Keynote lecture about vestibular implant technology

Scientific and clinical insights from vestibular implant clinical studies

Innovations and technology in diagnosis and management of vestibular disorders

Background: chronic unilateral vestibular hypofunction (UVH) is a disabling condition characterized by persistent imbalance, dizziness, and a significant decline in quality of life (qol). Despite its clinical relevance, the long-term symptomatology and functional burden associated with chronic UVH remain under-characterized.

outcome objectives: this lecture presents an integrated overview of five studies conducted as part of a phd project to advance our understanding of chronic UVH from multiple dimensions, including symptom burden, diagnostic complexity, and patient-reported outcomes.

description: the first study is a systematic review and meta-analysis that consolidates chronic symptom profiles in UVH and examines the effect of various interventions on symptom resolution. Findings highlight the heterogeneity and persistence of symptoms even after vestibular interventions.

building on these findings, in the second study, a qualitative study using the international classification of functioning, disability and health (ICF) framework explored the full spectrum of symptoms and their life impact through in-depth interviews with 15 patients. This study highlighted several crucial domains that are rarely captured by traditional self-report tools.

in the third study, a retrospective cohort analysis of 251 patients evaluated the underlying etiologies, clinical subtypes, and frequent co-diagnoses. The qol was assessed across domains, and potential predictors of poor qol were identified.

to contextualize UVH burden, the fourth study compared qol outcomes between patients with chronic UVH and those with bilateral vestibulopathy (BVP). Both disease-specific and general health proms were used, alongside normative population data. This comparison emphasized that chronic UVH, while often perceived as “less severe,” is associated with a substantial and comparable qol decline to BVP.

finally, the fifth study tested the validity and reliability of the bilateral vestibulopathy questionnaire (BVQ) in chronic UVH patients. Psychometric analysis supported its adapted use in this population, suggesting it may fill an important gap in outcome measurement.

collectively, these studies provide a comprehensive, multi-method evaluation of chronic UVH and propose practical strategies to improve diagnosis, monitoring, and patient-centered care.

Title: Transcanal Endoscopic Cholesteatoma Surgery: Advantages, Limitations, and Pushing the Technical Boundaries

Objective: Transcanal Endoscopic Ear Surgery (TEES) has revolutionized the management of middle ear cholesteatoma by offering unprecedented access to hidden recesses. This presentation aims to evaluate the clinical advantages, inherent drawbacks, and technical limitations of exclusive endoscopic cholesteatoma surgery, while highlighting contemporary boundary-pushing techniques that expand its indications in complex cases.

Methods: The surgical principles and clinical outcomes of TEES in cholesteatoma eradication were systematically analyzed. The focus was placed on the direct visualization of critical areas such as the sinus tympani, facial recess, and anterior epitympanum. Additionally, the presentation reviews advanced technical solutions—including customized structural graft modifications and modified attic reconstructions—designed to overcome traditional endoscopic constraints and prevent retraction pockets.

Results: The primary advantage of TEES in cholesteatoma treatment is its superior, wide-angle panoramic visualization, which facilitates complete disease eradication from deep recesses without the morbidity of extensive canalplasty or retroauricular mastoidectomy. This minimally invasive transcanal approach significantly reduces postoperative pain and ensures excellent cosmetic outcomes. However, the loss of binocular depth perception and the strict requirement for one-handed surgery remain major drawbacks, particularly during active bleeding. While narrow pediatric external auditory canals traditionally limit instrument maneuverability, contemporary boundary-pushing innovations—such as the utilization of highly pliable, customized annular chondroperichondrial grafts—successfully overcome structural limitations, preventing post-operative retractions while facilitating single-handed graft management even in complex reconstructions.

Conclusion: TEES is a highly effective, minimally invasive alternative that offers unmatched visualization for complete cholesteatoma eradication. While the one-handed learning curve demands structured training, this presentation underlines that understanding technical limits, while actively implementing innovations that push these boundaries, is paramount for expanding patient selection and achieving long-term surgical success without recurrence.

Surgical treatment of meniere's disease