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Ten Hoor M, van de Berg R, Pérez Fornos A, Stultiens JJA. Electrical stimulation of the vestibular nerve: evaluating effects and potential starting points for optimization in vestibular implants. Curr Opin Otolaryngol Head Neck Surg 2024:00020840-990000000-00144. [PMID: 39171746 DOI: 10.1097/moo.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
PURPOSE OF REVIEW Oscillopsia and unsteadiness are common and highly debilitating symptoms in individuals with bilateral vestibulopathy. A lack of adequate treatment options encouraged the investigation of vestibular implants, which aim to restore vestibular function with motion-modulated electrical stimulation. This review aims to outline the ocular and postural responses that can be evoked with electrical prosthetic stimulation of the semicircular canals and discuss potential approaches to further optimize evoked responses. Particular focus is given to the stimulation paradigm. RECENT FINDINGS Feasibility studies in animals paved the way for vestibular implantation in human patients with bilateral vestibulopathy. Recent human trials demonstrated prosthetic electrical stimulation to partially restore vestibular reflexes, enhance dynamic visual acuity, and generate controlled postural responses. To further optimize prosthetic performance, studies predominantly targeted eye responses elicited by the vestibulo-ocular reflex, aiming to minimize misalignments and asymmetries while maximizing the response. Changes of stimulation parameters are shown to hold promise to increase prosthetic efficacy, together with surgical refinements and neuroplastic effects. SUMMARY Optimization of the stimulation paradigm, in combination with a more precise electrode placement, holds great potential to enhance the clinical benefit of vestibular implants.
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Affiliation(s)
- Marieke Ten Hoor
- Department of Otorhinolaryngology & Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Raymond van de Berg
- Department of Otorhinolaryngology & Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Joost Johannes Antonius Stultiens
- Department of Otorhinolaryngology & Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, The Netherlands
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Loos E, Stultiens JJA, Volpe B, Vermorken BL, Van Boxel SCJ, Devocht EMJ, van Hoof M, Postma AA, Guinand N, Pérez-Fornos A, Van Rompaey V, Denys S, Desloovere C, Verhaert N, van de Berg R. Optimizing vestibular implant electrode positioning using fluoroscopy and intraoperative CT imaging. Eur Arch Otorhinolaryngol 2024; 281:3433-3441. [PMID: 38180608 PMCID: PMC11211140 DOI: 10.1007/s00405-023-08428-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE Vestibular implant electrode positioning close to the afferent nerve fibers is considered to be key for effective and selective electrical stimulation. However, accurate positioning of vestibular implant electrodes inside the semicircular canal ampullae is challenging due to the inability to visualize the target during the surgical procedure. This study investigates the accuracy of a new surgical protocol with real-time fluoroscopy and intraoperative CT imaging, which facilitates electrode positioning during vestibular implant surgery. METHODS Single-center case-controlled cohort study with a historic control group at a tertiary referral center. Patients were implanted with a vestibulocochlear implant, using a combination of intraoperative fluoroscopy and cone beam CT imaging. The control group consisted of five patients who were previously implanted with the former implant prototype, without the use of intraoperative imaging. Electrode positioning was analyzed postoperatively with a high-resolution CT scan using 3D slicer software. The result was defined as accurate if the electrode position was within 1.5 mm of the center of the ampulla. RESULTS With the new imaging protocol, all electrodes could be positioned within a 1.5 mm range of the center of the ampulla. The accuracy was significantly higher in the study group with intraoperative imaging (21/21 electrodes) compared to the control group without intraoperative imaging (10/15 electrodes), (p = 0.008). CONCLUSION The combined use of intraoperative fluoroscopy and CT imaging during vestibular implantation can improve the accuracy of electrode positioning. This might lead to better vestibular implant performance.
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Affiliation(s)
- Elke Loos
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.
- Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology (ExpORL), KU Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Joost J A Stultiens
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Benjamin Volpe
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bernd L Vermorken
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stan C J Van Boxel
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elke M J Devocht
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marc van Hoof
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alinda A Postma
- Department of Radiology and Nuclear Medicine, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angelica Pérez-Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Sam Denys
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology (ExpORL), KU Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Christian Desloovere
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology (ExpORL), KU Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Nicolas Verhaert
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology (ExpORL), KU Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Raymond van de Berg
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), Maastricht University Medical Center, Maastricht, The Netherlands
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Vermorken BL, Volpe B, van Boxel SCJ, Stultiens JJA, van Hoof M, Marcellis R, Loos E, van Soest A, McCrum C, Meijer K, Guinand N, Pérez Fornos A, van Rompaey V, Devocht E, van de Berg R. The VertiGO! Trial protocol: A prospective, single-center, patient-blinded study to evaluate efficacy and safety of prolonged daily stimulation with a multichannel vestibulocochlear implant prototype in bilateral vestibulopathy patients. PLoS One 2024; 19:e0301032. [PMID: 38547135 PMCID: PMC10977751 DOI: 10.1371/journal.pone.0301032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/02/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND A combined vestibular (VI) and cochlear implant (CI) device, also known as the vestibulocochlear implant (VCI), was previously developed to restore both vestibular and auditory function. A new refined prototype is currently being investigated. This prototype allows for concurrent multichannel vestibular and cochlear stimulation. Although recent studies showed that VCI stimulation enables compensatory eye, body and neck movements, the constraints in these acute study designs prevent them from creating more general statements over time. Moreover, the clinical relevance of potential VI and CI interactions is not yet studied. The VertiGO! Trial aims to investigate the safety and efficacy of prolonged daily motion modulated stimulation with a multichannel VCI prototype. METHODS A single-center clinical trial will be carried out to evaluate prolonged VCI stimulation, assess general safety and explore interactions between the CI and VI. A single-blind randomized controlled crossover design will be implemented to evaluate the efficacy of three types of stimulation. Furthermore, this study will provide a proof-of-concept for a VI rehabilitation program. A total of minimum eight, with a maximum of 13, participants suffering from bilateral vestibulopathy and severe sensorineural hearing loss in the ear to implant will be included and followed over a five-year period. Efficacy will be evaluated by collecting functional (i.e. image stabilization) and more fundamental (i.e. vestibulo-ocular reflexes, self-motion perception) outcomes. Hearing performance with a VCI and patient-reported outcomes will be included as well. DISCUSSION The proposed schedule of fitting, stimulation and outcome testing allows for a comprehensive evaluation of the feasibility and long-term safety of a multichannel VCI prototype. This design will give insights into vestibular and hearing performance during VCI stimulation. Results will also provide insights into the expected daily benefit of prolonged VCI stimulation, paving the way for cost-effectiveness analyses and a more comprehensive clinical implementation of vestibulocochlear stimulation in the future. TRIAL REGISTRATION ClinicalTrials.gov: NCT04918745. Registered 28 April 2021.
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Affiliation(s)
- Bernd L. Vermorken
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Benjamin Volpe
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stan C. J. van Boxel
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Joost J. A. Stultiens
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marc van Hoof
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rik Marcellis
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Elke Loos
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology (ExpORL), KU Leuven, University of Leuven, Leuven, Belgium
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Alexander van Soest
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Chris McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Nils Guinand
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Division of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Elke Devocht
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands
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Lucieer F, van der Lubbe M, van Stiphout L, Janssen M, Van Rompaey V, Devocht E, Perez-Fornos A, Guinand N, van de Berg R. Multi-frequency VEMPs improve detection of present otolith responses in bilateral vestibulopathy. Front Neurol 2024; 15:1336848. [PMID: 38450070 PMCID: PMC10915078 DOI: 10.3389/fneur.2024.1336848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/31/2024] [Indexed: 03/08/2024] Open
Abstract
Objective To investigate whether multi-frequency Vestibular Evoked Myogenic Potential (VEMP) testing at 500, 750, 1,000, and 2,000 Hz, would improve the detection of present dynamic otolith responses in patients with bilateral vestibulopathy (BV). Methods Prospective study in a tertiary referral center. BV patients underwent multi-frequency VEMP testing. Cervical VEMPs and ocular VEMPs were recorded with the Neuro-Audio system (v2010, Neurosoft, Ivanovo, Russia). The stimuli included air-conducted tone bursts of 500, 750, 1,000, and 2,000 Hz, at a stimulation rate of 13 Hz. Outcome measures included the percentage of present and absent VEMP responses, and VEMP thresholds. Outcomes were compared between frequencies and type of VEMPs (cVEMPs, oVEMPs). VEMP outcomes obtained with the 500 Hz stimulus, were also compared to normative values obtained in healthy subjects. Results Forty-nine BV patients completed VEMP testing: 47 patients completed cVEMP testing and 48 patients completed oVEMP testing. Six to 15 % more present VEMP responses were obtained with multifrequency testing, compared to only testing at 500 Hz. The 2,000 Hz stimulus elicited significantly fewer present cVEMP responses (right and left ears) and oVEMP responses (right ears) compared to the other frequencies (p ≤ 0.044). Using multi-frequency testing, 78% of BV patients demonstrated at least one present VEMP response in at least one ear. In 46% a present VEMP response was found bilaterally. BV patients demonstrated a significantly higher percentage of absent VEMP responses and significantly higher VEMP thresholds than healthy subjects, when corrected for age (p ≤ 0.002). Based on these results, a pragmatic VEMP testing paradigm is proposed, taking into account multi-frequency VEMP testing. Conclusion Multi-frequency VEMP testing improves the detection rate of present otolith responses in BV patients. Therefore, multi-frequency VEMPs should be considered when evaluation of (residual) otolith function is indicated.
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Affiliation(s)
- F. Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - M. van der Lubbe
- Division of Balance Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - L. van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - M. Janssen
- Department of Methodology and Statistics, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - V. Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - E. Devocht
- Division of Balance Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - A. Perez-Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - N. Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - R. van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
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D’Alessandro S, Handler M, Saba R, Garnham C, Baumgarten D. Computer Simulation of the Electrical Stimulation of the Human Vestibular System: Effects of the Reactive Component of Impedance on Voltage Waveform and Nerve Selectivity. J Assoc Res Otolaryngol 2022; 23:815-833. [PMID: 36050508 PMCID: PMC9789245 DOI: 10.1007/s10162-022-00868-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/13/2022] [Indexed: 01/06/2023] Open
Abstract
The vestibular system is responsible for our sense of balance and spatial orientation. Recent studies have shown the possibility of partially restoring the function of this system using vestibular implants. Electrical modeling is a valuable tool in assisting the development of these implants by analyzing stimulation effects. However, previous modeling approaches of the vestibular system assumed quasi-static conditions. In this work, an extended modeling approach is presented that considers the reactive component of impedance and the electrode-tissue interface and their effects are investigated in a 3D human vestibular computer model. The Fourier finite element method was employed considering the frequency-dependent electrical properties of the different tissues. The electrode-tissue interface was integrated by an instrumental electrode model. A neuron model of myelinated fibers was employed to predict the nerve responses to the electrical stimulus. Morphological changes of the predicted voltage waveforms considering the dielectric tissue properties were found compared to quasi-static simulations, particularly during monopolar electrode configuration. Introducing the polarization capacitance and the scar tissue around the electrode in combination with a power limitation leads to a considerable current reduction applied through the active electrode and, consequently, to reduced voltage amplitudes of the stimulus waveforms. The reactive component of impedance resulted in better selectivity for the excitation of target nerves compared to the quasi-static simulation at the expense of slightly increased stimulus current amplitudes. We conclude that tissue permittivity and effects of the electrode-tissue interface should be considered to improve the accuracy of the simulations.
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Affiliation(s)
- Simone D’Alessandro
- Institute of Electrical and Biomedical Engineering, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Michael Handler
- Institute of Electrical and Biomedical Engineering, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | | | | | - Daniel Baumgarten
- Institute of Electrical and Biomedical Engineering, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Pleshkov MO, D'Alessandro S, Svetlik M, Starkov D, Zaytsev V, Handler M, Baumgarten D, Saba R, van de Berg R, Demkin V, Kingma H. Fitting the determined impedance in the guinea pig inner ear to randles circuit using square error minimization in the range of 100 Hz to 50 kHz. Biomed Phys Eng Express 2022; 8. [PMID: 35042198 DOI: 10.1088/2057-1976/ac4c4a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/18/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE A number of lumped and distributed parameter models of the inner ear have been proposed in order to improve the vestibular implant stimulation. The models should account for all significant physical phenomena influencing the current propagation: electrical double layer (EDL) and medium polarization. The electrical properties of the medium are reflected in the electrical impedance, therefore the aim of this study was to measure the impedance in the guinea pig inner ear and construct its equivalent circuit. APPROACH The electrical impedance was measured from 100 Hz to 50 kHz between a pair of platinum electrodes immersed in saline solution using sinusoidal voltage signals. The Randles circuit was fitted to the measured impedance in the saline solution in order to estimate the EDL parameters (C, W, and Rct) of the electrode interface in saline. Then, the electrical impedance was measured between all combinations of the electrodes located in semicircular canal ampullae and the vestibular nerve in the guinea pig in vitro. The extended Randles circuit considering the medium polarization (Ri, Re, Cm) together with EDL parameters (C, Rct) obtained from the saline solution was fitted to the measured impedance of the guinea pig inner ear. The Warburg element was assumed negligible and was not considered in the guinea pig model. MAIN RESULTS For the set-up used, the obtained EDL parameters were: C=27.09*10-8F, Rct=18.75 kΩ. The average values of intra-, extracellular resistances, and membrane capacitance were Ri=4.74 kΩ, Re=45.05 kΩ, Cm=9.69*10-8F, respectively. SIGNIFICANCE The obtained values of the model parameters can serve as a good estimation of the EDL for modelling work. The EDL, together with medium polarization, plays a significant role in the electrical impedance of the guinea pig inner ear, therefore, they should be considered in electrical conductivity models to increase the credibility of the simulations.
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Affiliation(s)
- Maksim Olegovich Pleshkov
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, Limburg, 6202 AZ, NETHERLANDS
| | | | - Mikhail Svetlik
- Biological Institute, National Research Tomsk State University, Lenin ave., 36, Tomsk, Tomskaâ, 634050, RUSSIAN FEDERATION
| | - Dmitrii Starkov
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, Limburg, 6229 HX, NETHERLANDS
| | - Vasilii Zaytsev
- Physics Faculty, Laboratory for modelling of physical processes in biology and medicine Tomsk, National Research Tomsk State University, Lenin ave., 36, Tomsk, Tomskaâ, 634050, RUSSIAN FEDERATION
| | - Michael Handler
- Institute of Electrical and Biomedical Engineering, UMIT, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol, Tirol, 6060, AUSTRIA
| | - Daniel Baumgarten
- Institute of Electrical and Biomedical Engineering, UMIT, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol, Tirol, 6060, AUSTRIA
| | - Rami Saba
- MED-EL Electromedical Equipment, Fürstenweg 77a, Innsbruck, Tyrol, 6020, AUSTRIA
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, Limburg, 6229 HX, NETHERLANDS
| | - Vladimir Demkin
- Physics Faculty, National Research Tomsk State University, Lenin ave., 36, Tomsk, Tomskaâ, 634050, RUSSIAN FEDERATION
| | - Herman Kingma
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, Limburg, 6229 HX, NETHERLANDS
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van de Berg R, Ramos A, van Rompaey V, Bisdorff A, Perez-Fornos A, Rubinstein JT, Phillips JO, Strupp M, Della Santina CC, Guinand N. The vestibular implant: Opinion statement on implantation criteria for research. J Vestib Res 2021; 30:213-223. [PMID: 32651339 PMCID: PMC9249290 DOI: 10.3233/ves-200701] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This opinion statement proposes a set of candidacy criteria for vestibular implantation of adult patients with bilateral vestibulopathy (BVP) in a research setting. The criteria include disabling chronic symptoms like postural imbalance, unsteadiness of gait and/or head movement-induced oscillopsia, combined with objective signs of reduced or absent vestibular function in both ears. These signs include abnormal test results recorded during head impulses (video head impulse test or scleral coil technique), bithermal caloric testing and rotatory chair testing (sinusoidal stimulation of 0.1 Hz). Vestibular implant (VI) implantation criteria are not the same as diagnostic criteria for bilateral vestibulopathy. The major difference between VI-implantation criteria and the approved diagnostic criteria for BVP are that all included vestibular tests of semicircular canal function (head impulse test, caloric test, and rotatory chair test) need to show significant impairments of vestibular function in the implantation criteria. For this, a two-step paradigm was developed. First, at least one of the vestibular tests needs to fulfill stringent criteria, close to those for BVP. If this is applicable, then the other vestibular tests have to fulfill a second set of criteria which are less stringent than the original criteria for BVP. If the VI-implantation is intended to excite the utricle and/or saccule (otolith stimulation), responses to cervical and ocular vestibular evoked myogenic potentials must be absent in addition to the above mentioned abnormalities of semicircular canal function. Finally, requirements for safe and potentially effective stimulation should be met, including implanting patients with BVP of peripheral origin only, and assessing possible medical and psychiatric contraindications.
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Affiliation(s)
- Raymond van de Berg
- Department of Otorhinolaryngology and Head & Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russian Federation
| | - Angel Ramos
- Department of Otolaryngology Head Neck Surgery. Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria. Department of Otolaryngology. Las Palmas University. (ULPGC). Psychoacoustic & Equilibrium Laboratory. Las Palmas University (ULPGC)
| | - Vincent van Rompaey
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Alexandre Bisdorff
- Clinique du Vertige, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - Angelica Perez-Fornos
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Jay T Rubinstein
- Otolaryngology-HNS, Virginia Merrill Bloedel Hearing Research Center, University of Washington, Seattle, WA, USA
| | - James O Phillips
- Otolaryngology-HNS, Virginia Merrill Bloedel Hearing Research Center, University of Washington, Seattle, WA, USA
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilians University, Munich, Germany
| | - Charles C Della Santina
- Departments of Otolaryngology - Head & Neck Surgery and Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nils Guinand
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Stultiens JJA, Guinand N, Van Rompaey V, Pérez Fornos A, Kunst HPM, Kingma H, van de Berg R. The resilience of the inner ear-vestibular and audiometric impact of transmastoid semicircular canal plugging. J Neurol 2021; 269:5229-5238. [PMID: 34374862 PMCID: PMC9467949 DOI: 10.1007/s00415-021-10693-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/18/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022]
Abstract
Background Certain cases of superior semicircular canal dehiscence or benign paroxysmal positional vertigo can be treated by plugging of the affected semicircular canal. However, the extent of the impact on vestibular function and hearing during postoperative follow-up is not known. Objective To evaluate the evolution of vestibular function and hearing after plugging of a semicircular canal. Methods Six patients underwent testing before and 1 week, 2 months, and 6 months after plugging of the superior or posterior semicircular canal. Testing included caloric irrigation test, video Head Impulse Test (vHIT), cervical and ocular Vestibular Evoked Myogenic Potentials (VEMPs) and audiometry. Results Initially, ipsilateral caloric response decreased in all patients and vHIT vestibulo-ocular reflex (VOR) gain of each ipsilateral semicircular canal decreased in 4/6 patients. In 4/6 patients, postoperative caloric response recovered to > 60% of the preoperative value. In 5/6 patients, vHIT VOR gain was restored to > 85% of the preoperative value for both ipsilateral non-plugged semicircular canals. In the plugged semicircular canal, this gain decreased in 4/5 patients and recovered to > 50% of the preoperative value. Four patients preserved cervical and ocular VEMP responses. Bone conduction hearing deteriorated in 3/6 patients, but recovered within 6 months postoperatively, although one patient had a persistent loss of 15 dB at 8 kHz. Conclusion Plugging of a semicircular canal can affect both vestibular function and hearing. After initial deterioration, most patients show recovery during follow-up. However, a vestibular function loss or high-frequency hearing loss can persist. This stresses the importance of adequate counseling of patients considering plugging of a semicircular canal. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10693-5.
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Affiliation(s)
- Joost J A Stultiens
- Department of Otorhinolaryngology & Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Nils Guinand
- Division of Otorhinolaryngology and Head-and-Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head & Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Angélica Pérez Fornos
- Division of Otorhinolaryngology and Head-and-Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Henricus P M Kunst
- Department of Otorhinolaryngology & Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hermanus Kingma
- Department of Otorhinolaryngology & Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Raymond van de Berg
- Department of Otorhinolaryngology & Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
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9
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3D-reconstructions of Bast's Valve and Membranous Labyrinth: Insights for Vestibular Implantation and Meniere's Disease. Otol Neurotol 2021; 42:e1652-e1660. [PMID: 34172664 DOI: 10.1097/mao.0000000000003239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS/BACKGROUND Bast's valve is a poorly understood inner ear structure located at the junction between pars superior and inferior in the membranous labyrinth. Anatomically precise three-dimensional reconstructions (3D-reconstructions) of Bast's valve can help illuminate the morphology of the valve, and point toward its role in normal physiology and pathological states such as endolymphatic hydrops. This is of particular relevance to the development of a vestibular implant, a device intended to rehabilitate deficits in the vestibular system. METHODS Six postmortem human temporal bones from healthy donors were scanned using a micro-computed tomography (microCT) scanner. The microCT data allowed 3D-reconstructions of the membranous labyrinth, with a particular focus on Bast's valve, vestibule, and cochlear duct. RESULTS The microCT images of Bast's valve showed a rigid lip containing a core of soft tissue, opposing the thin membranous wall of the utricle. The maximum recorded length and width of the rigid lip were 440.4 μm and 88 μm, respectively. The 3D-reconstructions illustrated the slit-like opening of Bast's valve into the utricle, the twisting course of the basal turn of the cochlear duct, and the spatial orientation of utricle and saccule with respect to the stapes footplate. CONCLUSIONS The present study provided a novel anatomical perspective on the microscopic structure of Bast's valve. The interplay between endolymphatic hydrops and Bast's valve is an ongoing area of research, but defining this anatomy in 3D will play a key role in furthering our understanding of the disease process. Implications for vestibular implantation are explored through the various 3D-reconstructions.
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10
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Simultaneous activation of multiple vestibular pathways upon electrical stimulation of semicircular canal afferents. J Neurol 2020; 267:273-284. [PMID: 32778921 PMCID: PMC7718208 DOI: 10.1007/s00415-020-10120-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/02/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022]
Abstract
Background and purpose Vestibular implants seem to be a promising treatment for patients suffering from severe bilateral vestibulopathy. To optimize outcomes, we need to investigate how, and to which extent, the different vestibular pathways are activated. Here we characterized the simultaneous responses to electrical stimuli of three different vestibular pathways. Methods Three vestibular implant recipients were included. First, activation thresholds and amplitude growth functions of electrically evoked vestibulo-ocular reflexes (eVOR), cervical myogenic potentials (ecVEMPs) and vestibular percepts (vestibulo-thalamo-cortical, VTC) were recorded upon stimulation with single, biphasic current pulses (200 µs/phase) delivered through five different vestibular electrodes. Latencies of eVOR and ecVEMPs were also characterized. Then we compared the amplitude growth functions of the three pathways using different stimulation profiles (1-pulse, 200 µs/phase; 1-pulse, 50 µs/phase; 4-pulses, 50 µs/phase, 1600 pulses-per-second) in one patient (two electrodes). Results The median latencies of the eVOR and ecVEMPs were 8 ms (8–9 ms) and 10.2 ms (9.6–11.8 ms), respectively. While the amplitude of eVOR and ecVEMP responses increased with increasing stimulation current, the VTC pathway showed a different, step-like behavior. In this study, the 200 µs/phase paradigm appeared to give the best balance to enhance responses at lower stimulation currents. Conclusions This study is a first attempt to evaluate the simultaneous activation of different vestibular pathways. However, this issue deserves further and more detailed investigation to determine the actual possibility of selective stimulation of a given pathway, as well as the functional impact of the contribution of each pathway to the overall rehabilitation process.
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11
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Martin EC, Leue C, Delespaul P, Peeters F, Janssen AML, Lousberg R, Erdkamp A, van de Weijer S, Widdershoven J, Blom H, Bruintjes T, Zwergal A, Grill E, Guinand N, Perez-Fornos A, van de Berg MR, Stultiens JJA, Kingma H, van de Berg R. Introducing the DizzyQuest: an app-based diary for vestibular disorders. J Neurol 2020; 267:3-14. [PMID: 32712867 PMCID: PMC7718207 DOI: 10.1007/s00415-020-10092-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 01/10/2023]
Abstract
Background Most questionnaires currently used for assessing symptomatology of vestibular disorders are retrospective, inducing recall bias and lowering ecological validity. An app-based diary, administered multiple times in daily life, could increase the accuracy and ecological validity of symptom measurement. The objective of this study was to introduce a new experience sampling method (ESM) based vestibular diary app (DizzyQuest), evaluate response rates, and to provide examples of DizzyQuest outcome measures which can be used in future research. Methods Sixty-three patients diagnosed with a vestibular disorder were included. The DizzyQuest consisted of four questionnaires. The morning- and evening-questionnaires were administered once each day, the within-day-questionnaire 10 times a day using a semi-random time schedule, and the attack questionnaire could be completed after the occurrence of a vertigo or dizziness attack. Data were collected for 4 weeks. Response rates and loss-to-follow-up were determined. Reported symptoms in the within-day-questionnaire were compared within and between patients and subgroups of patients with different vestibular disorders. Results Fifty-one patients completed the study period. Average response rates were significantly higher than the desired response rate of > 50% (p < 0.001). The attack-questionnaire was used 159 times. A variety of neuro-otological symptoms and different disease profiles were demonstrated between patients and subgroups of patients with different vestibular disorders. Conclusion The DizzyQuest is able to capture vestibular symptoms within their psychosocial context in daily life, with little recall bias and high ecological validity. The DizzyQuest reached the desired response rates and showed different disease profiles between subgroups of patients with different vestibular disorders. This is the first time ESM was used to assess daily symptoms and quality of life in vestibular disorders, showing that it might be a useful tool in this population. Electronic supplementary material The online version of this article (10.1007/s00415-020-10092-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E C Martin
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - C Leue
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - P Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - F Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - A M L Janssen
- Department of ENT/Audiology, School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - R Lousberg
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - A Erdkamp
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S van de Weijer
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J Widdershoven
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - H Blom
- Department of ENT, HagaZiekenhuis, The Hague, The Netherlands
| | - T Bruintjes
- Apeldoorns duizeligheidscentrum, Gelre ziekenhuizen, Apeldoorn, The Netherlands
| | - A Zwergal
- Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - E Grill
- Department of Medical Informatics, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - N Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - A Perez-Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - M R van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J J A Stultiens
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - H Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - R van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands. .,Faculty of Physics, Tomsk State Research University, Tomsk, Russia.
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12
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Crétallaz C, Boutabla A, Cavuscens S, Ranieri M, Nguyen TAK, Kingma H, Van De Berg R, Guinand N, Pérez Fornos A. Influence of systematic variations of the stimulation profile on responses evoked with a vestibular implant prototype in humans. J Neural Eng 2020; 17:036027. [PMID: 32213673 PMCID: PMC8630998 DOI: 10.1088/1741-2552/ab8342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To explore the impact of different electrical stimulation profiles in human recipients of the Geneva-Maastricht vestibular implant prototypes. APPROACH Four implanted patients were recruited for this study. We investigated the relative efficacy of systematic variations of the electrical stimulus profile (phase duration, pulse rate, baseline level, modulation depth) in evoking vestibulo-ocular (eVOR) and perceptual responses. MAIN RESULTS Shorter phase durations and, to a lesser extent, slower pulse rates allowed maximizing the electrical dynamic range available for eliciting a wider range of intensities of vestibular percepts. When either the phase duration or the pulse rate was held constant, current modulation depth was the factor that had the most significant impact on peak velocity of the eVOR. SIGNIFICANCE Our results identified important parametric variations that influence the measured responses. Furthermore, we observed that not all vestibular pathways seem equally sensitive to the electrical stimulus when the electrodes are placed in the semicircular canals and monopolar stimulation is used. This opens the door to evaluating new stimulation strategies for a vestibular implant, and suggests the possibility of selectively activating one vestibular pathway or the other in order to optimize rehabilitation outcomes.
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Affiliation(s)
- Céline Crétallaz
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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13
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Drafting a Surgical Procedure Using a Computational Anatomy Driven Approach for Precise, Robust, and Safe Vestibular Neuroprosthesis Placement-When One Size Does Not Fit All. Otol Neurotol 2020; 40:S51-S58. [PMID: 31225823 DOI: 10.1097/mao.0000000000002211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To design and evaluate a new vestibular implant and surgical procedure that should reach correct electrode placement in 95% of patients in silico. DESIGN Computational anatomy driven implant and surgery design study. SETTING Tertiary referral center. PARTICIPANTS The population comprised 81 patients that had undergone a CT scan of the Mastoid region in the Maastricht University Medical Center. The population was subdivided in a vestibular implant eligible group (28) and a control group (53) without known vestibular loss. INTERVENTIONS Canal lengths and relationships between landmarks were calculated for every patient. The relationships in group-anatomy were used to model a fenestration site on all three semicircular canals. Each patient's simulated individual distance from the fenestration site to the ampulla was calculated and compared with the populations average to determine if placement would be successful. MAIN OUTCOME MEASURES Lengths of the semicircular canals, distances from fenestration site to ampulla (intralabyrinthine electrode length), and rate of successful electrode placement (robustness). RESULTS The canal lengths for the lateral, posterior, and superior canal were respectively 12.1 mm ± 1.07, 18.8 mm ± 1.62, and 17.5 mm ± 1.23, the distances from electrode fenestration site to the ampulla were respectively 3.73 mm ± 0.53, 9.02 mm ± 0.90, and 5.31 mm ± 0.73 and electrode insertions were successful for each respective semicircular canal in 92.6%, 66.7%, and 86.4% of insertions in silico. The implant electrode was subsequently revised to include two more electrodes per lead, resulting in a robustness of 100%. CONCLUSIONS The computational anatomy approach can be used to design and test surgical procedures. With small changes in electrode design, the proposed surgical procedure's target robustness was reached.
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14
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Haxby F, Akrami M, Zamani R. Finding a Balance: A Systematic Review of the Biomechanical Effects of Vestibular Prostheses on Stability in Humans. J Funct Morphol Kinesiol 2020; 5:E23. [PMID: 33467239 PMCID: PMC7739312 DOI: 10.3390/jfmk5020023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/20/2020] [Accepted: 03/28/2020] [Indexed: 11/16/2022] Open
Abstract
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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Affiliation(s)
- Felix Haxby
- Medical School, University of Exeter, Exeter EX1 2LU, UK; (F.H.); (R.Z.)
| | - Mohammad Akrami
- Department of Engineering, College of Engineering, Mathematics, and Physical Sciences University of Exeter, Exeter EX4 4QF, UK
| | - Reza Zamani
- Medical School, University of Exeter, Exeter EX1 2LU, UK; (F.H.); (R.Z.)
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15
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王 涛, 唐 凤, 袁 弘. [Current status and new progress of vestibular assistant systems]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:285-288. [PMID: 32791603 PMCID: PMC10127860 DOI: 10.13201/j.issn.2096-7993.2020.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 04/30/2023]
Abstract
Vestibular dysfunction can seriously affect patients' daily life and work. There is an urgent need for new methods to treat vestibular dysfunction. As awareness of these diseases increases, efforts are being made to improve vestibular function through a number of vestibular assistant systems. As far as current development is concerned, vestibular assistant system mainly focuses on two fields: external prosthesis and vestibular implant. This review shows the current status and future development trend of the vestibular assistant system.
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Affiliation(s)
- 涛 王
- 广西壮族自治区人民医院耳鼻咽喉头颈外科(南宁,530021)
| | - 凤珠 唐
- 广西壮族自治区人民医院耳鼻咽喉头颈外科(南宁,530021)
- 唐凤珠,
| | - 弘 袁
- 广西壮族自治区人民医院耳鼻咽喉头颈外科(南宁,530021)
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16
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Stultiens JJA, Postma AA, Guinand N, Pérez Fornos A, Kingma H, van de Berg R. Vestibular Implantation and the Feasibility of Fluoroscopy-Guided Electrode Insertion. Otolaryngol Clin North Am 2019; 53:115-126. [PMID: 31677739 DOI: 10.1016/j.otc.2019.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Recent research has shown promising results for the development of a clinically feasible vestibular implant in the near future. However, correct electrode placement remains a challenge. It was shown that fluoroscopy was able to visualize the semicircular canal ampullae and electrodes, and guide electrode insertion in real time. Ninety-four percent of the 18 electrodes were implanted correctly (<1.5 mm distance to target). The median distances were 0.60 mm, 0.85 mm, and 0.65 mm for the superior, lateral, and posterior semicircular canal, respectively. These findings suggest that fluoroscopy can significantly improve electrode placement during vestibular implantation.
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Affiliation(s)
- Joost Johannes Antonius Stultiens
- Department of Otorhinolaryngology-Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alida Annechien Postma
- Department of Radiology and Nuclear Medicine, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nils Guinand
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Division of Otorhinolaryngology-Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Hermanus Kingma
- Department of Otorhinolaryngology-Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Raymond van de Berg
- Department of Otorhinolaryngology-Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, P.O. box 5800, 6202 AZ, Maastricht University Medical Center, Maastricht, The Netherlands.
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17
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Starkov D, Guinand N, Lucieer F, Ranieri M, Cavuscens S, Pleshkov M, Guyot JP, Kingma H, Ramat S, Perez-Fornos A, van de Berg R. Restoring the High-Frequency Dynamic Visual Acuity with a Vestibular Implant Prototype in Humans. Audiol Neurootol 2019; 25:91-95. [PMID: 31661687 DOI: 10.1159/000503677] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/18/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The vestibular implant could become a clinically useful device in the near future. This study investigated the feasibility of restoring the high-frequency dynamic visual acuity (DVA) with a vestibular implant, using the functional Head Impulse Test (fHIT). METHODS A 72-year-old female, with bilateral vestibulopathy and fitted with a modified cochlear implant incorporating three vestibular electrodes (MED-EL, Innsbruck, Austria), was available for this study. Electrical stimulation was delivered with the electrode close to the lateral ampullary nerve in the left ear. The high-frequency DVA in the horizontal plane was tested with the fHIT. After training, the patient underwent six trials of fHIT, each with a different setting of the vestibular implant: (1) System OFF before stimulation; (2) System ON, baseline stimulation; (3) System ON, reversed stimulation; (4) System ON, positive stimulation; (5) System OFF, without delay after stimulation offset; and (6) System OFF, 25 min delay after stimulation offset. The percentage of correct fHIT scores for right and left head impulses were compared between trials. RESULTS Vestibular implant stimulation improved the high-frequency DVA compared to no stimulation. This improvement was significant for "System ON, baseline stimulation" (p = 0.02) and "System ON, positive stimulation" (p < 0.001). fHIT scores changed from 19 to 44% (no stimulation) to maximum 75-94% (System ON, positive stimulation). CONCLUSION The vestibular implant seems capable of improving the high-frequency DVA. This functional benefit of the vestibular implant illustrates again the feasibility of this device for clinical use in the near future.
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Affiliation(s)
- Dmitrii Starkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands, .,Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation,
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Florence Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Maurizio Ranieri
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Samuel Cavuscens
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Maksim Pleshkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
| | - Jean-Philippe Guyot
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
| | - Stefano Ramat
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Angelica Perez-Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, The Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
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18
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Vestibular implant: does it really work? A systematic review. Braz J Otorhinolaryngol 2019; 85:788-798. [PMID: 31606334 PMCID: PMC9443005 DOI: 10.1016/j.bjorl.2019.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/11/2019] [Accepted: 07/29/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction People with vestibular loss present a deficit in the vestibular system, which is primarily responsible for promoting postural control, gaze stabilization, and spatial orientation while the head moves. There is no effective treatment for a bilateral loss of vestibular function. Recently, a vestibular implant was developed for people with bilateral loss of vestibular function to improve this function and, consequently, the quality of life of these patients. Objective To identify in the scientific literature evidence that vestibular implants in people with vestibular deficit improves vestibular function. Methods One hundred and forty six articles were found from five databases and 323 articles from the gray literature mentioning the relationship between vestibular implant and vestibular function in humans. The PICOS strategy (Population, Intervention, Comparison and Outcome) was used to define the eligibility criteria. The studies that met the inclusion criteria for this second step were included in a qualitative synthesis, and each type of study was analyzed according to the bias risk assessment of the Joanna Briggs Institute through the critical assessment checklist Joanna Briggs institute for quasi-experimental studies and the Joanna Briggs institute critical assessment checklist for case reports. Results Of the 21 articles included in reading the full text, 10 studies were selected for the qualitative analysis in the present systematic review. All ten articles analyzed through the critical assessment checklist Joanna Briggs institute showed a low risk of bias. The total number of samples in the evaluated articles was 18 patients with vestibular implants. Conclusions Taken together, these findings support the feasibility of vestibular implant for restoration of the vestibulo-ocular reflex in a broad frequency range and illustrate new challenges for the development of this technology.
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Sluydts M, Curthoys I, Vanspauwen R, Papsin BC, Cushing SL, Ramos A, Ramos de Miguel A, Borkoski Barreiro S, Barbara M, Manrique M, Zarowski A. Electrical Vestibular Stimulation in Humans: A Narrative Review. Audiol Neurootol 2019; 25:6-24. [PMID: 31533097 DOI: 10.1159/000502407] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/29/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In patients with bilateral vestibulopathy, the regular treatment options, such as medication, surgery, and/or vestibular rehabilitation, do not always suffice. Therefore, the focus in this field of vestibular research shifted to electrical vestibular stimulation (EVS) and the development of a system capable of artificially restoring the vestibular function. Key Message: Currently, three approaches are being investigated: vestibular co-stimulation with a cochlear implant (CI), EVS with a vestibular implant (VI), and galvanic vestibular stimulation (GVS). All three applications show promising results but due to conceptual differences and the experimental state, a consensus on which application is the most ideal for which type of patient is still missing. SUMMARY Vestibular co-stimulation with a CI is based on "spread of excitation," which is a phenomenon that occurs when the currents from the CI spread to the surrounding structures and stimulate them. It has been shown that CI activation can indeed result in stimulation of the vestibular structures. Therefore, the question was raised whether vestibular co-stimulation can be functionally used in patients with bilateral vestibulopathy. A more direct vestibular stimulation method can be accomplished by implantation and activation of a VI. The concept of the VI is based on the technology and principles of the CI. Different VI prototypes are currently being evaluated regarding feasibility and functionality. So far, all of them were capable of activating different types of vestibular reflexes. A third stimulation method is GVS, which requires the use of surface electrodes instead of an implanted electrode array. However, as the currents are sent through the skull from one mastoid to the other, GVS is rather unspecific. It should be mentioned though, that the reported spread of excitation in both CI and VI use also seems to induce a more unspecific stimulation. Although all three applications of EVS were shown to be effective, it has yet to be defined which option is more desirable based on applicability and efficiency. It is possible and even likely that there is a place for all three approaches, given the diversity of the patient population who serves to gain from such technologies.
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Affiliation(s)
- Morgana Sluydts
- European Institute for Otorhinolaryngology, GZA Hospitals Antwerp, Wilrijk, Belgium,
| | - Ian Curthoys
- Vestibular Research Laboratory, University of Sydney, Sydney, New South Wales, Australia
| | - Robby Vanspauwen
- European Institute for Otorhinolaryngology, GZA Hospitals Antwerp, Wilrijk, Belgium
| | - Blake Croll Papsin
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon Lynn Cushing
- Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Angel Ramos
- Hearing Loss Unit, Otorhinolaryngology, Head and Neck Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas of Gran Canaria, Spain
| | - Angel Ramos de Miguel
- Hearing Loss Unit, Otorhinolaryngology, Head and Neck Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas of Gran Canaria, Spain
| | - Silvia Borkoski Barreiro
- Hearing Loss Unit, Otorhinolaryngology, Head and Neck Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas of Gran Canaria, Spain
| | | | - Manuel Manrique
- Otorhinolaryngology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Andrzej Zarowski
- European Institute for Otorhinolaryngology, GZA Hospitals Antwerp, Wilrijk, Belgium
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20
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Abstract
Purpose of review Bilateral vestibular deficits exist and their prevalence is more important than believed by the medical community. Their severe impact has inspired several teams to develop technical solutions in an attempt to rehabilitate patients. A particularly promising pathway is the vestibular implant. This article describes the main milestones in this field, mainly focusing on work conducted in human patients. Recent findings There have been substantial research efforts, first in animals and more recently in humans, toward the development of vestibular implants. Humans have demonstrated surprising adaptation capabilities to the artificial vestibular signal. Today, the possibility of restoring vestibular reflexes, particularly the vestibulo-ocular reflex, and even achieving useful function in close-to-reality tasks (i.e. improving visual abilities while walking) have been demonstrated in humans. Summary The vestibular implant opens new perspectives, not only as an effective therapeutic tool, but also pushes us to go beyond current knowledge and well-established clinical concepts.
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Fornos AP, van de Berg R, Armand S, Cavuscens S, Ranieri M, Crétallaz C, Kingma H, Guyot JP, Guinand N. Cervical myogenic potentials and controlled postural responses elicited by a prototype vestibular implant. J Neurol 2019; 266:33-41. [PMID: 31396689 PMCID: PMC6722147 DOI: 10.1007/s00415-019-09491-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 02/04/2023]
Abstract
Gaze stabilization and postural control are two key functions of the vestibular system. In consequence, oscillopsia and chronic imbalance are the two main complaints of patients presenting with a severe bilateral vestibular function loss. The vestibular implant is emerging as a promising treatment for this group of patients whose quality of life is significantly impaired. Although the final aim of the vestibular implant should be to restore vestibular function as a whole, until now the research has focused mainly on the restoration of the vestibulo-ocular reflex to improve gaze stabilization. In this study, we aimed to explore whether the vestibulo-collic and vestibulo-spinal pathways could be activated and controlled with the electrical stimuli provided by our vestibular implant prototype. This was first explored and demonstrated with recordings of electrically elicited cervical vestibular evoked myogenic potentials (ecVEMPs). ecVEMPs with characteristics similar to the classical acoustically elicited cervical vestibular evoked myogenic potentials (cVEMPs) were successfully evoked in five out of the eight tested patients. Amplitudes of the electrically elicited N–P complex varied, ranging from 44 to 120 µV. Mean latencies of the N and P waves were of 9.71(± 1.17) ms and 17.24 ms (± 1.74), respectively. We also evaluated the possibility of generating controlled postural responses using a stepping test. Here, we showed that controlled and consistent whole-body postural responses can be effectively obtained with rapid changes in the “baseline” (constant rate and amplitude) electrical activity delivered by the vestibular implant in two out of the three tested subjects. Furthermore, obtained amplitude of body rotations was significantly correlated with the intensity of stimulation and direction of body rotations correlated with the side of the delivered stimulus (implanted side). Altogether, these data suggest that the vestibular implant could also be used to improve postural control in patients with bilateral vestibulopathy.
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Affiliation(s)
- Angelica Perez Fornos
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Raymond van de Berg
- Division of Balance Disorders, Department of ENT, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Stéphane Armand
- Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Samuel Cavuscens
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Maurizio Ranieri
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Céline Crétallaz
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Herman Kingma
- Division of Balance Disorders, Department of ENT, Maastricht University Medical Centre, Maastricht, The Netherlands
- Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Jean-Philippe Guyot
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Nils Guinand
- Division of Otorhinolaryngology Head and Neck Surgery, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
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22
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Schier P, Handler M, Johnson Chacko L, Schrott-Fischer A, Fritscher K, Saba R, Baumgartner C, Baumgarten D. Model-Based Vestibular Afferent Stimulation: Evaluating Selective Electrode Locations and Stimulation Waveform Shapes. Front Neurosci 2018; 12:588. [PMID: 30214391 PMCID: PMC6125370 DOI: 10.3389/fnins.2018.00588] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/06/2018] [Indexed: 12/02/2022] Open
Abstract
A dysfunctional vestibular system can be a severe detriment to the quality of life of a patient. Recent studies have shown the feasibility for a vestibular implant to restore rotational sensation via electrical stimulation of vestibular ampullary nerves. However, the optimal stimulation site for selective elicitation of the desired nerve is still unknown. We realized a finite element model on the basis of μCT scans of a human inner ear and incorporated naturally distributed, artificial neural trajectories. A well-validated neuron model of myelinated fibers was incorporated to predict nerve responses to electrical stimulation. Several virtual electrodes were placed in locations of interest inside the bony labyrinth (intra-labyrinthine) and inside the temporal bone, near the target nerves (extra-labyrinthine), to determine preferred stimulation sites and electrode insertion depths. We investigated various monopolar and bipolar electrode configurations as well as different pulse waveform shapes for their ability to selectively stimulate the target nerve and for their energy consumption. The selectivity was evaluated with an objective measure of the fiber recruitment. Considerable differences of required energy and achievable selectivity between the configurations were observed. Bipolar, intra-labyrinthine electrodes provided the best selectivities but also consumed the highest amount of energy. Bipolar, extra-labyrinthine configurations did not offer any advantages compared to the monopolar approach. No selective stimulation could be performed with the monopolar, intra-labyrinthine approach. The monopolar, extra-labyrinthine electrodes required the least energy for satisfactory selectivities, making it the most promising approach for functional vestibular implants. Different pulse waveform shapes did not affect the achieved selectivity considerably but shorter pulse durations showed consistently a more selective activation of the target nerves. A cathodic, centered triangular waveform shape was identified as the most energy-efficient of the tested shapes. Based on these simulations we are able to recommend the monopolar, extra-labyrinthine stimulation approach with cathodic, centered triangular pulses as good trade-off between selectivity and energy consumption. Future implant designs could benefit from the findings presented here.
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Affiliation(s)
- Peter Schier
- Department for Biomedical Computer Science and Mechatronics, Institute of Electrical and Biomedical Engineering, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Michael Handler
- Department for Biomedical Computer Science and Mechatronics, Institute of Electrical and Biomedical Engineering, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Lejo Johnson Chacko
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Karl Fritscher
- Department for Biomedical Computer Science and Mechatronics, Institute of Biomedical Image Analysis, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | | | - Christian Baumgartner
- Department for Biomedical Computer Science and Mechatronics, Institute of Electrical and Biomedical Engineering, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.,Faculty of Computer Science and Biomedical Engineering, Institute of Health Care Engineering, Graz University of Technology, Graz, Austria
| | - Daniel Baumgarten
- Department for Biomedical Computer Science and Mechatronics, Institute of Electrical and Biomedical Engineering, UMIT-Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.,Department of Computer Science and Automation, Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
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Jiang W, Rajguru SM. Eye Movements Evoked by Pulsed Infrared Radiation of the Rat Vestibular System. Ann Biomed Eng 2018; 46:1406-1418. [PMID: 29845411 PMCID: PMC6095805 DOI: 10.1007/s10439-018-2059-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/24/2018] [Indexed: 10/16/2022]
Abstract
Light at infrared wavelengths has been demonstrated to modulate the pattern of neural signals transmitted from the angular motion sensing semicircular canals of the vestibular system to the brain. In the present study, we have characterized physiological eye movements evoked by focused, pulsed infrared radiation (IR) stimuli directed at an individual semicircular canal in a mammalian model. Pulsed IR (1863 nm) trains were directed at the posterior semicircular canal in a rat using 200-400 µm optical fibers. Evoked bilateral eye movements were measured using a custom-modified video-oculography system. The activation of vestibulo-ocular motor pathways by frequency modulated pulsed IR directed at single posterior semicircular canals evoked significant, characteristic bilateral eye movements. In this case, the resulting eye movements were disconjugate with ipsilateral eye moving upwards with a rotation towards the stimulated ear and the contralateral eye moving downwards. The eye movements were stable through several hours of repeated stimulation and could be maintained with 30 + minutes of continuous, frequency-modulated IR stimulation. Following the measurements, the distance of the fiber from target structures and orientation of the beam relative to vestibular structures were determined using micro-computed tomography. Results highlight the spatial selectivity of optical stimulation. Our results demonstrate a novel strategy for direct optical stimulation of the vestibular pathway in rodents and lays the groundwork for future applications of optical neural stimulation in inner ear research and therapeutic applications.
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Affiliation(s)
- Weitao Jiang
- Department of Biomedical Engineering, University of Miami, 1251 Memorial Drive, MEA 204, Coral Gables, FL, 33146, USA
| | - Suhrud M Rajguru
- Department of Biomedical Engineering, University of Miami, 1251 Memorial Drive, MEA 204, Coral Gables, FL, 33146, USA.
- Department of Otolaryngology, University of Miami, 1600 NW 10th Ave, RMSB 3160, Miami, FL, 33136, USA.
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24
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Lucieer F, Duijn S, Van Rompaey V, Pérez Fornos A, Guinand N, Guyot JP, Kingma H, van de Berg R. Full Spectrum of Reported Symptoms of Bilateral Vestibulopathy Needs Further Investigation-A Systematic Review. Front Neurol 2018; 9:352. [PMID: 29915554 PMCID: PMC5994412 DOI: 10.3389/fneur.2018.00352] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/01/2018] [Indexed: 12/16/2022] Open
Abstract
Objective To systematically review the symptoms reported by patients with bilateral vestibulopathy (BV) in clinical studies and case reports. This would serve as the first step in establishing a validated patient-reported outcome measures (PROM) for BV. Methods A search on symptoms reported by patients with BV was performed in PubMed, and all publications covering these symptoms were included. Exclusion criteria comprised reviews and insufficient details about the frequency of occurrence of symptoms. Results 1,442 articles were retrieved. 88 studies were included (41 clinical studies, 47 case reports). In consensus, 68 descriptions of symptoms were classified into 6 common and generic symptoms. Frequency of symptoms in clinical studies and case reports were reviewed, respectively; imbalance (91 and 86%), chronic dizziness (58 and 62%), oscillopsia (50 and 70%), and recurrent vertigo (33 and 67%). BV could be accompanied by hearing loss (33 and 43%) and tinnitus (15 and 36%). 15 clinical studies and 10 case reports reported symptoms beyond vestibular and hearing deficits such as limited social activities, depression, concentration, and memory impairment and reduced quality of life in general. Conclusion The literature on BV symptomatology mainly focuses on classic symptoms such as imbalance and oscillopsia, while only few report additional symptoms such as cognitive memory impairment and performing dual tasks. In fact, none of the reviewed clinical studies and case reports provided a comprehensive overview of BV symptoms. To develop a validated PROM, qualitative research using semi-structured and unstructured interviews is needed to explore the full spectrum of BV symptoms.
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Affiliation(s)
- Florence Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands
| | - Stijn Duijn
- Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, Netherlands
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Angelica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Jean Philippe Guyot
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands.,Faculty of Physics, Tomsk State Research University, Tomsk, Russia
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25
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Johnson Chacko L, Schmidbauer DT, Handschuh S, Reka A, Fritscher KD, Raudaschl P, Saba R, Handler M, Schier PP, Baumgarten D, Fischer N, Pechriggl EJ, Brenner E, Hoermann R, Glueckert R, Schrott-Fischer A. Analysis of Vestibular Labyrinthine Geometry and Variation in the Human Temporal Bone. Front Neurosci 2018. [PMID: 29535601 PMCID: PMC5834493 DOI: 10.3389/fnins.2018.00107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Stable posture and body movement in humans is dictated by the precise functioning of the ampulla organs in the semi-circular canals. Statistical analysis of the interrelationship between bony and membranous compartments within the semi-circular canals is dependent on the visualization of soft tissue structures. Thirty-one human inner ears were prepared, post-fixed with osmium tetroxide and decalcified for soft tissue contrast enhancement. High resolution X-ray microtomography images at 15 μm voxel-size were manually segmented. This data served as templates for centerline generation and cross-sectional area extraction. Our estimates demonstrate the variability of individual specimens from averaged centerlines of both bony and membranous labyrinth. Centerline lengths and cross-sectional areas along these lines were identified from segmented data. Using centerlines weighted by the inverse squares of the cross-sectional areas, plane angles could be quantified. The fit planes indicate that the bony labyrinth resembles a Cartesian coordinate system more closely than the membranous labyrinth. A widening in the membranous labyrinth of the lateral semi-circular canal was observed in some of the specimens. Likewise, the cross-sectional areas in the perilymphatic spaces of the lateral canal differed from the other canals. For the first time we could precisely describe the geometry of the human membranous labyrinth based on a large sample size. Awareness of the variations in the canal geometry of the membranous and bony labyrinth would be a helpful reference in designing electrodes for future vestibular prosthesis and simulating fluid dynamics more precisely.
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Affiliation(s)
- Lejo Johnson Chacko
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dominik T Schmidbauer
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria.,Department of Biotechnology & Food Engineering, Management Center Innsbruck, Innsbruck, Austria
| | - Stephan Handschuh
- VetImaging, VetCore Facility for Research, University of Veterinary Medicine, Vienna, Austria
| | - Alen Reka
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Karl D Fritscher
- Institute of Biomedical Image Analysis, UMIT, Hall in Tirol, Austria
| | - Patrik Raudaschl
- Institute of Biomedical Image Analysis, UMIT, Hall in Tirol, Austria
| | | | - Michael Handler
- Institute of Electrical and Biomedical Engineering, UMIT, Hall in Tirol, Austria
| | - Peter P Schier
- Institute of Electrical and Biomedical Engineering, UMIT, Hall in Tirol, Austria
| | - Daniel Baumgarten
- Institute of Electrical and Biomedical Engineering, UMIT, Hall in Tirol, Austria.,Institute of Biomedical Engineering and Informatics, Technische Universität Ilmenau, Ilmenau, Germany
| | - Natalie Fischer
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elisabeth J Pechriggl
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Brenner
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Romed Hoermann
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rudolf Glueckert
- Department of Otolaryngology, Medical University of Innsbruck, Innsbruck, Austria.,University Clinics Innsbruck, Tirol Kliniken, Innsbruck, Austria
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De Belder J, Matthysen S, Claes AJ, Mertens G, Van de Heyning P, Van Rompaey V. Does Otovestibular Loss in the Autosomal Dominant Disorder DFNA9 Have an Impact of on Cognition? A Systematic Review. Front Neurosci 2018; 11:735. [PMID: 29375286 PMCID: PMC5767272 DOI: 10.3389/fnins.2017.00735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 12/18/2017] [Indexed: 12/21/2022] Open
Abstract
Background and Purpose: Cognitive impairment has been observed in patients with bilateral vestibular loss (BVL) and in patients with sensorineural hearing loss (SNHL). DFNA9 is an autosomal dominant disorder that causes a combination of both sensory deficits by the 3rd to 5th decade. We therefore hypothesize a combined detrimental effect on cognition. The aim of this systematic review was to identify studies related to DFNA9 in general and its relationship with cognitive impairment more specifically. Materials and Methods: Several databases including Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, ISI Web of Knowledge, and Web of Science were searched to accumulate information about DFNA9-mutations, including phenotype, genotype, pathophysiology, quality of life (QOL), and imaging in general and cognitive function more specifically. A qualitative analysis was performed on the 55 articles that qualified. Results: The clinical features of DFNA9 are different along the 24 COCH mutations, described up to now. Vestibular symptoms generally present themselves a few years after SNHL onset in mutations associated with the vWFA-domain although they can precede SNHL onset in other mutations associated with the LCCL-domain. QoL has not been studied extensively in DFNA9, although scarce work is available on the positive impact of cochlear implantation to rehabilitate hearing. No studies were found evaluating cognition in DFNA9 patients. Conclusion: Although cognitive impairment has been demonstrated in patients with hearing loss as well as in patients with BVL, no studies have been reported on the combination of both sensory deficits, such as in DFNA9. Further research is warranted to correlate otovestibular status with cognition.
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Affiliation(s)
- Jonas De Belder
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stijn Matthysen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annes J Claes
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Griet Mertens
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul Van de Heyning
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
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27
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van de Berg R, Guinand N, Ranieri M, Cavuscens S, Khoa Nguyen TA, Guyot JP, Lucieer F, Starkov D, Kingma H, van Hoof M, Perez-Fornos A. The Vestibular Implant Input Interacts with Residual Natural Function. Front Neurol 2017; 8:644. [PMID: 29312107 PMCID: PMC5735071 DOI: 10.3389/fneur.2017.00644] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/16/2017] [Indexed: 12/12/2022] Open
Abstract
Objective Patients with bilateral vestibulopathy (BV) can still have residual “natural” function. This might interact with “artificial” vestibular implant input (VI-input). When fluctuating, it could lead to vertigo attacks. Main objective was to investigate how “artificial” VI-input is integrated with residual “natural” input by the central vestibular system. This, to explore (1) whether misalignment in the response of “artificial” VI-input is sufficiently counteracted by well-aligned residual “natural” input and (2) whether “artificial” VI-input is able to influence and counteract the response to residual “natural” input, to show feasibility of a “vestibular pacemaker.” Materials and methods Five vestibular electrodes in four BV patients implanted with a VI were available. This involved electrodes with a predominantly horizontal response and electrodes with a predominantly vertical response. Responses to predominantly horizontal residual “natural” input and predominantly horizontal and vertical “artificial” VI-input were separately measured first. Then, inputs were combined in conditions where both would hypothetically collaborate or counteract. In each condition, subjects were subjected to 60 cycles of sinusoidal stimulation presented at 1 Hz. Gain, asymmetry, phase and angle of eye responses were calculated. Signal averaging was performed. Results Combining residual “natural” input and “artificial” VI-input resulted in an interaction in which characteristics of the resulting eye movement responses could significantly differ from those observed when responses were measured for each input separately (p < 0.0013). In the total eye response, inputs with a stronger vector magnitude seemed to have stronger weights than inputs with a lower vector magnitude, in a non-linear combination. Misalignment in the response of “artificial” VI-input was not sufficiently counteracted by well-aligned residual “natural” input. “Artificial” VI-input was able to significantly influence and counteract the response to residual “natural” input. Conclusion In the acute phase of VI-activation, residual “natural” input and “artificial” VI-input interact to generate eye movement responses in a non-linear fashion. This implies that different stimulation paradigms and more complex signal processing strategies will be required unless the brain is able to optimally combine both sources of information after adaptation during chronic use. Next to this, these findings could pave the way for using the VI as “vestibular pacemaker.”
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Affiliation(s)
- Raymond van de Berg
- Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Nils Guinand
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Maurizio Ranieri
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Samuel Cavuscens
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - T A Khoa Nguyen
- Translational Neural Engineering Lab, Center for Neuroprosthetics, Interfaculty Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Jean-Philippe Guyot
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Florence Lucieer
- Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Herman Kingma
- Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Marc van Hoof
- Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Angelica Perez-Fornos
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
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Guinand N, Van de Berg R, Cavuscens S, Ranieri M, Schneider E, Lucieer F, Kingma H, Guyot JP, Pérez Fornos A. The Video Head Impulse Test to Assess the Efficacy of Vestibular Implants in Humans. Front Neurol 2017; 8:600. [PMID: 29184530 PMCID: PMC5694451 DOI: 10.3389/fneur.2017.00600] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/27/2017] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study was to evaluate whether it is possible to restore the high-frequency angular vestibulo-ocular reflex (aVOR) in patients suffering from a severe bilateral vestibulopathy (BV) and implanted with a vestibular implant prototype. Three patients (S1–3) participated in the study. They received a prototype vestibular implant with one to three electrode branches implanted in the proximity of the ampullary branches of the vestibular nerve. Five electrodes were available for electrical stimulation: one implanted in proximity of the left posterior ampullary nerve in S1, one in the left lateral and another one in the superior ampullary nerves in S2, and one in the right lateral and another one in the superior ampullary nerves in S3. The high-frequency aVOR was assessed using the video head impulse test (EyeSeeCam; EyeSeeTec, Munich, Germany), while motion-modulated electrical stimulation was delivered via one of the implanted vestibular electrodes at a time. aVOR gains were compared to control measurements obtained in the same patients when the device was not activated. In three out of the five tested electrodes the aVOR gain increased monotonically with increased stimulation strength when head impulses were delivered in the plane of the implanted canal. In these cases, gains ranging from 0.4 to values above 1 were measured. A “reversed” aVOR could also be generated when inversed stimulation paradigms were used. In most cases, the gain for excitatory head impulses was superior to that recorded for inhibitory head impulses, consistent with unilateral vestibular stimulation. Improvements of aVOR gain were generally accompanied by a concomitant decrease of corrective saccades, providing additional evidence of an effective aVOR. High inter-electrode and inter-subject variability were observed. These results, together with previous research, demonstrate that it is possible to restore the aVOR in a broad frequency range using motion-modulated electrical stimulation of the vestibular afferents. This provides additional encouraging evidence of the possibility of achieving a useful rehabilitation alternative for patients with BV in the near future.
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Affiliation(s)
- Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.,Division of Balance Disorders, Department of ENT, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Raymond Van de Berg
- Division of Balance Disorders, Department of ENT, Maastricht University Medical Centre, Maastricht, Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Samuel Cavuscens
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Maurizio Ranieri
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Erich Schneider
- Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Floor Lucieer
- Division of Balance Disorders, Department of ENT, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Herman Kingma
- Division of Balance Disorders, Department of ENT, Maastricht University Medical Centre, Maastricht, Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Jean-Philippe Guyot
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
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Karmali F, Bermúdez Rey MC, Clark TK, Wang W, Merfeld DM. Multivariate Analyses of Balance Test Performance, Vestibular Thresholds, and Age. Front Neurol 2017; 8:578. [PMID: 29167656 PMCID: PMC5682300 DOI: 10.3389/fneur.2017.00578] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/13/2017] [Indexed: 11/30/2022] Open
Abstract
We previously published vestibular perceptual thresholds and performance in the Modified Romberg Test of Standing Balance in 105 healthy humans ranging from ages 18 to 80 (1). Self-motion thresholds in the dark included roll tilt about an earth-horizontal axis at 0.2 and 1 Hz, yaw rotation about an earth-vertical axis at 1 Hz, y-translation (interaural/lateral) at 1 Hz, and z-translation (vertical) at 1 Hz. In this study, we focus on multiple variable analyses not reported in the earlier study. Specifically, we investigate correlations (1) among the five thresholds measured and (2) between thresholds, age, and the chance of failing condition 4 of the balance test, which increases vestibular reliance by having subjects stand on foam with eyes closed. We found moderate correlations (0.30–0.51) between vestibular thresholds for different motions, both before and after using our published aging regression to remove age effects. We found that lower or higher thresholds across all threshold measures are an individual trait that account for about 60% of the variation in the population. This can be further distributed into two components with about 20% of the variation explained by aging and 40% of variation explained by a single principal component that includes similar contributions from all threshold measures. When only roll tilt 0.2 Hz thresholds and age were analyzed together, we found that the chance of failing condition 4 depends significantly on both (p = 0.006 and p = 0.013, respectively). An analysis incorporating more variables found that the chance of failing condition 4 depended significantly only on roll tilt 0.2 Hz thresholds (p = 0.046) and not age (p = 0.10), sex nor any of the other four threshold measures, suggesting that some of the age effect might be captured by the fact that vestibular thresholds increase with age. For example, at 60 years of age, the chance of failing is roughly 5% for the lowest roll tilt thresholds in our population, but this increases to 80% for the highest roll tilt thresholds. These findings demonstrate the importance of roll tilt vestibular cues for balance, even in individuals reporting no vestibular symptoms and with no evidence of vestibular dysfunction.
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Affiliation(s)
- Faisal Karmali
- Jenks Vestibular Physiology Laboratory, Mass Eye and Ear Infirmary, Boston, MA, United States.,Otolaryngology, Harvard Medical School, Harvard University, Boston, MA, United States
| | - María Carolina Bermúdez Rey
- Jenks Vestibular Physiology Laboratory, Mass Eye and Ear Infirmary, Boston, MA, United States.,Otolaryngology, Harvard Medical School, Harvard University, Boston, MA, United States
| | - Torin K Clark
- Jenks Vestibular Physiology Laboratory, Mass Eye and Ear Infirmary, Boston, MA, United States.,Otolaryngology, Harvard Medical School, Harvard University, Boston, MA, United States.,Smead Aerospace Engineering Sciences, University of Colorado, Boulder, CO, United States
| | - Wei Wang
- Otolaryngology, Harvard Medical School, Harvard University, Boston, MA, United States.,Division of Sleep Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Daniel M Merfeld
- Jenks Vestibular Physiology Laboratory, Mass Eye and Ear Infirmary, Boston, MA, United States.,Otolaryngology, Harvard Medical School, Harvard University, Boston, MA, United States
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Strupp M, Kim JS, Murofushi T, Straumann D, Jen JC, Rosengren SM, Della Santina CC, Kingma H. Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society. J Vestib Res 2017; 27:177-189. [PMID: 29081426 PMCID: PMC9249284 DOI: 10.3233/ves-170619] [Citation(s) in RCA: 308] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper describes the diagnostic criteria for bilateral vestibulopathy (BVP) by the Classification Committee of the Bárány Society. The diagnosis of BVP is based on the patient history, bedside examination and laboratory evaluation. Bilateral vestibulopathy is a chronic vestibular syndrome which is characterized by unsteadiness when walking or standing, which worsen in darkness and/or on uneven ground, or during head motion. Additionally, patients may describe head or body movement-induced blurred vision or oscillopsia. There are typically no symptoms while sitting or lying down under static conditions. The diagnosis of BVP requires bilaterally significantly impaired or absent function of the vestibulo-ocular reflex (VOR). This can be diagnosed for the high frequency range of the angular VOR by the head impulse test (HIT), the video-HIT (vHIT) and the scleral coil technique and for the low frequency range by caloric testing. The moderate range can be examined by the sinusoidal or step profile rotational chair test. For the diagnosis of BVP, the horizontal angular VOR gain on both sides should be <0.6 (angular velocity 150–300°/s) and/or the sum of the maximal peak velocities of the slow phase caloric-induced nystagmus for stimulation with warm and cold water on each side <6°/s and/or the horizontal angular VOR gain <0.1 upon sinusoidal stimulation on a rotatory chair (0.1 Hz, Vmax = 50°/sec) and/or a phase lead >68 degrees (time constant of <5 seconds). For the diagnosis of probable BVP the above mentioned symptoms and a bilaterally pathological bedside HIT are required. Complementary tests that may be used but are currently not included in the definition are: a) dynamic visual acuity (a decrease of ≥0.2 logMAR is considered pathological); b) Romberg (indicating a sensory deficit of the vestibular or somatosensory system and therefore not specific); and c) abnormal cervical and ocular vestibular-evoked myogenic potentials for otolith function. At present the scientific basis for further subdivisions into subtypes of BVP is not sufficient to put forward reliable or clinically meaningful definitions. Depending on the affected anatomical structure and frequency range, different subtypes may be better identified in the future: impaired canal function in the low- or high-frequency VOR range only and/or impaired otolith function only; the latter is evidently very rare. Bilateral vestibulopathy is a clinical syndrome and, if known, the etiology (e.g., due to ototoxicity, bilateral Menière’s disease, bilateral vestibular schwannoma) should be added to the diagnosis. Synonyms include bilateral vestibular failure, deficiency, areflexia, hypofunction and loss.
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Affiliation(s)
- Michael Strupp
- Department of Neurology and German Center for Vertigo, Hospital of the LMU Munich, Germany
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Toshihisa Murofushi
- Department of Otolaryngology, Teikyo University School of Medicine, Mizonokuchi Hospital Kawasaki, Japan
| | - Dominik Straumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland
| | - Joanna C. Jen
- Department of Neurology and Neurobiology, University of California, Los Angeles, USA
| | - Sally M. Rosengren
- Department of Neurology, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Camperdown, Sydney, Australia
| | | | - Herman Kingma
- Department of Otolaryngology, Maastricht, The Netherlands/Department of Medical Physics, Tomsk Research State University, Russian Federation
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van de Berg R, Lucieer F, Guinand N, van Tongeren J, George E, Guyot JP, Kingma H, van Hoof M, Temel Y, van Overbeeke J, Perez-Fornos A, Stokroos R. The Vestibular Implant: Hearing Preservation during Intralabyrinthine Electrode Insertion-A Case Report. Front Neurol 2017; 8:137. [PMID: 28443060 PMCID: PMC5385458 DOI: 10.3389/fneur.2017.00137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/24/2017] [Indexed: 11/30/2022] Open
Abstract
Objective The vestibular implant seems feasible as a clinically useful device in the near future. However, hearing preservation during intralabyrinthine implantation remains a challenge. It should be preserved to be able to treat patients with bilateral vestibulopathy and (partially) intact hearing. This case study investigated the feasibility of hearing preservation during the acute phase after electrode insertion in the semicircular canals. Methods A 40-year-old woman with normal hearing underwent a translabyrinthine approach for a vestibular schwannoma Koos Grade IV. Hearing was monitored using auditory brainstem response audiometry (ABR). ABR signals were recorded synchronously to video recordings of the surgery. Following the principles of soft surgery, a conventional dummy electrode was inserted in the lateral semicircular canal for several minutes and subsequently removed. The same procedure was then applied for the posterior canal. Finally, the labyrinthectomy was completed, and the schwannoma was removed. Results Surgery was performed without complications. No leakage of endolymph and no significant reduction of ABR response were observed during insertion and after removal of the electrodes from the semicircular canals, indicting no damage to the peripheral auditory function. The ABR response significantly changed when the semicircular canals were completely opened during the labyrinthectomy. This was indicated by a change in the morphology and latency of peak V of the ABR signal. Conclusion Electrode insertion in the semicircular canals is possible without acutely damaging the peripheral auditory function measured with ABR, as shown in this proof-of-principle clinical investigation.
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Affiliation(s)
- Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Florence Lucieer
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Nils Guinand
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Joost van Tongeren
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Erwin George
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jean-Philippe Guyot
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Herman Kingma
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Marc van Hoof
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jacobus van Overbeeke
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, Netherlands
| | - Angelica Perez-Fornos
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Robert Stokroos
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, Maastricht, Netherlands
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Perez Fornos A, Cavuscens S, Ranieri M, van de Berg R, Stokroos R, Kingma H, Guyot JP, Guinand N. The vestibular implant: A probe in orbit around the human balance system. J Vestib Res 2017; 27:51-61. [DOI: 10.3233/ves-170604] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Angelica Perez Fornos
- Department of Clinical Neurosciences, Service of Otorhinolaryngology, Head and Neck Surgery, University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Samuel Cavuscens
- Department of Clinical Neurosciences, Service of Otorhinolaryngology, Head and Neck Surgery, University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Maurizio Ranieri
- Department of Clinical Neurosciences, Service of Otorhinolaryngology, Head and Neck Surgery, University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center, The Netherlands
- Faculty of Physics, Tomsk State University, Russian Federation
| | - Robert Stokroos
- Department of Clinical Neurosciences, Service of Otorhinolaryngology, Head and Neck Surgery, University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Herman Kingma
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center, The Netherlands
- Faculty of Physics, Tomsk State University, Russian Federation
| | - Jean-Philippe Guyot
- Department of Clinical Neurosciences, Service of Otorhinolaryngology, Head and Neck Surgery, University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nils Guinand
- Department of Clinical Neurosciences, Service of Otorhinolaryngology, Head and Neck Surgery, University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Guinand N, Van de Berg R, Cavuscens S, Stokroos R, Ranieri M, Pelizzone M, Kingma H, Guyot JP, Pérez Fornos A. Restoring Visual Acuity in Dynamic Conditions with a Vestibular Implant. Front Neurosci 2016; 10:577. [PMID: 28066163 PMCID: PMC5177740 DOI: 10.3389/fnins.2016.00577] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 12/05/2016] [Indexed: 11/13/2022] Open
Abstract
Vestibular implants are devices designed to rehabilitate patients with a bilateral vestibular loss (BVL). These patients lack a properly functioning vestibulo-ocular reflex (VOR), which impairs gaze stabilization abilities and results in an abnormal loss of visual acuity (VA) in dynamic situations (i.e., severely limiting the patient's ability to read signs or recognize faces while walking). We previously demonstrated that the VOR can be artificially restored in a group of BVL patients fitted with a prototype vestibular implant. This study was designed to investigate whether these promising results could be translated to a close-to-reality task, significantly improving VA abilities while walking. Six BVL patients previously implanted with a vestibular implant prototype participated in the experiments. VA was determined using Sloan letters displayed on a computer screen, in four conditions: (1) with the patient standing still without moving (static), (2) while the patient was walking on a treadmill at constant speed with the vestibular implant prototype turned off (systemOFF), (3) while the patient was walking on a treadmill at constant speed with the vestibular implant prototype turned on providing coherent motion information (systemONmotion), and (4) a “placebo” condition where the patient was walking on a treadmill at constant speed with the vestibular implant prototype turned on providing reversed motion information (systemONsham). The analysis (one-way repeated measures analysis of variance) revealed a statistically significant effect of the test condition [F(3, 12) = 30.5, p < 0.001]. Significant decreases in VA were observed with the systemOFF condition when compared to the static condition (Tukey post-hoc p < 0.001). When the vestibular implant was turned on, delivering pertinent motion information (systemONmotion) the VA improved to close to normal values. The improvement disappeared in the placebo condition (systemONsham) and VA-values also dropped significantly in this condition (Tukey post-hoc p < 0.001). These results are a significant step forward in the field, demonstrating for the first time in humans that gaze stabilization abilities can be restored with a vestibular implant prototype. The vestibular implant shows considerable promise of being the first-ever effective therapeutic alternative for patients with a BVL in the near future.
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Affiliation(s)
- Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University HospitalsGeneva, Switzerland; Division of Balance Disorders, Department of ENT, Maastricht University Medical CentreMaastricht, Netherlands
| | - Raymond Van de Berg
- Division of Balance Disorders, Department of ENT, Maastricht University Medical CentreMaastricht, Netherlands; Faculty of Physics, National Research Tomsk State UniversityTomsk, Russia
| | - Samuel Cavuscens
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals Geneva, Switzerland
| | - Robert Stokroos
- Division of Balance Disorders, Department of ENT, Maastricht University Medical Centre Maastricht, Netherlands
| | - Maurizio Ranieri
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals Geneva, Switzerland
| | - Marco Pelizzone
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals Geneva, Switzerland
| | - Herman Kingma
- Division of Balance Disorders, Department of ENT, Maastricht University Medical CentreMaastricht, Netherlands; Faculty of Physics, National Research Tomsk State UniversityTomsk, Russia
| | - Jean-Philippe Guyot
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals Geneva, Switzerland
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals Geneva, Switzerland
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Guinand N, van de Berg R, Ranieri M, Cavuscens S, DiGiovanna J, Nguyen TAK, Micera S, Stokroos R, Kingma H, Guyot JP, Perez Fornos A. Vestibular implants: Hope for improving the quality of life of patients with bilateral vestibular loss. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:7192-5. [PMID: 26737951 DOI: 10.1109/embc.2015.7320051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The vestibular system plays an essential role in crucial tasks such as postural control, gaze stabilization, and spatial orientation. Currently, there is no effective treatment for a bilateral loss of the vestibular function (BVL). The quality of life of affected patients is significantly impaired. During the last decade, our group has explored the potential of using electrical stimulation to artificially restore the vestibular function. Our vestibular implant prototype consists of a custom modified cochlear implant featuring one to three vestibular electrodes implanted in the proximity of the ampullary branches of the vestibular nerve; in addition to the main cochlear array. Special surgical techniques for safe implantation of these devices have been developed. In addition, we have developed stimulation strategies to generate bidirectional eye movements as well as the necessary interfaces to capture the signal from a motion sensor (e.g., gyroscope) and use it to modulate the stimulation signals delivered to the vestibular nerves. To date, 24 vestibular electrodes have been implanted in 11 BVL patients. Using a virtual motion profile to modulate the "baseline" electrical stimulation, vestibular responses could be evoked with 21 electrodes. Eye movements with mean peak eye velocities of 32°/s and predominantly in the plane of the stimulated canal were successfully generated. These are within the range of normal compensatory eye movements during walking and were large enough to have a significant effect on the patients' visual acuity. These results indicate that electrical stimulation of the vestibular nerve has a significant functional impact; eye movements generated this way could be sufficient to restore gaze stabilization during essential everyday tasks such as walking. The innovative concept of the vestibular implant has the potential to restore the vestibular function and have a central role in improving the quality of life of BVL patients in the near future.
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Hitier M, Sato G, Zhang YF, Zheng Y, Besnard S, Smith PF, Curthoys IS. Anatomy and surgical approach of rat’s vestibular sensors and nerves. J Neurosci Methods 2016; 270:1-8. [DOI: 10.1016/j.jneumeth.2016.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/14/2016] [Accepted: 05/16/2016] [Indexed: 11/25/2022]
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36
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Nguyen TAK, DiGiovanna J, Cavuscens S, Ranieri M, Guinand N, van de Berg R, Carpaneto J, Kingma H, Guyot JP, Micera S, Fornos AP. Characterization of pulse amplitude and pulse rate modulation for a human vestibular implant during acute electrical stimulation. J Neural Eng 2016; 13:046023. [DOI: 10.1088/1741-2560/13/4/046023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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37
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Vestibular assistance systems: promises and challenges. J Neurol 2016; 263 Suppl 1:S30-5. [PMID: 27083882 PMCID: PMC4833784 DOI: 10.1007/s00415-015-7922-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/24/2015] [Accepted: 09/25/2015] [Indexed: 11/16/2022]
Abstract
The handicap resulting from a bilateral vestibular deficit is often underestimated. In most cases the deficit settles gradually. Patients do not understand what is happening to them and have many difficulties to describe their symptoms. They have to consult several doctors with different medical specialties before diagnosis. Once the diagnosis is made there is no biological way to “repair” the deficient vestibular apparatus and vestibular exercises are mildly effective. Attempts have been made to help patients using substitution devices replacing the defective vestibular information by tactile or acoustic cues. Currently, efforts are being made towards the development of a vestibular implant, conceptually similar to the cochlear implant for the rehabilitation of deaf patients. In recent years, several experiments on animal models have demonstrated the feasibility of this project. This paper reports the steps accomplished in human experiments and the main results obtained in our laboratory.
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Van Rompaey V, De Belder F, Parizel P, Van de Heyning P. Semicircular Canal Fibrosis as a Biomarker for Lateral Semicircular Canal Function Loss. Front Neurol 2016; 7:43. [PMID: 27047448 PMCID: PMC4803745 DOI: 10.3389/fneur.2016.00043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/11/2016] [Indexed: 11/13/2022] Open
Abstract
Background and purpose Radiological abnormalities at the level of the semicircular canals are frequently observed without known correlation to a pathologic condition or function. They include narrowing or sclerosis on computed tomography (CT) and narrowing or signal loss on T2-weighted magnetic resonance imaging (MRI). Our hypothesis was that these radiological abnormalities at the level of the semicircular canals reflect an aspecific but advanced stage of vestibular decay. Materials and methods Retrospective study in 35 consecutive patients with bilateral profound deafness eligible for cochlear implantation. Electronystagmography, CT, and MRI were performed as part of evaluation for cochlear implant candidacy. Results In our population, 31.4% had a bilateral lateral semicircular canal function loss, while 11.4% had a unilateral lateral semicircular canal function loss. CT-scan abnormalities did not correlate to lateral semicircular canal function loss at a statistically significant level. However, abnormalities observed on MRI correlated significantly with ipsilateral lateral semicircular canal function loss. This statistically significant difference was present not only if abnormalities were observed in at least one of the semicircular canals but also if we studied the posterior, superior, and lateral semicircular canals separately. Conclusion Semicircular canal abnormalities on T2-weighted MRI (including narrowing and/or signal loss in one or more semicircular canals) are correlated to lateral semicircular canal function loss.
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Affiliation(s)
- Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Frank De Belder
- Department of Radiology, Antwerp University Hospital , Edegem , Belgium
| | - Paul Parizel
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Paul Van de Heyning
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Lucieer F, Vonk P, Guinand N, Stokroos R, Kingma H, van de Berg R. Bilateral Vestibular Hypofunction: Insights in Etiologies, Clinical Subtypes, and Diagnostics. Front Neurol 2016; 7:26. [PMID: 26973594 PMCID: PMC4777732 DOI: 10.3389/fneur.2016.00026] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/19/2016] [Indexed: 01/03/2023] Open
Abstract
Objective To evaluate the different etiologies and clinical subtypes of bilateral vestibular hypofunction (BVH) and the value of diagnostic tools in the diagnostic process of BVH. Materials and methods A retrospective case review was performed on 154 patients diagnosed with BVH in a tertiary referral center, between 2013 and 2015. Inclusion criteria comprised (1) imbalance and/or oscillopsia during locomotion and (2) summated slow phase velocity of nystagmus of less than 20°/s during bithermal caloric tests. Results The definite etiology of BVH was determined in 47% of the cases and the probable etiology in 22%. In 31%, the etiology of BVH remained idiopathic. BVH resulted from more than 20 different etiologies. In the idiopathic group, the percentage of migraine was significantly higher compared to the non-idiopathic group (50 versus 11%, p < 0.001). Among all patients, 23.4% were known with autoimmune disorders in their medical history. All four clinical subtypes (recurrent vertigo with BVH, rapidly progressive BVH, slowly progressive BVH, and slowly progressive BVH with ataxia) were found in this population. Slowly progressive BVH with ataxia comprised only 4.5% of the cases. The head impulse test was abnormal in 94% of the cases. The torsion swing test was abnormal in 66%. Bilateral normal hearing to moderate hearing loss was found in 49%. Blood tests did not often contribute to the determination of the etiology of the disease. Abnormal cerebral imaging was found in 21 patients. Conclusion BVH is a heterogeneous condition with various etiologies and clinical characteristics. Migraine seems to play a significant role in idiopathic BVH and autoimmunity could be a modulating factor in the development of BVH. The distribution of etiologies of BVH probably depends on the clinical setting. In the diagnostic process of BVH, the routine use of some blood tests can be reconsidered and a low-threshold use of audiometry and cerebral imaging is advised. The torsion swing test is not the “gold standard” for diagnosing BVH due to its lack of sensitivity. Future diagnostic criteria of BVH should consist of standardized vestibular tests combined with a history that is congruent with the vestibular findings.
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Affiliation(s)
- F Lucieer
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, School for Mental Health and Neuroscience , Maastricht , Netherlands
| | - P Vonk
- Faculty of Health, Medicine and life Sciences, University of Maastricht , Maastricht , Netherlands
| | - N Guinand
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals , Geneva , Switzerland
| | - R Stokroos
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, School for Mental Health and Neuroscience , Maastricht , Netherlands
| | - H Kingma
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands; Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands; Faculty of Physics, Tomsk State Research University, Tomsk, Russian Federation
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Abstract
The leading symptoms of bilateral vestibulopathy (BVP) are postural imbalance and unsteadiness of gait that worsens in darkness and on uneven ground. There are typically no symptoms while sitting or lying under static conditions. A minority of patients also have movement-induced oscillopsia, in particular while walking. The diagnosis of BVP is based on a bilaterally reduced or absent function of the vestibulo-ocular reflex (VOR). This deficit is diagnosed for the high-frequency range of the angular VOR by a bilaterally pathologic bedside head impulse test (HIT) and for the low-frequency range by a bilaterally reduced or absent caloric response. If the results of the bedside HIT are unclear, angular VOR function should be quantified by a video-oculography system (vHIT). An additional test supporting the diagnosis is dynamic visual acuity. Cervical and ocular vestibular-evoked myogenic potentials (c/oVEMP) may also be reduced or absent, indicating impaired otolith function. There are different subtypes of BVP depending on the affected anatomic structure and frequency range of the VOR deficit: impaired canal function in the low- and/or high-frequency VOR range only and/or otolith function only; the latter is very rare. The etiology of BVP remains unclear in more than 50% of patients: in these cases neurodegeneration is assumed. Frequent known causes are ototoxicity mainly due to gentamicin, bilateral Menière's disease, autoimmune diseases, meningitis and bilateral vestibular schwannoma, as well as an association with cerebellar degeneration (cerebellar ataxia, neuropathy, vestibular areflexia syndrome=CANVAS). In general, in the long term there is no improvement of vestibular function. There are four treatment options: first, detailed patient counseling to explain the cause, etiology, and consequences, as well as the course of the disease; second, daily vestibular exercises and balance training; third, if possible, treatment of the underlying cause, as in bilateral Menière's disease, meningitis, or autoimmune diseases; fourth, if possible, prevention, i.e., being very restrictive with the use of ototoxic substances, such as aminoglycosides. In the future vestibular implants may also be an option.
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Affiliation(s)
- M Strupp
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany; Department of Neurology, University Hospital Munich, Campus Grosshadern, Munich, Germany.
| | - K Feil
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany; Department of Neurology, University Hospital Munich, Campus Grosshadern, Munich, Germany
| | - M Dieterich
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany; Department of Neurology, University Hospital Munich, Campus Grosshadern, Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Ludwig-Maximilians University, Munich, Germany
| | - T Brandt
- German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich, Germany; Institute for Clinical Neurosciences, University Hospital Munich, Campus Grosshadern, Munich, Germany
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Gay A, Guinand N, Miffon M, Guyot JP. Perception of Discomfort Caused by a Unilateral Hearing Loss in People Suffering from a Total Bilateral Vestibular Loss. ORL J Otorhinolaryngol Relat Spec 2015; 77:248-253. [DOI: 10.1159/000433552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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42
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van de Berg R, van Tilburg M, Kingma H. Bilateral Vestibular Hypofunction: Challenges in Establishing the Diagnosis in Adults. ORL J Otorhinolaryngol Relat Spec 2015; 77:197-218. [DOI: 10.1159/000433549] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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43
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Guinand N, van de Berg R, Cavuscens S, Stokroos RJ, Ranieri M, Pelizzone M, Kingma H, Guyot JP, Perez-Fornos A. Vestibular Implants: 8 Years of Experience with Electrical Stimulation of the Vestibular Nerve in 11 Patients with Bilateral Vestibular Loss. ORL J Otorhinolaryngol Relat Spec 2015; 77:227-240. [PMID: 26367113 DOI: 10.1159/000433554] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The concept of the vestibular implant is primarily to artificially restore the vestibular function in patients with a bilateral vestibular loss (BVL) by providing the central nervous system with motion information using electrical stimulation of the vestibular nerve. Our group initiated human trials about 10 years ago. METHODS Between 2007 and 2013, 11 patients with a BVL received a vestibular implant prototype providing electrodes to stimulate the ampullary branches of the vestibular nerve. Eye movements were recorded and analyzed to assess the effects of the electrical stimulation. Perception induced by electrical stimulation was documented. RESULTS Smooth, controlled eye movements were obtained in all patients showing that electrical stimulation successfully activated the vestibulo-ocular pathway. However, both the electrical dynamic range and the amplitude of the eye movements were variable from patient to patient. The axis of the response was consistent with the stimulated nerve branch in 17 out of the 24 tested electrodes. Furthermore, in at least 1 case, the elicited eye movements showed characteristics similar to those of compensatory eye movements observed during natural activities such as walking. Finally, diverse percepts were reported upon electrical stimulation (i.e., rotatory sensations, sound, tickling or pressure) with intensity increasing as the stimulation current increased. CONCLUSIONS These results demonstrate that electrical stimulation is a safe and effective means to activate the vestibular system, even in a heterogeneous patient population with very different etiologies and disease durations. Successful tuning of this information could turn this vestibular implant prototype into a successful artificial balance organ.
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Marianelli P, Capogrosso M, Bassi Luciani L, Panarese A, Micera S. A Computational Framework for Electrical Stimulation of Vestibular Nerve. IEEE Trans Neural Syst Rehabil Eng 2015; 23:897-909. [DOI: 10.1109/tnsre.2015.2407861] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sun DQ, Lehar M, Dai C, Swarthout L, Lauer AM, Carey JP, Mitchell DE, Cullen KE, Santina CCD. Histopathologic Changes of the Inner ear in Rhesus Monkeys After Intratympanic Gentamicin Injection and Vestibular Prosthesis Electrode Array Implantation. J Assoc Res Otolaryngol 2015; 16:373-87. [PMID: 25790951 PMCID: PMC4417088 DOI: 10.1007/s10162-015-0515-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/02/2015] [Indexed: 11/29/2022] Open
Abstract
Bilateral vestibular deficiency (BVD) due to gentamicin ototoxicity can significantly impact quality of life and result in large socioeconomic burdens. Restoring sensation of head rotation using an implantable multichannel vestibular prosthesis (MVP) is a promising treatment approach that has been tested in animals and humans. However, uncertainty remains regarding the histopathologic effects of gentamicin ototoxicity alone or in combination with electrode implantation. Understanding these histological changes is important because selective MVP-driven stimulation of semicircular canals (SCCs) depends on persistence of primary afferent innervation in each SCC crista despite both the primary cause of BVD (e.g., ototoxic injury) and surgical trauma associated with MVP implantation. Retraction of primary afferents out of the cristae and back toward Scarpa's ganglion would render spatially selective stimulation difficult to achieve and could limit utility of an MVP that relies on electrodes implanted in the lumen of each ampulla. We investigated histopathologic changes of the inner ear associated with intratympanic gentamicin (ITG) injection and/or MVP electrode array implantation in 11 temporal bones from six rhesus macaque monkeys. Hematoxylin and eosin-stained 10-μm temporal bone sections were examined under light microscopy for four treatment groups: normal (three ears), ITG-only (two ears), MVP-only (two ears), and ITG + MVP (four ears). We estimated vestibular hair cell (HC) surface densities for each sensory neuroepithelium and compared findings across end organs and treatment groups. In ITG-only, MVP-only, and ITG + MVP ears, we observed decreased but persistent ampullary nerve fibers of SCC cristae despite ITG treatment and/or MVP electrode implantation. ITG-only and ITG + MVP ears exhibited neuroepithelial thinning and loss of type I HCs in the cristae but little effect on the maculae. MVP-only and ITG + MVP ears exhibited no signs of trauma to the cochlea or otolith end organs except in a single case of saccular injury due to over-insertion of the posterior SCC electrode. While implanted electrodes reached to within 50-760 μm of the target cristae and were usually ensheathed in a thin fibrotic capsule, dense fibrotic reaction and osteoneogenesis were each observed in only one of six electrode tracts examined. Consistent with physiologic studies that have demonstrated directionally appropriate vestibulo-ocular reflex responses to MVP electrical stimulation years after implantation in these animals, histologic findings in the present study indicate that although intralabyrinthine MVP implantation causes some inner ear trauma, it can be accomplished without destroying the distal afferent fibers an MVP is designed to excite.
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Affiliation(s)
- Daniel Q. Sun
- />Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
- />Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Outpatient Center, 6th floor, 601 North Caroline Street, Baltimore, MD 21287 USA
| | - Mohamed Lehar
- />Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Chenkai Dai
- />Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Lani Swarthout
- />Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Amanda M. Lauer
- />Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - John P. Carey
- />Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | | | | | - Charles C. Della Santina
- />Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
- />Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Phillips C, Ling L, Oxford T, Nowack A, Nie K, Rubinstein JT, Phillips JO. Longitudinal performance of an implantable vestibular prosthesis. Hear Res 2015; 322:200-11. [PMID: 25245586 PMCID: PMC4369472 DOI: 10.1016/j.heares.2014.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/20/2014] [Accepted: 09/08/2014] [Indexed: 11/30/2022]
Abstract
Loss of vestibular function may be treatable with an implantable vestibular prosthesis that stimulates semicircular canal afferents with biphasic pulse trains. Several studies have demonstrated short-term activation of the vestibulo-ocular reflex (VOR) with electrical stimulation. Fewer long-term studies have been restricted to small numbers of animals and stimulation designed to produce adaptive changes in the electrically elicited response. This study is the first large consecutive series of implanted rhesus macaque to be studied longitudinally using brief stimuli designed to limit adaptive changes in response, so that the efficacy of electrical activation can be studied over time, across surgeries, canals and animals. The implantation of a vestibular prosthesis in animals with intact vestibular end organs produces variable responses to electrical stimulation across canals and animals, which change in threshold for electrical activation of eye movements and in elicited slow phase velocities over time. These thresholds are consistently lower, and the slow phase velocities higher, than those obtained in human subjects. The changes do not appear to be correlated with changes in electrode impedance. The variability in response suggests that empirically derived transfer functions may be required to optimize the response of individual canals to a vestibular prosthesis, and that this function may need to be remapped over time. This article is part of a Special Issue entitled .
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Affiliation(s)
| | - Leo Ling
- Otolaryngology - HNS, University of Washington, Seattle, WA, USA; Washington National Primate Research Center, University of Washington, Seattle, WA, USA
| | - Trey Oxford
- Washington National Primate Research Center, University of Washington, Seattle, WA, USA
| | - Amy Nowack
- Washington National Primate Research Center, University of Washington, Seattle, WA, USA
| | - Kaibao Nie
- Otolaryngology - HNS, University of Washington, Seattle, WA, USA; Electrical Engineering, University of Washington, Seattle, WA, USA
| | - Jay T Rubinstein
- Otolaryngology - HNS, University of Washington, Seattle, WA, USA; Bioengineering, University of Washington, Seattle, WA, USA
| | - James O Phillips
- Otolaryngology - HNS, University of Washington, Seattle, WA, USA; Washington National Primate Research Center, University of Washington, Seattle, WA, USA.
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Phillips JO, Ling L, Nie K, Jameyson E, Phillips CM, Nowack AL, Golub JS, Rubinstein JT. Vestibular implantation and longitudinal electrical stimulation of the semicircular canal afferents in human subjects. J Neurophysiol 2015; 113:3866-92. [PMID: 25652917 DOI: 10.1152/jn.00171.2013] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 02/02/2015] [Indexed: 11/22/2022] Open
Abstract
Animal experiments and limited data in humans suggest that electrical stimulation of the vestibular end organs could be used to treat loss of vestibular function. In this paper we demonstrate that canal-specific two-dimensionally (2D) measured eye velocities are elicited from intermittent brief 2 s biphasic pulse electrical stimulation in four human subjects implanted with a vestibular prosthesis. The 2D measured direction of the slow phase eye movements changed with the canal stimulated. Increasing pulse current over a 0-400 μA range typically produced a monotonic increase in slow phase eye velocity. The responses decremented or in some cases fluctuated over time in most implanted canals but could be partially restored by changing the return path of the stimulation current. Implantation of the device in Meniere's patients produced hearing and vestibular loss in the implanted ear. Electrical stimulation was well tolerated, producing no sensation of pain, nausea, or auditory percept with stimulation that elicited robust eye movements. There were changes in slow phase eye velocity with current and over time, and changes in electrically evoked compound action potentials produced by stimulation and recorded with the implanted device. Perceived rotation in subjects was consistent with the slow phase eye movements in direction and scaled with stimulation current in magnitude. These results suggest that electrical stimulation of the vestibular end organ in human subjects provided controlled vestibular inputs over time, but in Meniere's patients this apparently came at the cost of hearing and vestibular function in the implanted ear.
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Affiliation(s)
- James O Phillips
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington; National Primate Research Center, University of Washington, Seattle, Washington; and Virginia Merrill Bloedel Hearing Research Center, University of Washington, Seattle, Washington
| | - Leo Ling
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington; National Primate Research Center, University of Washington, Seattle, Washington; and
| | - Kaibao Nie
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington; Virginia Merrill Bloedel Hearing Research Center, University of Washington, Seattle, Washington
| | - Elyse Jameyson
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington
| | - Christopher M Phillips
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington; National Primate Research Center, University of Washington, Seattle, Washington; and
| | - Amy L Nowack
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington; National Primate Research Center, University of Washington, Seattle, Washington; and
| | - Justin S Golub
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington
| | - Jay T Rubinstein
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington; Department of Bioengineering, University of Washington, Seattle, Washington; National Primate Research Center, University of Washington, Seattle, Washington; and Virginia Merrill Bloedel Hearing Research Center, University of Washington, Seattle, Washington
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Pelizzone M, Fornos AP, Guinand N, van de Berg R, Kos I, Stokroos R, Kingma H, Guyot JP. First functional rehabilitation via vestibular implants. Cochlear Implants Int 2015; 15 Suppl 1:S62-4. [PMID: 24869447 DOI: 10.1179/1467010014z.000000000165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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van de Berg R, Guinand N, Nguyen TAK, Ranieri M, Cavuscens S, Guyot JP, Stokroos R, Kingma H, Perez-Fornos A. The vestibular implant: frequency-dependency of the electrically evoked vestibulo-ocular reflex in humans. Front Syst Neurosci 2015; 8:255. [PMID: 25653601 PMCID: PMC4299437 DOI: 10.3389/fnsys.2014.00255] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 12/29/2014] [Indexed: 12/05/2022] Open
Abstract
The vestibulo-ocular reflex (VOR) shows frequency-dependent behavior. This study investigated whether the characteristics of the electrically evoked VOR (eVOR) elicited by a vestibular implant, showed the same frequency-dependency. Twelve vestibular electrodes implanted in seven patients with bilateral vestibular hypofunction (BVH) were tested. Stimuli consisted of amplitude-modulated electrical stimulation with a sinusoidal profile at frequencies of 0.5, 1, and 2 Hz. The main characteristics of the eVOR were evaluated and compared to the “natural” VOR characteristics measured in a group of age-matched healthy volunteers who were subjected to horizontal whole body rotations with equivalent sinusoidal velocity profiles at the same frequencies. A strong and significant effect of frequency was observed in the total peak eye velocity of the eVOR. This effect was similar to that observed in the “natural” VOR. Other characteristics of the (e)VOR (angle, habituation-index, and asymmetry) showed no significant frequency-dependent effect. In conclusion, this study demonstrates that, at least at the specific (limited) frequency range tested, responses elicited by a vestibular implant closely mimic the frequency-dependency of the “normal” vestibular system.
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Affiliation(s)
- Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center Maastricht, Netherlands ; Faculty of Physics, Tomsk State University Tomsk, Russia
| | - Nils Guinand
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals Geneva, Switzerland
| | - T A Khoa Nguyen
- Translational Neural Engineering Lab, Center for Neuroprosthetics, Interfaculty Institute of Bioengineering, École Polytechnique Fédérale de Lausanne Lausanne, Switzerland
| | - Maurizio Ranieri
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals Geneva, Switzerland
| | - Samuel Cavuscens
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals Geneva, Switzerland
| | - Jean-Philippe Guyot
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals Geneva, Switzerland
| | - Robert Stokroos
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center Maastricht, Netherlands
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center Maastricht, Netherlands ; Faculty of Physics, Tomsk State University Tomsk, Russia
| | - Angelica Perez-Fornos
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals Geneva, Switzerland
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Perez Fornos A, Guinand N, van de Berg R, Stokroos R, Micera S, Kingma H, Pelizzone M, Guyot JP. Artificial balance: restoration of the vestibulo-ocular reflex in humans with a prototype vestibular neuroprosthesis. Front Neurol 2014; 5:66. [PMID: 24808890 PMCID: PMC4010770 DOI: 10.3389/fneur.2014.00066] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 04/16/2014] [Indexed: 12/05/2022] Open
Abstract
The vestibular system plays a crucial role in the multisensory control of balance. When vestibular function is lost, essential tasks such as postural control, gaze stabilization, and spatial orientation are limited and the quality of life of patients is significantly impaired. Currently, there is no effective treatment for bilateral vestibular deficits. Research efforts both in animals and humans during the last decade set a solid background to the concept of using electrical stimulation to restore vestibular function. Still, the potential clinical benefit of a vestibular neuroprosthesis has to be demonstrated to pave the way for a translation into clinical trials. An important parameter for the assessment of vestibular function is the vestibulo-ocular reflex (VOR), the primary mechanism responsible for maintaining the perception of a stable visual environment while moving. Here we show that the VOR can be artificially restored in humans using motion-controlled, amplitude modulated electrical stimulation of the ampullary branches of the vestibular nerve. Three patients received a vestibular neuroprosthesis prototype, consisting of a modified cochlear implant providing vestibular electrodes. Significantly higher VOR responses were observed when the prototype was turned ON. Furthermore, VOR responses increased significantly as the intensity of the stimulation increased, reaching on average 79% of those measured in healthy volunteers in the same experimental conditions. These results constitute a fundamental milestone and allow us to envision for the first time clinically useful rehabilitation of patients with bilateral vestibular loss.
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Affiliation(s)
- Angelica Perez Fornos
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals , Geneva , Switzerland
| | - Nils Guinand
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals , Geneva , Switzerland
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center , Maastricht , Netherlands
| | - Robert Stokroos
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center , Maastricht , Netherlands
| | - Silvestro Micera
- Translational Neural Engineering Laboratory, Center for Neuroprosthetics, Institute of Bioengineering, École Polytechnique Fédérale de Lausanne , Lausanne , Switzerland ; The BioRobotics Institute, Scuola Superiore Sant'Anna , Pisa , Italy
| | - Herman Kingma
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Center , Maastricht , Netherlands
| | - Marco Pelizzone
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals , Geneva , Switzerland
| | - Jean-Philippe Guyot
- Service of Otorhinolaryngology and Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals , Geneva , Switzerland
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