematic Review of the Biomechanical Effects of Vestibular Prostheses on Stability in Humans

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