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REVIEW ARTICLES
Vestibular Implants: A Literature Review
Vestibüler Ä°mplantlar: Literatür Derlemesi
Received Date : 08 Sep 2022
Accepted Date : 23 Sep 2022
Available Online : 26 Sep 2022
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Mustafa KARABULUTa, Banu MÃœJDECÄ°b
aMaastricht Üniversitesi Tıp Merkezi, Kulak Burun Boğaz Hastalıkları ABD, Maastricht, Hollanda bAnkara Yıldırım Beyazıt Üniversitesi Sağlık Bilimleri Fakültesi, Odyoloji Bölümü, Ankara, Türkiye
Doi: 10.24179/kbbbbc.2022-93282 - Makale Dili: TR
KBB ve BBC Dergisi. 2022;30(4):224-31
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Vestibular implant (VI) is a prosthesis that aims to restore bilaterally damaged peripheral vestibular function. VI fundamentally consists of three key components. (1) Gyroscopes and/or accelerometers, (2) An external processor, and (3) implanted stimulator. VI is applied to patients with bilateral vestibulopathy (BVP). In order to restore peripheral vestibular function, a new artificial (electrical) baseline stimulation needs to be created as the peripheral vestibular physiology is bilaterally damaged in patients with BVP. After adjusting the new artificial baseline stimulation with the vestibular implant, motion modulations are applied in order to adapt the individuals to the new electrical stimulation. VI research-based implantation criteria basically consist of 2 main processes: Bilaterally reduced or absent peripheral vestibular function as a result of the caloric test, rotational chair test (video) head impulse test and (2) the presence of severe vestibular function with the chronic symptoms such as imbalance and oscillopsia. However, one should pay attention to the existence of extra criteria. Regarding VI surgery, two different types of surgical approaches, intralabyrinthine and extralabyrinthine, can be used. Although both approaches have pros and cons, the most preferred approach is the intralabyrinthine approach. Intraoperative measurements are also performed during the surgery in order to assess the integrity of the implant and the appropriateness of the placement of the electrodes. The VI started with animal experiments and has been currently continuing with research based on humans. The aim of this review is to address fundamental knowledge and convey the scientific results on vestibular implants.
Keywords: Vestibular implant; bilateral vestibulopathy; bilateral vestibular loss; electrical stimulation; vestibular prosthesis; vestibulo-ocular reflex
ÖZET
Vestibüler implant (Vİ), bilateral olarak fonksiyonu bozulmuş periferik vestibüler sistemi tekrar onarmayı amaçlayan bir protezdir. Temel olarak 3 bileşenden oluşmaktadır: (1) Jiroskoplar ve/veya ivmeölçerler (2) dış işlemci ve (3) implante edilmiş bir uyarıcıdır. VI bilateral vestibülopatisi (BVP) olan hastalara uygulanmaktadır. BVP’si olan bireylerde, vestibüler fizyolojinin bozulması nedeniyle sistemi restore edebilmek için, yapay olarak (elektriksel) yeni bir temel ateşleme hızının oluşturulması gerekmektedir. Vestibüler implant ile yeni temel ateşleme hızı ayarlanmasının ardından, baş hareket modülasyonları uygulanarak, bireyin yeni elektriksel uyarıma uyumu sağlanmaktadır. Vİ araştırma bazlı implantasyon kriterleri temelde 2 ana süreçten oluşmaktadır: (1) Kalorik test, rotasyonel sandalye testi (video), baş savurma testi sonucunda her iki kulakta azalmış veya mevcut olmayan vestibüler fonksiyonun saptanması ve (2) kronik dengesizlik ve osilopsi gibi kronik semptomların var olduğu ileri derecede vestibüler fonksiyon kaybıdır. Ancak ekstra kriterlerin varlığına dikkat edilmelidir. VI cerrahisinde intralabirentin ve ekstralabirentin olmak üzere iki farklı cerrahi yaklaşım kullanılabilir. Her iki yaklaşımın avantaj ve dezavantajları olmasına rağmen en çok tercih edilen intralabirentin yaklaşımıdır. Cerrahi süreç esnasında implantın bütünlüğünü ve elektrotların yerleşiminin uygunluğunu değerlendirmek için intraoperatif ölçümler uygulanmaktadır. Vestibüler implantlar, hayvan deneyleri ile başlamış olup günümüzde insanlar üzerinde araştırma tabanlı olarak uygulanmaya devam etmektedir. Bu gözden geçirme yazısında Vİ’ye yönelik temel bilgilerin ele alınması ve literatür sonuçlarının aktarılması amaçlanmıştır.
Anahtar Kelimeler: Vestibüler implant; bilateral vestibülopati; bilateral vestibüler bozukluk; elektriksel uyarım; vestibüler protez; vestibülooküler refleks
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