Vestibular implantation: are we there yet?
Reviewed by Victor Osei-Lah

The objectives of this review article were to ascertain, through a systematic literature review, device design, surgical approaches, objective and subjective outcomes as well as limitations of vestibular implantation (VI). Following an extensive systematic search using PRISMA guidelines, 21 studies were eligible for a full text review. Year of publication of these were between 2011 and 2023. Interestingly, eight studies were excluded due to wrong outcomes, study design, intervention, patient population and lack of peer-review. The authors identified 36 (13 female and 23 male) recipients of VI worldwide across four centres. The aetiology of the bilateral vestibular failure (BVF) was Ménière’s (eight), aminoglycosides (seven), meningitis (six), idiopathic (five), trauma (four), DFNA9 (four) and one each of Cogan’s and cholesteatoma. The device design was variable. Some centres utilised combined vestibulo-cochlear implants for simultaneous implantation, and others used VI alone. Four main devices were used: Modified CI and MVI from MED-EL and Nucleus Freedom Modified CI and CI24RE from Cochlear Ltd. The surgical approach employed was extralabyrithine or intralabyrithine with electrode placement on one or more of the following nerves: posterior ampullary, lateral ampullary, superior ampullary or near saccular macula. In 22 patients, all three ampullary nerves were implanted. Unsurprisingly, stimulus paradigms were variable. The evaluation of outcome varied between centres but all utilised objective measures such as 2/3D oculography to assess eVOR, cVEMPs, vHIT, dynamic visual acuity, and functional questionnaires such as DHI, Dynamic Gait Index, Time-and-Go, Oscillopsia Severity Questionnaire and 36 Short-Form Health Survey. The authors concluded that although the results were promising overall, both objectively and functionally, questions regarding long-term benefit and continuous use, hearing preservation and cost remain to be answered. An important limitation the authors reported was that because only publications in peer-reviewed journals were included, there was a risk omitting data in the grey literature. The article highlights the current state of play of vestibular implantation.

Methods and clinical outcomes in vestibular implantation– A systematic literature review.
Hansen JO, Sass HCR, West NC, Cayé-Thomasen P.
J VESTIB RES
2025;35(4):172–84.