title: A multichannel semicircular canal neural prosthesis using electrical stimulation to restore 3-d vestibular sensation.
abstract: Bilateral loss of vestibular sensation can be disabling. Those afflicted suffer illusory visual field movement during head movements, chronic disequilibrium and postural instability due to failure of vestibulo-ocular and vestibulo-spinal reflexes. A neural prosthesis that emulates the normal transduction of head rotation by semicircular canals could significantly improve quality of life for these patients. Like the three semicircular canals in a normal ear, such a device should at least transduce three orthogonal (or linearly separable) components of head rotation into activity on corresponding ampullary branches of the vestibular nerve. We describe the design, circuit performance and in vivo application of a head-mounted, semi-implantable multichannel vestibular prosthesis that encodes head movement in three dimensions as pulse-frequency-modulated electrical stimulation of three or more ampullary nerves. In chinchillas treated with intratympanic gentamicin to ablate vestibular sensation bilaterally, prosthetic stimuli elicited a partly compensatory angular vestibulo-ocular reflex in multiple planes. Minimizing misalignment between the axis of eye and head rotation, apparently caused by current spread beyond each electrode's targeted nerve branch, emerged as a key challenge. Increasing stimulation selectivity via improvements in electrode design, surgical technique and stimulus protocol will likely be required to restore AVOR function over the full range of normal behavior.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA. charley.dellasantina@jhu.edu
authors.forename: Charles C
authors.initials: CC
authors.lastname: Della Santina
authors.forename: Americo A
authors.initials: AA
authors.lastname: Migliaccio
authors.forename: Amit H
authors.initials: AH
authors.lastname: Patel
mesh_terms: D000818:Animals; D002682:Chinchilla; D004599:Electric Stimulation Therapy / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted; D019544:Equipment Failure Analysis; D005133:Eye Movements; D005240:Feasibility Studies; D019416:Head Movements; D008839:Microelectrodes; D019736:Prostheses and Implants; D011474:Prosthesis Design; D012027:Reflex, Vestibulo-Ocular; D012665:Semicircular Canals / Q000294:innervation* / Q000503:physiopathology*; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation; D013813:Therapy, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D015837:Vestibular Diseases / Q000503:physiopathology* / Q000534:rehabilitation*