Document Detail


Progress toward development of a multichannel vestibular prosthesis for treatment of bilateral vestibular deficiency.
MedLine Citation:
PMID:  23044664     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This article reviews vestibular pathology and the requirements and progress made in the design and construction of a vestibular prosthesis. Bilateral loss of vestibular sensation is disabling. When vestibular hair cells are injured by ototoxic medications or other insults to the labyrinth, the resulting loss of sensory input disrupts vestibulo-ocular reflexes (VORs) and vestibulo-spinal reflexes that normally stabilize the eyes and body. Affected individuals suffer poor vision during head movement, postural instability, chronic disequilibrium, and cognitive distraction. Although most individuals with residual sensation compensate for their loss over time, others fail to do so and have no adequate treatment options. A vestibular prosthesis analogous to cochlear implants but designed to modulate vestibular nerve activity during head movement should improve quality of life for these chronically dizzy individuals. We describe the impact of bilateral loss of vestibular sensation, animal studies supporting feasibility of prosthetic vestibular stimulation, the current status of multichannel vestibular sensory replacement prosthesis development, and challenges to successfully realizing this approach in clinical practice. In bilaterally vestibular-deficient rodents and rhesus monkeys, the Johns Hopkins multichannel vestibular prosthesis (MVP) partially restores the three-dimensional (3D) VOR for head rotations about any axis. Attempts at prosthetic vestibular stimulation of humans have not yet included the 3D eye movement assays necessary to accurately evaluate VOR alignment, but these initial forays have revealed responses that are otherwise comparable to observations in animals. Current efforts now focus on refining electrode design and surgical technique to enhance stimulus selectivity and preserve cochlear function, optimizing stimulus protocols to improve dynamic range and reduce excitation-inhibition asymmetry, and adapting laboratory MVP prototypes into devices appropriate for use in clinical trials.
Authors:
Gene Y Fridman; Charles C Della Santina
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review     Date:  2012-10-08
Journal Detail:
Title:  Anatomical record (Hoboken, N.J. : 2007)     Volume:  295     ISSN:  1932-8494     ISO Abbreviation:  Anat Rec (Hoboken)     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-23     Completed Date:  2013-04-04     Revised Date:  2014-04-07    
Medline Journal Info:
Nlm Unique ID:  101292775     Medline TA:  Anat Rec (Hoboken)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2010-29     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Wiley Periodicals, Inc.
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MeSH Terms
Descriptor/Qualifier:
Animals
Electric Stimulation
Humans
Prostheses and Implants*
Prosthesis Implantation*
Vestibular Diseases / therapy*
Vestibule, Labyrinth / innervation*,  physiology
Grant Support
ID/Acronym/Agency:
R01 DC009255/DC/NIDCD NIH HHS; R01DC9255/DC/NIDCD NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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