Enhancing balance and auditory function in bilateral vestibulopathy through otolithic vestibular stimulation: insights from a pilot study on cochlea-vestibular implant efficacy

Ángel Ramos-de-Miguel; Morgana Sluydts; Juan Carlos Falcón; Raquel Manrique-Huarte; Isaura Rodriguez; Andrzej Zarowski; Maurizio Barbara; Manuel Manrique; Silvia Borkoski; Joan Lorente; Marc Leblanc; Antonin Rambault; Erika Van Baelen; Carl Van Himbeeck; Alicia Huarte; Ángel Ramos Macías

doi:10.3389/fneur.2025.1520554

Enhancing balance and auditory function in bilateral vestibulopathy through otolithic vestibular stimulation: insights from a pilot study on cochlea-vestibular implant efficacy

Front Neurol. 2025 Jan 30:16:1520554. doi: 10.3389/fneur.2025.1520554. eCollection 2025.

Authors

Ángel Ramos-de-Miguel^{1

2}, Morgana Sluydts³, Juan Carlos Falcón¹, Raquel Manrique-Huarte⁴, Isaura Rodriguez¹, Andrzej Zarowski³, Maurizio Barbara⁵, Manuel Manrique⁴, Silvia Borkoski¹, Joan Lorente⁴, Marc Leblanc³, Antonin Rambault⁶, Erika Van Baelen⁶, Carl Van Himbeeck⁶, Alicia Huarte⁴, Ángel Ramos Macías^{1

2}

Affiliations

¹ Unit of Hearing Loss, Department of Otorhinolaryngology, Head and Neck, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas of Gran Canaria, Spain.
² Universidad Las Palmas de Gran Canaria, Las Palmas of Gran Canaria, Spain.
³ European Institute for Otorhinolaryngology, GZA Hospitals Antwerp, Wilrijk, Belgium.
⁴ Department of Otorhinolaryngology, Clinica Universidad de Navarra, Pamplona, Spain.
⁵ Department of NESMOS, ENT Clinic, Sapienza University, Rome, Italy.
⁶ Cochlear Technology Centre, Mechelen, Belgium.

Abstract

Introduction: This study evaluates cochleovestibular implants (CVI) for improving auditory and vestibular function in patients with bilateral vestibulopathy and severe-to-profound hearing loss. CVI uniquely combines auditory and vestibular stimulation, offering a potential solution for dual impairments in hearing and balance.

Methods: Ten patients underwent CVI implantation. Auditory function was assessed with pure-tone audiometry (PTA) and speech recognition at baseline, 3, and 9 months post-implantation. Vestibular function was measured using the Dynamic Gait Index (DGI), Sensory Organization Test (SOT), posturography, and the Dizziness Handicap Inventory (DHI). Placebo-controlled tests verified cochleovestibular stimulation specificity.

Results: Auditory outcomes showed PTA improvements from 78 dB HL preoperatively to 34 dB HL at 3 months and 36 dB HL at 9 months, alongside speech recognition gains. Vestibular improvements included significant DGI (p < 0.05) and SOT score increases (33% to 68%, p < 0.05). DHI scores reflected reduced dizziness-related disability. Residual balance gains after device deactivation suggest neural adaptation, and placebo tests confirmed cochleovestibular stimulation specificity.

Discussion: CVI effectively restores auditory and vestibular function, with improvements in hearing, balance, and quality of life. Neural plasticity likely supports long-term benefits. Future research should refine device design and stimulation protocols to enhance outcomes further.

Keywords: balance improvement; bilateral vestibular dysfunction; cochleovestibular implant; dynamic gait index; otolithic implants; vestibular rehabilitation.