Sensory substitution devices for bilateral vestibular loss

Timothy C. Hain, MD • Last revision: September 29, 2022

See also: bilat_causebilat_preventBilat_recentbilat_vngentamicin_toxicityototoxic_dropsototoxins progressive_bilateral regeneration sensory_substitution

When a sense breaks down, it is quite reasonable to attempt to substitute other senses. At this writing, there are several approaches that have been tried, but none of them work well enough for most people to adopt them. The purpose of this page is to review the current state of the art for these devices. The devices that we will review are in the following categories.

In the long run, it seems to us that hair cell regeneration is the most likely to succeed route for recovery from gentamicin ototoxicity. Sensory substitution, using non-vestibular input such as vibrotactile, seems tous to be the most likely route for amelioration of vestibular nerve injury.

Galvanic stimulation

It has been suggested that external electrical current might be used to substitute for loss of inner ear function. (Scinicariello, Eaton et al. 2001; Orlov, Stolbkov et al. 2008). At the present writing, these efforts have not been translated into a usable device. Logically, it would seem difficult to imagine that a disorganized mass current flow from an external electrode could substitute for a spatially separate input from each semicircular canal.  Perhap a "hybrid" device with a set of electrodes in a mastoid cavity combined with an external stimulator would be worth trying however.

There is also a new literature about adding noise to the vestibular input using galvanic stimulation. This is reviewed here.

Auditory stimulation

It seems reasonable that auditory input might be used to assist with balance. Some effort has been made (Lee, Wong et al. 1996; Wong, Mak et al. 2001; Dozza, Chiari et al. 2004; Dozza, Chiari et al. 2005; Dozza, Chiari et al. 2006; Dozza, Horak et al. 2007; Ernst, Singbartl et al. 2007; Basta, Singbartl et al. 2008.

This direction seems reasonable to us and we hope that commercial devices emerge.

Vestibular implants -- see this page.


Tongue Input (TDU) or "brainport" device

In a bizarre twist, there have been efforts to replace vestibular input using a tongue stimulator. (Tyler, Danilov et al. 2003; Danilov, Tyler et al. 2006; Danilov, Tyler et al. 2007; Vuillerme, Chenu et al. 2008; Vuillerme and Cuisinier 2008; Uneri and Polat 2009; Vuillerme and Cuisinier 2009; Wood, Black et al. 2009). Imagine --going around with a head-mounted paddle on your tongue ! Follow the TDU link for more details.

Vibrotactile input

It is somewhat reasonable that vibration input to the body might substitute for vestibular input, and again there has been considerable work done here. (Mackenzie, McCracken et al. 1997; Rochlis and Newman 2000; Kentala, Vivas et al. 2003; Nagel, Carl et al. 2005; Wall and Kentala 2005; Peterka, Wall et al. 2006; Asseman, Bronstein et al. 2007; Dozza, Wall et al. 2007; Basta and Ernst 2008; Guzy, Albery et al. 2008; Sienko, Balkwill et al. 2008; Goebel, Sinks et al. 2009; Horak 2009; Horak, Dozza et al. 2009)

We think that this direction is presently the most logical one

References regarding galvanic input

References for auditory input

References regarding tongue input -- also see (TDU)

References regarding vibrotactile input