A growing understanding of how our complex balance system works is leading to potential new treatment approaches.

Technological advances

Researchers are working to develop new balance and treatment devices These include:

• Vestibular implants
  Much like cochlear implants restore hearing, vestibular implants are a promising technical solution to restore balance for those with bilateral vestibulopathy. Researchers have shown the possibility of restoring the vestibulo-ocular reflex (VOR). This will allow people with severe loss of vestibular (inner ear balance system) sensation to regain a sense of equilibrium and keep vision steady during head movement.
  Two different vestibular implant devices are currently under clinical development. Both are limited to restoring semicircular canal function:
  • The Geneva-Maastricht group’s initial prototype, based on a modified cochlear implant, was implanted in 2007. As of 2019, this research group has equipped 13 patients with prototype cochleo-vestibular implants.
  • Since 2002, a group at the Vestibular NeuroEngineering Laboratory at Johns Hopkins has followed a different path, developing a standalone MVI multichannel vestibular prosthesis that is not combined with a cochlear implant. It functions 24/7, is waterproof and is designed so that battery can be changed without disrupting balance. Clinical trials of the MVImultichannel vestibular implant are continuing.
• Lenire^® tinnitus treatment device
  In the largest clinical trial of its kind, researchers from the United States and Europe in partnership with the Irish medical device company Neuromod Devices Ltd. show that combining sound and electrical stimulation of the tongue can significantly reduce tinnitus. They also found that the therapeutic effects can be sustained for up to 12 months post-treatment. The device consists of wireless (Bluetooth^®) headphones that deliver sequences of audio tones layered with wideband noise to both ears, combined with electrical stimulation pulses delivered to 32 electrodes on the tip of the tongue by a proprietary device trademarked as Tonguetip^®. Treatment with the device is available in Europe but as of January 2021 has not been approved in Canada or the United States.
• Technology to objectively detect tinnitus
  A research study published in November 2020 suggests technology called functional near-infrared spectroscopy (fNIRS) may be a feasible way to objectively measure the severity of ringing in the ears (tinnitus). fNIRS is a non-invasive and non-radioactive imaging method which can track the complex changes that tinnitus triggers in a sufferer’s brain. This ability is critical for the development of new tinnitus treatments.
• Biofeedback systems with wearable sensors
  Research suggests these devices have good potential for use in laboratory- and home-based rehabilitation training settings as well as balance aids during activities of daily living. The devices give visual, auditory, vibrotactile and electrotactile feedback. In the future, it is likely these devices will be enhanced with state-of-the art technologies, such as Bluetooth^® This will give them more powerful processing capacities to assess body balance. As a result, they will be lighter, smaller and more user-friendly.
• Technology for Injury Prevention in Seniors (TIPS)
  A research group at Simon Fraser University in BC is developing technology related to the prevention of falls and fall-related injuries in older adults including a wearable sensor system that automatically detects falls, and solutions to prevent injuries in the event of a fall, including wearable hip protectors and compliant flooring.

Gene-related therapy advances

Growing evidence suggests a genetic component to some inner-ear (vestibular) disorders. Although little is known about the genetic contribution to most disorders, ongoing research suggests that treatment, in some cases personalized, for some conditions may be possible.

Researchers are discovering genetic variants associated with a number of disorders including motion sickness, familial Ménière’s disease, semicircular canal dehiscence (SCD), acoustic neuroma, otosclerosis and enlarged vestibular aqueduct (EVA).

Researchers have found a way to regrow hair cells in the inner ears of mice.  About 70% of the mice recovered vestibular function. The finding is a proof of concept and has opened the door for many more possible treatments of vestibular disorders. Read more about this research.

Medical treatment advances

Research is ongoing that hopefully will lead to the development of new drugs to treat - or prevent - some vestibular disorders and symptoms.

Researchers are looking at how medications used for other conditions might be used to treat some vestibular disorders. These are example of what is being investigated:

• bisphosphonates (a class of drugs that stops the loss of bone density) and vitamin D as a possible treatment for otosclerosis
• oral supplementation with mitochondrial antioxidants such as alpha-lipoic acid and coenzyme Q10 to reduce hair cell loss in the inner ear

Vestibular rehabilitation advances

Vestibular rehabilitation programs are likely to become more individualized and take advantage of emerging technologies including:

• mobile sensors
• on-demand training using mobile apps
• training in virtual environments,
• increased use of neuromodulation (direct stimulation of the nervous system with electrical signals)

Clinical trials

The most comprehensive source for information about current clinical trials is ClinicalTrials.gov. It is a database maintained by the US government of privately and publicly funded clinical studies conducted around the world.

• Are you looking for vestibular patients for clinical trials? If so, contact us so we can post your link. However, your trial must be authorized by Health Canada, registered, board-certified and have passed an ethics committee review. No drug trials, please!

Sources

Action on Hearing Loss. Investigating the genetics of otosclerosis. Available from: https://bit.ly/32YLgqz. Accessed October 28, 2019.

JM, Raz Y, Whitney SL. Geriatric vestibulopathy assessment and management. Curr Opin Otolaryngol Head Neck Surg. 2010 Oct 18(5): 386-391. Available from: https://bit.ly/2Yv425G

Gaggego-Martinez A, Espinosa-Sanchez JM, Lopez-Escamez JA. Genetic contribution to vestibular diseases. J Neurol. 2018 Oct;265(Suppl 1):29-34. Available from: https://bit.ly/2G9DGPu

Guyot JP, Perez Fornos A. Milestones in the development of a vestibular implant. Current Opinion in Neurology: February 2019 - Volume 32 - Issue 1 - p 145–153. Available from: https://bit.ly/2ZezcQy

Ma CZH, Wong DWC, Lam WK, Wan AHP, Lee WCC. Balance improvement effects of biofeedback systems with state-of-the-art wearable sensors: A systematic review. Sensors. 2016. 16(4); 434. Available from: https://bit.ly/2NHqPJI

Mowat AJ, Crompton M, Ziff JL, Aldren CP, Lavy JA, Saeed SR, Dawson SJ. Evidence of distinct RELN and TGFB1 genetic association in familial and non-familial otosclerosis in a British population. Human Genetics. 2018. 137:357-363. Available from: https://bit.ly/2N0Ke7X

Tjernström F, Zur O, Jahn K. Current concepts and future approaches to vestibular rehabilitation. J Neurol. 2016. Apr;263 Suppl 1:S65-70. Available from: https://bit.ly/2Yocnbp

University of Michigan News. Specially timed signals ease tinnitus symptoms in test aimed at condition’s root cause. Available from: https://bit.ly/2YBAIPj