News flash: Do you have bilateral vestibular loss? VNEL is recruiting for two vestibular implant trials (which are closely related but focused on different age groups and causes of bilateral vestibular hypofunction):
Vestibular Implantation to Treat Adult-Onset Bilateral Vestibular Hypofunction (NCT05674786 at ClinicalTrials.gov) is currently focused on recruiting individuals ages 22-64 years with non-ototoxic adult-onset bilateral vestibular hypofunction (BVH), although we also encourage individuals with ototoxic BVH to apply.
Vestibular Implantation in Older Adults (NCT05676944 at ClinicalTrials.gov) is recruiting individuals ages 65-90 years with ototoxic or non-ototoxic adult-onset BVH.
News flash: Do you have normal balance function but want to help people who don't? If you live near Baltimore or will be visiting Johns Hopkins for other reasons and don't mind spending ~90-120 minutes advancing science and supporting vestibular implant research, consider participating in our study of normal vestibular function, which we're doing to better understand how vestibular function changes with age. We are recruiting participants who are least 50 years old, have no known balance disorders, and are able to walk normally. Participation involves 1 visit for about 2 hours and includes doing some walking tasks, eyesight tests while walking on a treadmill, sitting on a chair that turns left and right, and filling out some surveys about balance function and quality of life. Participants receive a $50 gift card (which can be used anywhere that takes Visa) and a parking voucher. You can click this link to apply to the normal vestibular function and aging trial (IRB00353685, Principal Investigator Bryan Ward MD) or learn more by emailing study coordinators at balancestudy@jhmi.edu or calling 410-502-5129. We typically schedule 8 participants per test day. If you plan to come with some friends who will also participate, please let us know you will be a group so that we know to line up your visits to all occur one after another on the same day.
2025
In its July 2025 issue, Smithsonian magazine featured a story on VNEL's vestibular implant clinical trials, featuring VNEL investigators Fernandez Brillet, Vesper, Lane and Della Santina. The also includes interviews with three vestibular implant recipients. Access the article here: "Can a Medical Device Restore Your Balance?" Smithsonian magazine, July 2025
2024
In March 2024, VNEL investigators Andrianna I Ayiotis, Desi P Schoo, Celia Fernandez Brillet, Kelly E Lane, John P Carey and Charles C Della Santina published an update of quality of life data for the first 10 vestibular implant recipients in the JHU VNEL clinical trials. The key conclusion: "This cohort study found that vestibular implant recipients report vestibular symptom improvements not reported by a control group. These patient-reported benefits support the use of vestibular implantation as a treatment for bilateral vestibular hypofunction." Access the article here: "Patient-Reported Outcomes After Vestibular Implantation for Bilateral Vestibular Hypofunction", JAMA-Otolaryngology Head & Neck Surgery, 2024 March
In April 2024, VNEL investigators Schoo, Ward, Chow et al. published an article in the journal Laryngoscope teaching surgeons how to do vestibular implant surgery. Access the article here: "Vestibular Implant Surgery", Laryngoscope 2024 April issue. Access the article's narrated video here.
2023
Prosthetic Stimulation of the Vestibular Nerve Can Evoke Robust Eye and Head Movements Despite Prior Labyrinthectomy: Some patients with unrelenting vertigo episodes thought to be caused by Meniere's disease ultimately undergo a surgery called labyrinthectomy, in which the surgeon deliberately destroys the vestibular labyrinth in hopes of preventing vertigo attacks caused by sudden changes in function. That destructive approach is becoming much less common as ear surgeons increasingly identify and treat vestibular migraine as the cause of vertigo attacks in most patients who seem to have Meniere's disease. However, some patients still undergo labyrinthectomy once all else has failed, and thousands of individuals currently live with only one working labyrinth after the other ear underwent surgical labyrinthectomy. If that one working labyrinth fails, those patients suffer chronic dizziness, difficulty walking and shaky vision due to bilateral vestibular hypofunction. Until now, we supposed that vestibular implantation was unlikely to work after prior labyrinthectomy, but in December 2023, Kantapon Pum Wiboonsaksakul, Dr. Della Santina, and Dr. Kathleen E. Cullen at Johns Hopkins published a case report in the journal Otology & Neurotology showing that vestibular implantation and stimulation worked surprisingly well in a rhesus monkey that underwent surgical labyrinthectomy 8 years earlier. Apart from giving hope that patients with BVH after prior labyrinthectomy might benefit from vestibular implantation, the finding in this report also suggest that surgeons who perform labyrinthectomies should consider trying to preserve the medial walls of the ampullae and the ampullary nerves, to increase the likelihood of success for a future VI. Access the article here.
In May 2023, VNEL investigators Chow, Fernandez Brillet, Hageman, et al. published a new study of otolith-targeting vestibular implant stimulation in animals in the Journal of Neurophysiology ("Binocular 3-D otolith-ocular reflexes: responses of chinchillas to natural and prosthetic stimulation after ototoxic injury and vestibular implantation"). As the article's "New & Noteworthy" section describes, "Previous studies to expand the scope of prosthetic stimulation of the otolith end organs showed that selective stimulation of the utricle and saccule is possible. This article further defines those possibilities by characterizing a diseased animal model and subsequently studying its responses to electrical stimulation alone and in combination with mechanical motion. We show that we can partially restore responses to tilt and translation in animals with unilateral gentamicin ototoxic injury and contralateral surgical disruption." Access the article here.
In February 2023, VNEL investigators Schoo, Ayiotis, Fernandez Brillet, Chow et al. published a case study in the journal Otology/Neurotology showing that "Vestibular Implantation Can Work Even After More Than 20 Years of Bilateral Vestibular Hypofunction". The fact that vestibular implantation can yield a good outcome even afer two decades of bilateral vestibular hypofunction is especially important news for individuals who will have been living with BVH for many years by the time vestibular implantation becomes widely available as a part of routine clinical care. Access the article and its video of eye movements here.
2022
VNEL investigators and alumni presented 13 podium presentations and posters at the at the Barany Society's XXXIth International Congress in Madrid May 2022. We presented updates on vestibular implant safety and efficacy data for the first 10 who have used their implants daily or 24 hr/day for >6 months (and so far up to 5.5 years), animal experiments providing key data to support optimization of VI design, and data validating the novel equipment we use for clinical vestibular testing. VNEL member and Johns Hopkins biomedical engineering PhD candidate Brian Morris was a co-awardee of both the Won-Sang Lee Young Scientist Award and the Lorente de Nó Best Poster award for presentations and posters describing 3-Dimensional eye movements and utricular neuron responses to vestibular implant stimulation. His data provide valuable insight into how vestibular implant electrodes and stimulus waveforms should be designed to optimize the strength and selectivity of vestibular implant stimulation targeting semicircular canal branches of the vestibular nerve while minimizing - or possibly capitalizing on - current spread that excites utricular (and probably also saccular) neurons. VNEL presentations and posters included:
1) Andrianna I Ayiotis, Margaret R Chow, Celia Fernandez Brillet, Kelly E Lane, John P Carey, Charles C Della Santina, “Dynamic Visual Acuity in Individuals with a Unilateral Vestibular Implant”
2) Andrianna I Ayiotis, Desi P Schoo, Margaret R Chow, Celia Fernandez Brillet, Kelly E Lane, John P Carey, Charles C Della Santina, “Video Head Impulse Testing in Individuals with a Unilateral Vestibular Implant”,
3) Andrianna I Ayiotis, Margaret R Chow, Celia Fernandez Brillet, Kelly E Lane, Desi P Schoo, John P Carey, Charles C Della Santina, “Modulating Vestibular Implant Stimulation Using Angular Head Velocity and Acceleration”
4) Andrianna I Ayiotis, Desi P Schoo, Celia Fernandez Brillet, Kelly E Lane, John P Carey, Charles C Della Santina, “Patient Reported Outcomes and Quality of Life in Individuals with a Vestibular Implant”
5) Celia Fernandez Brillet, Margaret R Chow, Kristin N Hageman, Andrianna I Ayiotis, Dale C Roberts, Charles C Della Santina, “Vestibular Stimulation Targeting the Utricle and Saccule Partially Restores Otolith-Ocular Reflex in Chinchillas after Intratympanic Gentamicin Injection”
6) Margaret R Chow, Kristin N Hageman, Celia Fernandez Brillet, Dale C Roberts, Americo A Migliaccio, Charles C Della Santina, “The Three-Dimensional Angular Vestibulo-Ocular Reflex in Chinchillas Depends on Head Orientation Relative to Gravity”
7) Margaret R Chow, Celia Fernandez Brillet, Kelly E Lane, Brian J Morris, Desi P Schoo, Yoav Gimmon, Andrianna I Ayiotis, Carolina Treviño Guajardo, Michael C Schubert, John P Carey, Charles C Della Santina, “Effects of Vestibular Implant Stimulation on Gait during Cognitive Distraction and in Dim Lighting”
8) Brian J Morris*, Margaret R Chow, Abderrahmane Hedjoudje, Dale C Roberts, Chenkai Dai, Kathleen E Cullen, Roland Hessler, Charles C Della Santina, “Optimization of Stimulating Electrode Array Design for a Vestibular Implant in Rhesus Macaque”
*Winner, Won-Sang Lee Young Scientist Award
9) Brian J Morris*, Margaret R Chow, Abderrahmane Hedjoudje, Dale C Roberts, Kathleen E Cullen, Roland Hessler, Charles C Della Santina, “The Effect of Vestibular Implant Stimulation on Utricular Primary Afferents in Rhesus Macaque”
*Winner, Lorente de Nó Award
10) Brian J Morris, Margaret R Chow, Abderrahmane Hedjoudje, Dale C Roberts, Kathleen E Cullen, Roland Hessler, Charles C Della Santina, “The Effect of Pulse Asymmetry in Vestibular Implants on the Vestibulo-Ocular Reflex of Rhesus Macaque”
11) Brian J Morris, Margaret R Chow, Abderrahmane Hedjoudje, Dale C Roberts, Kathleen E Cullen, Roland Hessler, Charles C Della Santina, “Optimization of Return Electrode Location for a Vestibular Implant in Rhesus Macaque”
12) Desi P Schoo, Andrianna I Ayiotis, Celia Fernandez Brillet, Margaret R. Chow, Grace X. Tan, Matthew R Ehrenburg, John P Carey, Charles C Della Santina, “Validation of an Automated Head Impulse System”
13) Desi P Schoo, Andrianna I Ayiotis, Celia Fernandez Brillet, Margaret R. Chow, Grace X. Tan, Matthew R Ehrenburg, John P Carey, Charles C Della Santina, “Effect of Clinician Experience on Video Head Impulse Testing”
2021
The New England Journal of Medicine published the first comprehensive journal article detailing posture, gait, quality of life and hearing outcomes for the Multichannel Vestibular Implant Early Feasibility Study (here). After undergoing single-side vestibular implant surgery and continuous (24hr/day) artificial stimulation for at least 6 months each, eight patients - the first in the world to use this implant - were reassessed at 6 and 12 months post-op. Overall results were consistent with improvements in balance, ability to walk, dizziness, disability and quality of life. All but one had some drop in hearing in the implanted ear, with three having a severe or profound loss and five retaining sufficient hearing to use a telephone unaided in the implanted ear.
2020
In September 2020, the United States Food & Drug Administration approved an increase in the total number of subjects for the trial to 30.
The ninth person to receive an MVI vestibular implant underwent surgery in September 2020 and initial device activation in October.
The first journal article detailing electrically-evoked 3-dimensional vestibulo-ocular reflex results in animals using vestibular implant electrodes designed to stimulate the utricle and saccule in addition to the semicircular canals (Hageman et al., "Binocular 3D otolith-ocular reflexes: responses of chinchillas to prosthetic electrical stimulation targeting the utricle and saccule" in Journal of Neurophysiology ) is now freely available online here.
2019
The first publication for the Multichannel Vestibular Implant Early Feasibility Study, "Continuous vestibular implant stimulation partially restores eye-stabilizing reflexes" was published in JCI Insight November 2019. It is free to download here.
As of June 2019, we had enrolled 7 subjects in the MVI vestibular implant trial.
2018
In May 2018, we received FDA approval to increase the number of subjects from 5 to 15. To date, we have had >300 applicants for the trial. Because of the overwhelming interest, we do have a backlog of applicants that we are still reviewing. We appreciate your patience and understanding as we select the most appropriate subjects for this early feasibility study.
Several papers have been submitted for publication and we are anxiously awaiting their approval to share the results we have accomplished thus far. Please check back for links once they approved.
Competing in among >100 submissions at the 2018 Barany Society Meeting, Meg Chow was 1 of 3 to win the Won-Sang Lee award for "Spatial and Temporary Dynamics of Eye Movements Elicited by Combined Otoliths and Semicircular Canal Stimulation" and "Multichannel Vestibular Implant Early Feasibility Study: Gait and Posture".
2017
As of May 2017, we have implanted 3 subjects in the MVI vestibular implant trial. All are doing well so far.
Competing in among >100 submissions at the 2017 Minnesota Neuromodulation Symposium, Peter Boutros won 2nd place for "Continuous Restoration of the Human Vestibulo-Ocular Reflex via a Multichannel Vestibular Implant" and Kristin Hageman won a Travel Award for "Electrically-Evoked Eye Movements using a Vestibular Prosthesis Designed to Restore Sensation of Gravitoinertial Acceleration".
2016
2016-04-01 Big news! We now have both FDA Investigational Device Exemption and the Johns Hopkins School of Medicine Institutional Review Board approval needed to start our clinical trial of a vestibular implant system based on VNEL research and technology. The device is manufactured by Labyrinth Devices, LLC, and uses an implanted stimulator that is a modified version of the MedEl Concerto cochlear implant. If you would like to learn more about the trial and/or apply to participate in it, click here.
2016-04-01 Big News! the Labyrinth Devices MVI Multichannel Vestibular Implant System was granted Humanitarian Use Designation, which may help smooth the path for getting a Humanitarian Device Exemption that would allow broader use of the system if our clinical trial shows favorable results.
Competing in among >100 submissions at the 2016 Minnesota Neuromodulation Symposium, Kristin Hageman won 2nd place for "Design of a Vestibular Prosthesis for Sensation of Gravitoinertial Acceleration" and Dilawer Singh won 3rd place for "Safe Direct Current Stimulation Increases the Dynamic Range of Head Velocities Encoded by the Vestibular Prosthesis".
VNEL members and colleagues have presented research regarding the Johns Hopkins Multichannel Vestibular Prosthesis at ARO 2016 in San Diego and the Design of Medical Devices Conference and Neuromodulation Symposium in Minneapolis. Lab member Kristin Hageman's poster won 2nd place at the Neuromodulation Symposium.
2015
VNEL members and colleagues have presented research regarding the Johns Hopkins Multichannel Vestibular Prosthesis at ARO 2015 in Baltimore.
2014
VNEL members and colleagues have presented research regarding the Johns Hopkins Multichannel Vestibular Prosthesis at ARO 2014 in San Diego, NCM in Amsterdam, and invited lectures at the Halle/Saale Otology Jubilee, Barany International Congress and CI2014. Topics included:
Lie, TjenSin; Davidovics, Natan; Chiang, Bryce; Law, Yichung; Tan, Grace; Romano, Robert; Wo, Luccie;Shefter, Ben; Migliaccio, Americo; Della Santina, Charles C. “Compact, inexpensive, automated, motorized head-on-body motion device yields highly repeatable head impulses, sinusoids and velocity steps for testing 3D vestibulo-ocular reflex in any canal plane”, Barany Society 2014 Interntional Congress, Buenos Aires, Argentina
Diana E. Mitchell, Charles C. Della Santina, Kathleen E. Cullen, “Plasticity at the vestibular afferent to central neuron synapse: effects of vestibular prosthetic stimulation,” Society for Neuroscience 2014
Chenkai Dai; Joong Ho Ahn; Kristin Hageman; Charles C Della Santina, “Effects of unilateral intra-tympanic gentamicin on vestibulo-ocular reflex function in rhesus monkeys,” ARO2014 Ann Mtg #PS202
Gene Fridman, Evan Kararo, Bryan Kuo, Charles Della Santina, “Safe direct current stimulator microfluidic design for vestibular prosthesis,” ARO2014 Ann Mtg #PS261
Bryan K Ward, Grace Tan, Dale Roberts, Charles C Della Santina, David Zee, John Carey, “Strong static magnetic fields elicit swimming behaviors consistent with direct vestibular stimulation in adult zebrafish,” ARO2014 Ann Mtg #PS216
Diana E. Mitchell, Chenkai Dai, Charles C. Della Santina, Kathleen E. Cullen, “Characterization of postural responses and central vestibular neuron activity during electrical stimulation delivered by a vestibular prosthesis,” NCM 2014
Kristin N. Hageman, Zaven Kalayjian, Mehdi A. Rahman, Bryce Chiang, Francisco Tejada, Gene Fridman, Chenkai Dai, Andreas Andreou, Charles C. Della Santina, “System Integration of an Application Specific Integrated Circuit to Advance Toward a Fully Implantable Multichannel Vestibular Prosthesis,” Midatlantic Micro/Nano Alliance MAMNA 2014, College Park, MD
2013
VNEL members presented 6 posters regarding the Johns Hopkins Multichannel Vestibular Prosthesis at ARO 2013 in Baltimore. Topics included: laser infrared light stimulation of the vestibular nerve, which may offer special advantages in stimulation of the inner ear if some fundamental challenges can be overcome; a new application-specific integrated circuit (ASIC), which should allow us to make a much smaller and more powerful MVP for human use; a significantly improved "Safe Direct Current" stimulator that could revolutionize electrical stimulation of the nervous system not just for balance but also for hearing, pain, and other neurologic disorders; reflexive eye movements in mice during exposure to the magnetic field of an MRI machine (a fascinating effect likely to have a major impact on MRI use and design); outcomes using a bilateral MVP in monkeys (more symmetric results, but at the cost of implanting both ears); and improvements to a very precise and comprehensive model of electrical current flow in the implanted inner ear (which will help us create optimal designs for human electrode arrays).
Posters:
"Vestibulo-Ocular Reflex Eye Movement Responses to Infra-Red Laser Stimulation of the Mammalian Labyrinth" (Boutros et al.)
"Magnetic Field-Induced Eye Movements in Mice" (Ward et al.)
"Bilateral Stimulation of the Vestibular Labyrinth in Rhesus Monkeys Using a Multichannel Vestibular Prosthesis" (Dai et al.)
"System Integration of an Application Specific Integrated Circuit to Advance Toward a Fully Implantable Multichannel Vestibular Prosthesis" (Hageman et al.)
"An Enhanced Safe Direct Current Stimulation System to Improve Vestibular Prosthesis Performance" (Fridman & Della Santina)
"A Finite Element Virtual Labyrinth Model of the Human Inner Ear Facilitates Electrode Design for a Multichannel Vestibular Prosthesis" (Hedjoudje et al.)
For more information, search on "Della Santina" here.
A collaboration between the University of Iowa Molecular Otology Research Laboratory, VNEL, the Johns Hopkins Ménière’s disease DNA Bank, and other contributors resulted in identification of the first gene causally related to Ménière’s disease, a common ailment that causes debilitating bouts of vertigo associated with episodic hearing loss. Funded in part by a grant from the American Otologic Society [to MORL principal investigator Richard Smith and supporting lead scientist Colleen Campbell] and by donors to the Johns Hopkins Ménière’s DNA Bank, this study represents both the end result of a herculean effort and a highly promising first step toward understanding the causes and best treatments for this disease. To read more, search on "Mutation of SLC45A3 in Familial and Sporadic Ménière’s Disease" here.
2012
VNEL members presented 1 invited lecture, 3 contributed lectures, and 5 posters regarding the Johns Hopkins Multichannel Vestibular Prosthesis at ARO 2012 in San Diego. Topics included a new MVP based on a cochlear implant designed for human implantation; results using eCAPs to guide MVP implantation surgery and programming; using lasers to stimulate the vestibular nerve; a new rehab technique that significantly enhances responses of animals implanted with the MVP; two new studies of how the nervous system uses MVP input to recreate stable vision; a new model of how current flows in the inner ear to stimulate the vestibular nerve; and "Safe DC" - a new approach that could dramatically expand the ways "bionic" implants can be used to stimulate the nervous system.
Invited Lectures:
"Virtual Labyrinth Model Accurately Predicts Responses to Stimulation Using a Multichannel Vestibular Prosthesis in Rhesus Monkeys" (Hedjoudje et al.)
Contributed Lectures:
"Infra-Red Laser Stimulation Modulates Vestibular Nerve Afferent Responses in the Mammalian Labyrinth" (Ahn et al.)
"Concurrent Modulation of Pulse Frequency and Current with Coordinate Transformation Yields Improved 3D VOR Dynamic Range, Symmetry and Alignment in Monkeys Using a Multichannel Vestibular Prosthesis" (Davidovics et al.)
"Addition of Chronic Direct Current Stimulation Improves Vestibular Prosthesis Dynamic Range" (Fridman et al.)
Posters:
"Development of a Human-Implantable Multichannel Vestibular Prosthesis Via Modification of a Commercially Available Cochlear Implant" (Valentin et al.)
"Multichannel Vestibular Prosthesis Restores Vergence-Mediated Changes in Vestibulo-Ocular Reflex of Rhesus Monkeys with Gentamicin-Induced Bilateral Vestibular Hypofunction (Ahn et al.)
"Electrically-Evoked Compound Action Potentials and 3D Vestibulo-Ocular Reflex Are Correlated to Each Other and to Electrode Position in Rhesus Monkeys Using a Multichannel Vestibular Prosthesis" (Dai et al.)
"Repeated Unidirectional Rotations Reduce Vestibulo-Ocular Reflex Gain Asymmetry in Rhesus Monkeys Using a Unilateral Multichannel Vestibular Prosthesis" (Dai et al.)
"Responses of Vestibular-Deficient Rhesus Monkeys to Prosthetic Stimulation Via a Multichannel Vestibular Prosthesis Are Enhanced When Multisensory Inputs Are Congruent" (Dai et al.)
For more information, search on "Della Santina" here.
In a study led by Yoshi Kawashima and groups headed by Andrew Griffith and Jeff Holt, JHU-VNEL researchers contributed vestibulo-ocular reflex data to a study that provides compelling evidence that the genes TMC1 and TMC2 encode an essential part of the channel responsible for hair cell mechanotransduction. To read more, click here.
2011
Dr. Della Santina chaired the Feb 20, 2011 Symposium on Prosthetic Stimulation of the Vestibular System at the Association for Research In Otolaryngology MidWinter Meeting in Baltimore, and JHU-VNEL members Chenkai Dai, Natan Davidovics and Gene Fridman presented 4 posters.
For more information, search on "Della Santina" here.
New JHU-VNELab article in Hearing Research demonstrate hearing preservation after multichannel vestibular prosthesis electrode implantation.
JHU-VNEL's MVP Multichannel Vestibular Prosthesis featured in Illustrert Vitenskap (Norway's popular science magazine)
Collaboration between Neuroscience Research Australia's Migliaccio Oculomotor Engineering Lab and JHU-VNELab results in new 3D video-oculography technique for mice and world's first comprehensive analysis of 3D vestibulo-ocular reflex in mice, opening door to assessment of natural vestibular function in mice with targeted genetic alterations.
2010
JHU-VNELab research covered in Popular Science
Recent IEEE TNSRE article on the effects of varying stimulation pulse parameters using the Multichannel Vestibular Prosthesis
Best Poster Award at Neural Interfaces Conference 2010 to Natan Davidovics et al. on improvements in vestibular stimulation pulse parameters
Recent JARO article on new "precompensation" coding strategy that achieves markedly better results with the Johns Hopkins Multichannel Vestibular Prosthesis
Recent Scientific American article on work in JHU-VNELab
JHU-VNELab members presented 4 posters at ARO 2010 in Anaheim, on the precompensation strategy, stimulus timing optimization, adaptation to chronic use of the MVP, and hearing preservation after MVP electrode implantation. To read more, search on "Della Santina" here.