Implant improves quality of life in patients with bilateral vestibular hypofunction

Getting around without having to focus on every step is something most of us can take as a result because our inner ears are driving reflexes that maintain balance automatically. However, for approximately 1.8 million adults worldwide with bilateral vestibular hypofunction (BVH) – loss of sense of balance of the inner ears – walking requires constant attention to avoid falls.

Now, Johns Hopkins Medicine researchers have shown that they can enable walking, relieve colds and improve quality of life in patients with BVH by introducing an electronically stimulating device that avoiding areas that are wrong in the inner ear and restoring a sense of balance to some extent.

Results from their study of eight patients using the device are published today in the New England Journal of Medicine.

To maintain balance as they move through the world around us, our brains receive and process data from many sensory systems, including vision, proprioception (muscles and joints) and vestibular sensation from the inner ears. People with BVH have difficulty keeping their eyes, head and body stable. Head movements cause their vision to jump and blur, and walking requires conscious effort. In dealing with this mental disorder, people with BVH suffer a greater than thirty increase in the risk of falls and the social stigma that seems to make them walk like someone who is drunk.

Conventional treatment for BVH is limited to vestibular rehabilitation exercises. Doctors advise their patients with BVH to avoid medications that damage the inner ear (ototoxic drugs) or inhibit brain activity (sedatives), and warn them to avoid clean guidance from activities that may endanger them or others, such as driving, swimming and walking in. lit fields.

“While around 20 people have been implanted elsewhere with devices used to stimulate the vestibular nerve in a laboratory setting, participants in this trial are true pioneers – the first a man who used a vestibular implant as a long-term, 24-hour-a-day sensory restoration treatment, ”says study lead author Charley Della Santina, MD, Ph.D., professor of head and neck surgery otolaryngology and engineering biochemist at Johns Hopkins University School of Medicine and director of the Johns Hopkins Vestibular NeuroEngineering Laboratory, who conducted the study.

To achieve this milestone, Della Santina and her colleagues used basic research and engineering technology to modify a cochlear implant – a device that improves hearing loss by stimulating the cochlear electricity of the inner ear – to the nerve activated nearby vestibular in response to signals from a motion sensor on the patient’s head. The strength and timing of electronic movement provides information about the speed and direction of movement of the patient’s head which, in turn, drives head and eye reflexes that help maintain a clearer vision during head movement and reduces the need for conscious effort to avoid waterfalls.

In their study, Johns Hopkins Medicine researchers evaluated eight patients with BVH who received the vestibular implant, assessing changes in postural stability, walking, hearing, and patient-reported outcomes, including cooling and quality of life. Assessments were performed before implant surgery (the baseline measurement) and at six months and a year later. Moderate scores for the group improved on four of the five posture and gait measurements, and on three of the four patient-reported outcomes.

All eight patients had hearing loss in the affected ear. Five held in-ear hearing aid enough to use a phone without hearing aid, and three suffered more hearing loss.

The improvement in routine clinical trials of balance and walking has been remarkable. Even more thankful is that our patients have been able to return to activities that add to their daily lives, such as exercise, cycling, gardening or dancing at a girl’s wedding. “

Margaret Chow, Principal Research Author and Doctoral Candidate, Biomedical Engineering, Johns Hopkins University

Overall, the improvement in quality of life and relief from BVH distress has been life-changing, says A’ndrea Messer, Ph.D., one of the patients diagnosed in a Johns Medicine study Hopkins and senior science and research information officer at Penn State University.

“The multichannel vestibular implant is amazing,” Messer says. “Before I got it, I couldn’t walk in the dark, on uneven ground or without a rod. Now, I can do all these things and live a very normal life. . “