Device tested at Johns Hopkins improves symptoms, quality of life for patients with bilateral vestibular hypofunction

Around Thanksgiving in 2016, science writer A’ndrea Messer was prescribed gentamicin, an antibiotic that can cause ototoxicity — a risk she was willing to take after experiencing a recurrent and resistant infection for months. Soon after, she woke in the middle of the night unable to stand up. “I had no sense of what upright was,” she remembers.

After a visit to her primary care physician, she was told that her new loss of balance, a side effect of gentamicin, was incurable. After limited improvement with physical therapy, Messer resigned herself to a life with constant repercussions of vestibular issues: She learned to walk with a cane, depended on friends to navigate in the dark and was exhausted by simple tasks.

But hope was on the horizon. In 2018, Messer received a multichannel vestibular implant (MVI) as part of a small clinical trial at Johns Hopkins. This device, developed and tested over the past several years by a team led by otolaryngologist–head and neck surgeon Charles Della Santina, has dramatically improved symptoms and quality of life for Messer and 14 other trial participants who received MVIs.

“The benefits we saw in the 15 patients who now have these devices have been significant and stable, even in those who developed their vestibular issues more than 20 years ago,” he says.

An estimated 1.8 million adults worldwide, including 64,000 Americans, suffer from bilateral vestibular hypofunction (BVH), which causes symptoms including blurred vision with head movement, postural instability, chronic dizziness and fatigue, and increased frequency of falls. Standard-of-care treatments are limited, often inadequate, and have changed little over the past century.

Several years ago, Della Santina and his colleagues realized that by combining technology from cochlear implants and small motion sensors akin to those used in cellphones to keep the display properly oriented, they could develop a device that could bring BVH patients relief. Promising experiments in animal models supported the need for a clinical trial to test this technology in humans.

In results from the first eight patients, which include Messer and were published in the New England Journal of Medicine in 2021, Della Santina and his colleagues showed that six months after implantation, patients had substantial improvements in measures of posture, gait, self-reported disability and quality of life. An update published in JAMA Otolaryngology–Head & Neck Surgery in February 2024 mirrored these results up to six years later for these eight patients plus two more who had received implants since.

“We were not expecting the magnitude of responses we saw in terms of improvements in quality of life and how it was reflected in actual behavior,” says Andrianna Ayiotis, a Johns Hopkins University biomedical engineering graduate student whose dissertation research involved collecting, analyzing and interpreting data for the MVI clinical trial.

“More work needs to happen before it is approved by the U.S. Food and Drug Administration for widespread clinical use,” Della Santina says, “but we are excited about future possibilities for this device to help restore balance to patients who for too long have had no good options.”  

To learn more or refer a patient, call 443-997-6467.