Continuous Restoration of the Human Vestibulo-Ocular Reflex Using a Multichannel Vestibular Implant
Boutros, Peter J
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Bilateral loss of vestibular sensation causes blurry vision during head movement, postural instability, chronic unsteadiness, and an increased fall risk. Individuals who fail to compensate despite rehabilitation therapy and cessation of exacerbating medications have no adequate treatment options. Inspired by the success of cochlear implants in restoring hearing, prosthetic stimulation of vestibular afferent neurons to encode head motion has been investigated as a potential treatment. Until now, no human had been continuously stimulated for more than a day, and human responses had not been assessed using 3-dimensional (3D) binocular oculography, without which one cannot determine whether an implant independently stimulates each of the implanted ear’s three semicircular canals. We report 3D binocular vestibulo-ocular reflex (VOR) responses in four human subjects with bilateral vestibular loss who were each implanted with a system designed to provide long-term motion-modulated prosthetic stimulation via electrodes in the semicircular canals of one ear. Initiation of prosthetic stimulation evoked nystagmus that decayed within 30 minutes. Stimulation targeting one canal produced 3D VOR responses aligned with that canal’s anatomic axis, while targeting canal pairs reliably yielded responses aligned with a vector sum of individual responses. Over 8 weeks of continuous use, modulated electrical stimulation produced robust and stable VOR responses that grew predictably with stimulus intensity and aligned approximately with any specified 3D head rotation axis. Combining mechanical and electrical stimulation enhanced low frequency responses. These results demonstrate that a vestibular implant can partially restore 3D inner ear sensation to individuals disabled by vestibular loss. Lastly, we show that temporal discretization inherent to cochlear implant signal processing has minimal effects on evoked responses, motivating a future combined device.