The vestibular implant: quo vadis?

Raymond van de Berg, Nils Guinand, Robert J Stokroos, Jean-Philippe Guyot, Herman Kingma, Raymond van de Berg, Nils Guinand, Robert J Stokroos, Jean-Philippe Guyot, Herman Kingma

Abstract

Objective: To assess the progress of the development of the vestibular implant (VI) and its feasibility short-term.

Data sources: A search was performed in Pubmed, Medline, and Embase. Key words used were "vestibular prosth*" and "VI." The only search limit was language: English or Dutch. Additional sources were medical books, conference lectures and our personal experience with per-operative vestibular stimulation in patients selected for cochlear implantation.

Study selection: All studies about the VI and related topics were included and evaluated by two reviewers. No study was excluded since every study investigated different aspects of the VI.

Data extraction and synthesis: Data was extracted by the first author from selected reports, supplemented by additional information, medical books conference lectures. Since each study had its own point of interest with its own outcomes, it was not possible to compare data of different studies.

Conclusion: To use a basic VI in humans seems feasible in the very near future. Investigations show that electric stimulation of the canal nerves induces a nystagmus which corresponds to the plane of the canal which is innervated by the stimulated nerve branch. The brain is able to adapt to a higher baseline stimulation, while still reacting on a dynamic component. The best response will be achieved by a combination of the optimal stimulus (stimulus profile, stimulus location, precompensation), complemented by central vestibular adaptation. The degree of response will probably vary between individuals, depending on pathology and their ability to adapt.

Keywords: acclimation; adaptation; bilateral vestibular areflexia; bilateral vestibulopathy; neural prosthesis; vestibular implant; vestibular prosthesis.

Figures

Figure 1
Figure 1
Biphasic rectangular pulse. This means that there are two phases with charge delivery. The first phase is the cathodic (negative) one (A), after that there is a delay (B). The anodic (positive) phase follows (C), which has the same charge as the cathodic one, but with a positive charge instead of a negative. In this way the charge remains balanced. The last phase is the resting phase (D). The duration of it determines the frequency of the stimulus. A longer duration of phase D implies less pulses per second (pps) and thus a lower stimulus frequency. The shape of all the phases are rectangular and a current is delivered, instead of a voltage.
Figure 2
Figure 2
Monophasic pulse.
Figure 3
Figure 3
Pseudomonophasic pulse.
Figure 4
Figure 4
Delayed pseudomonophasic pulse.
Figure 5
Figure 5
Continuous 1-co-sinusoidal stimulation.

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