Department of Otorhinolaryngology & Head and Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, P. Debyelaan 25, Maastricht, 6202 AZ, The Netherlands.
Department of Otolaryngology and Neurology, Harvard Medical School, Boston, MA, USA.
J Assoc Res Otolaryngol. 2023 Aug;24(4):401-412. doi: 10.1007/s10162-023-00906-1. Epub 2023 Jul 29.
Patients with bilateral vestibulopathy suffer from a variety of complaints, leading to a high individual and social burden. Available treatments aim to alleviate the impact of this loss and improve compensatory strategies. Early experiments with electrical stimulation of the vestibular nerve in combination with knowledge gained by cochlear implant research, have inspired the development of a vestibular neuroprosthesis that can provide the missing vestibular input. The feasibility of this concept was first demonstrated in animals and later in humans. Currently, several research groups around the world are investigating prototype vestibular implants, in the form of vestibular implants as well as combined cochlear and vestibular implants. The aim of this review is to convey the presentations and discussions from the identically named symposium that was held during the 2021 MidWinter Meeting of the Association for Research in Otolaryngology, with researchers involved in the development of vestibular implants targeting the ampullary nerves. Substantial advancements in the development have been made. Yet, research and development processes face several challenges to improve this neuroprosthesis. These include, but are not limited to, optimization of the electrical stimulation profile, refining the surgical implantation procedure, preserving residual labyrinthine functions including hearing, as well as gaining regulatory approval and establishing a clinical care infrastructure similar to what exists for cochlear implants. It is believed by the authors that overcoming these challenges will accelerate the development and increase the impact of a clinically applicable vestibular implant.
双侧前庭病患者会出现各种不适，导致个人和社会负担沉重。现有的治疗方法旨在减轻这种损失的影响，并改善代偿策略。早期对前庭神经进行电刺激的实验结合了耳蜗植入研究获得的知识，激发了前庭神经假体的发展，该假体可以提供缺失的前庭输入。这一概念的可行性首先在动物身上得到了验证，后来在人类身上也得到了验证。目前，世界各地的几个研究小组正在研究原型前庭植入物，包括前庭植入物以及耳蜗和前庭联合植入物。本文回顾的目的是传达在 2021 年听觉研究协会冬季中期会议上同名专题讨论会上的演讲和讨论，该专题讨论涉及针对壶腹神经的前庭植入物的研究人员。在开发方面已经取得了实质性的进展。然而，研究和开发过程面临着许多挑战，需要改进这种神经假体。这些挑战包括但不限于优化电刺激方案、改进手术植入程序、保留残余迷路功能（包括听力），以及获得监管部门的批准，并建立类似于耳蜗植入物的临床护理基础设施。作者认为，克服这些挑战将加速临床应用前庭植入物的开发和应用。
