Vestibular implants in bilateral vestibular failure: current evidence and future directions

Bilateral vestibular failure is a rare and disabling condition for which restorative treatment options remain limited. Vestibular implants have emerged as a potential neuroprosthetic intervention. This review summarises current evidence for vestibular implantation and considers relevant clinical, ethical and health system implications, including the New Zealand healthcare context.

A narrative review of the published literature was conducted using PubMed, Embase and the Cochrane Library from database inception to June 2025. Search terms included "vestibular implant", "vestibular neuroprosthesis" and "bilateral vestibular failure". English-language human studies and relevant preclinical studies were included. Given the limited number of clinical trials and heterogeneity of outcomes, findings were synthesised narratively.

Early human studies have demonstrated that vestibular implants can evoke canal-specific vestibulo-ocular reflexes and, in selected patients, modest improvements in dynamic visual acuity and balance. However, functional and quality of life benefits remain inconsistent across small cohorts. Surgical risks, including loss of residual hearing, remain an important consideration.

Vestibular implants offer proof of concept for partial restoration of vestibular function but remain experimental. Further technological development and robust clinical trials are required before routine clinical adoption. Their role within publicly funded systems such as New Zealand's must be considered in the context of cost, access and equity.