Can a Medical Device Restore Your Balance?

Nearly two million people worldwide have lost the simple ability to feel steady. Now researchers have developed an experimental medical implant that promises to restore the sensory machinery responsible for balance

July/August 2025

Opener v3 — The patient looks through measuring goggles at a series of markers on a grid. Dina Litovsky

Key takeaways: What are vestibular disorders?

People with vestibular disorders have trouble maintaining balance or other problems with vision, touch and body positioning. Twenty percent of people experience vertigo at some point in their lives.
A new medical device works like a cochlear implant and has shown impressive results treating vestiular disorders.

For almost four years, Richard Stephens’ brain felt as if it were jiggling around inside his skull. If he turned his head, his vision wobbled for a few seconds before it became steady again. To cope, he had to constantly pause to stabilize himself and make every movement deliberately to avoid getting a headache. Though he initially had to be in a wheelchair, he trained himself to walk around with a cane and even to keep working his job as an employee benefits counselor, though he had to be driven there.

Stephens already knew what ailed him: bilateral vestibular loss. He no longer had function in the sensory machinery responsible for balance. The involuntary movement of his vision was a common symptom. The trouble had begun after a motor scooter accident. The hospital treated him with antibiotics, and as happens in rare cases, the medication damaged the hair cells in his inner ear that detected his body’s motion.

Simple tasks like eating popcorn during a movie were out of reach, and he was prone to falling. He lost tens of pounds of muscle, no longer able to do his fitness training. His condition was irreversible, so he was prepared to deal with it for the rest of his life. “It was just mind over matter, that you knew the sidewalk was not moving and it was just your vision making it look like it was moving,” he said. “I just progressed to the point that I could do things, but it was with severe restrictions.”

Opening Image — A patient at Johns Hopkins sits in a rotary chair. As her body turns, scientists measure how her vestibular system steadies her eyes. Dina Litovsky

Most people can’t imagine losing their sense of balance completely. But simply walking around depends on the vestibular system. It sends messages to the brain that combine with other information such as vision, touch and an internal understanding of body position (called proprioception). The invisible nature of this system makes it hard to recognize. We take it for granted—until it goes awry.

While only about 1.8 million people worldwide have severe vestibular loss, partial loss is extremely common. Some 20 percent of people experience vertigo at some point. And falling is the No. 1 cause of death from injury in the elderly because people lose their sense of balance as they age. “I’d argue there’s no area of medicine where there’s a bigger discrepancy between the number of people who suffer from a problem and the number of providers who are trying to take care of those patients,” says Jeffrey D. Sharon, director of the Balance and Falls Center at the University of California, San Francisco.

In 2016, Stephens took friends’ advice to reach out to hospitals that were researching potential cures. He emailed Charley Della Santina, an inner ear specialist who is also an electrical engineer, a biomedical engineer and a neurophysiologist—and director of the Johns Hopkins Vestibular NeuroEngineering Lab. Della Santina called him half an hour later. “There is hope,” Stephens remembers Della Santina telling him. Around this time, Della Santina had received FDA approval for a trial designed to test a new inner ear implant to restore balance. Stephens would be the very first person in the world to take one home with him to test out.

Stephens felt like he had nothing to lose when he traveled from his home in Southlake, Texas, to Baltimore for his surgery. A vestibular implant is a device that measures motion using a sensor that’s attached to the side of a patient’s head with a magnet. It conveys information using a series of electrical impulses that get transmitted directly to the vestibular nerve through a device placed in the inner ear, bypassing the damaged ear cells. The system looks and functions much like a cochlear implant, which restores hearing.

Cover image of the Smithsonian Magazine July/August 2025 issue

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This article is a selection from the July/August 2025 issue of Smithsonian magazine

Dr. Della Santina — After working on devices to fix hearing loss, Charley Della Santina—an engineer and a doctor—invented an inner ear implant for balance. Dina Litovsky

When Stephens went back three weeks later to have the implant activated, Della Santina warned him that it would take time to adjust to it. But right there in the office, Stephens felt as though there was an electrical current firing through parts of his brain that controlled his sense of balance. He noticed that his eyes weren’t darting around as usual and he was stumbling less, though he still needed the security of his walking stick and his wife, Susan, next to him as they made their way to their car. “I turned to her and said, ‘It’s almost like it’s normal,’” he recalled.

The couple spent the weekend in nearby Annapolis, where they walked along the Chesapeake Bay and ate crabs. Stephens folded up his walking stick, to experiment without it, and when his wife reached for his hand, he told her he was OK. When they were in the car, he didn’t have to close his eyes to keep his vision from bouncing around. While the shaky sensation didn’t go away completely, the scene in front of him didn’t appear to swing several feet as usual—just a few inches, which he could manage.

On Sunday night, while the couple was sitting in bed, the hotel room suddenly looked to him like it had turned upside down. Disoriented, Stephens fell over onto his wife as she sat next to him trying to type on her computer. She told him it wasn’t funny. But it was no joke. It looked to him as though the room was flipping back and forth, and he had to hold onto the comforter to keep himself from falling off the bed. When the movement stopped, he called Della Santina, who sympathetically reassured him that it would take some time for his brain to accept the new inputs and that they could talk about it at his appointment the next day.

“Bear with it,” Della Santina told him. “It’s a learning curve.”

Because almost all creatures need to sense gravity, our ability to balance has ancient origins. Even plant roots know how to grow into the earth, while stems know to move up toward the light. That might be considered a rudimentary vestibular system. As soon as there were animals that could move, they needed to keep themselves stable and reflexively adjust their heads and eyeballs, like a Steadicam. A jellyfish has mechanisms called hair cells that, when brushed up against beach sand, tell it where it’s tilted in relation to gravity. A fish has a line of hair cells that help it turn into the flow of water and control its oxygen absorption.

The vestibular system of reptiles and mammals relies on the movement of hair cells within the watery landscape of the inner ear organs. Two inner ear structures called otolith sensors detect both head motion and the pull of gravity, while three structures called semicircular canals specialize in sensing quick head rotations, driving a reflex that keeps our eyes and vision steady and clear. Fundamentally, the system works by detecting the movement of fluid within. “Your inner ear is just an internalized version of the ocean that you have learned through millennia of evolution to carry around with you,” Della Santina says.

A vestibular implant on a human skull. The device, attached to the side of the head, sends motion signals that bypass damaged parts of the inner ear. Dina Litovsky

Scientists have never seen the cells inside a living person’s inner ear. The tiny system is embedded in the densest bone in the body, deep within the base of the skull. Accessing it would risk damaging it. “You know how Lincoln is on a penny?” says Konstantina M. Stankovic, an ear and skull base surgeon at Stanford University, whose lab is developing methods to access these cells. “The size of the human cochlea, the organ of hearing, in cross section, is the size of Lincoln’s upper face on a penny, and the total fluid volume in the entire human inner ear is the equivalent to three raindrops.”

Like the three legs of a stool, the vestibular system works along with our senses of touch and vision to keep us stable. There are fail-safes when any part of the system doesn’t work. If we lose function in one ear, the other can mostly handle the job. Even if we lose most function in both ears, the brain can amplify whatever weak signals still come from the ears, combining them with vision and other senses to tell us which way is up and how we’re moving through the world. But all of those fail-safes are slower and less reliable than the vestibular reflexes that normally keep the eyes, head and body upright and steady.

Evolutionarily, balance came before hearing. Only later did the same kinds of cells that allowed animals to sense gravitational pull adapt for sensing vibrations through the snail-shaped cochlea, our organ of hearing. But treatments for hearing loss preceded those for balance issues. The first cochlear implant was placed in 1961, while the first vestibular implant was tested in 2007 by a team at the University of Geneva in Switzerland and Maastricht University in the Netherlands.

“For the vestibular field, it’s been a bit longer because we don’t understand the functioning that well. It’s an invisible sense, an automatic sense,” says Angélica Perez Fornos, a senior lecturer at Geneva University Neurocenter, which pioneered the vestibular implant. “We have the success of the cochlear implants to inspire us to move forward and say, OK, yes, we can maybe do something.”

A lab technician connects a patient’s vestibular device to testing equipment. The gray circle contains a head-motion sensor, a magnet and a coil that transmits data to the implant. Dina Litovsky

The Geneva patients had hearing loss as well as vestibular malfunction. Scientists didn’t want to risk damaging a patient’s hearing by trying a vestibular implant on its own, but they wanted to test whether cochlear and vestibular implants could work in the same way. Initial tests showed that the system gave patients more controlled eye movements in the lab. Over time, the vestibular implant became more complex, with additional electrodes, though it still stimulates only the semicircular canals of the inner ear to steady a patient’s gaze. By then, Della Santina was already at work on a device that was solely for vestibular loss, and secure enough that a patient could wear it long-term.

To an onlooker, someone with a vestibular disorder can appear clumsy or awkward or drunk, which adds a level of embarrassment to what’s already a serious physical impairment. (In the TV series “Arrested Development,” a character played by Liza Minnelli made the condition into a running gag.) It’s not easy to explain a balance disorder to the average person, let alone to a doctor. The Geneva research group did one small study that found patients took an average of three years to receive a diagnosis after their first symptoms appeared. Many describe being misunderstood by their doctors, who sometimes hesitate to acknowledge a condition they can’t treat.

Laptop — A laptop runs video-oculography software, which records the patient’s eye movements. Dina Litovsky

In recent years, research in the vestibular field has exploded. Along with the exciting developments on a vestibular implant, a whole other field of gene research could soon help patients with genetic hearing and vestibular problems, replacing the mutated gene with a healthy copy. Effective treatments, Perez Fornos says, could also make doctors take these cases more seriously and diagnose patients faster because there’s finally a clear reason to do so. “Our understanding of the field also helps patients a lot because they’re not ignored anymore,” Perez Fornos says.

When I visited Della Santina’s lab, he was getting ready to meet with a patient who would become an implantee the following day. Michelle Bernas, a woman in her 50s from Waterford, Michigan, lost her vestibular function slowly for reasons she still doesn’t know. She simply became more unsteady over time and fell more often. Through testing, she learned that her balance function was nearly gone, but because she’s been able to compensate using vision, other people have a hard time understanding her condition. “I tell them that I feel dizzy and off-balance, that if I were to fall, I couldn’t catch myself, that I’m not able to help myself once it starts,” she told me. “And, you know, they really don’t get it. People don’t believe you, and that can be tough.”

An ear surgery at the Johns Hopkins department of otolaryngology. Dina Litovsky

As a former medical assistant, Bernas figured out fairly quickly that her vestibular system was malfunctioning. She worried, however, that Johns Hopkins would reject her as an implant recipient because she performed so well during her testing. She was relieved when she found out she remained a candidate and would receive her implant the following day.

Another trial participant named Michael Laframboise, a maple syrup farmer from Orwell, Vermont, lost vestibular sensation in one ear in his 20s and the other in his 50s. Today, he is in his 60s, and he doesn’t know the reason he lost balance. Initially, he suffered from debilitating nausea, and while his body eventually got over that discomfort, he could never manage to focus his eyes unless he was completely still. He said he went from doctor to doctor trying to figure out what was wrong with him before landing on an ear, nose and throat specialist who suggested he get involved in medical trials for vestibular system treatment.

He received his implant four years ago, and he said it improved his visual focus by about 50 percent. That’s been enough for him to resume most of his daily tasks. I watched Laframboise perform various timed exercises: standing on a balance beam, walking in a straight line on the floor and practicing standing on one foot with varying levels of electric stimulation. When he took a break, I told him how hard it was to understand, as someone who’s never had a vestibular issue, what the loss of balance would feel like, because he seemed to be doing quite well.

“Let me show you,” he said, looking at me steadily. “Look at my eyes when I turn off the prosthesis.” He removed the magnets that connected the prosthesis to his head, and his eyes began shaking back and forth uncontrollably. “I’m back to where I started.”

Della Santina had said he would make time for me to go through balance testing, too, so I could see what the patients experience. They were also in need of some control subjects, who didn’t come in with balance disorders. He’d mentioned something about a “rotary chair.” I asked Laframboise what I should expect, and he warned me about it. “It’s worse when your vestibular system is working,” he said. “You’ll know that you’re spinning, and you’ll get sick, but without it working, you don’t realize you’re spinning. You just you feel the breeze.” Della Santina came in a few seconds later, telling me the team was ready for me, so I stepped out into the hall for them.

Test Photo 1 — The research team helps a post-operative patient go through a series of tests. The patient reads an eye chart while walking on a treadmill, assisted by Lauren Trainer and Celia Fernández Brillet (at wall) Dina Litovsky

The researchers had me subtract numbers while standing in awkward positions and walking on a line of tape on the floor. After getting the lab’s first perfect score on my balance and gait test, I sat down in the chair. It was a large contraption that looked like an airplane pilot’s seat. Once I was strapped into the harness, I had to maintain a straightforward gaze so that the researchers could measure my eye movements. Soon, I felt myself spinning, my eyes shifting back and forth, trying to make sense of what my body was doing. After a few moments, I got used to the sensation and stopped feeling the motion so much. When the chair stopped a minute later, I felt as though I was being jerked back the opposite way.

“I’ve seen that happen sometimes,” said Evan Vesper, a PhD student in biomedical engineering. He compared my inner ear to a spinning coffee cup that stops abruptly. The fluid continues to spin for a while longer after the container is standing still.

The feeling only started to go away after they spun me around in the other direction for a minute. A wave of nausea hit me once I stood up to walk again. It took a few minutes to dissipate. To be in balance is about much more than avoiding falls or walking in a straight line, I realized. It is to feel in alignment. It affirms us to ourselves.

Before Della Santina went to medical school, he completed his PhD in bioengineering at the University of California, Berkeley, where he helped manufacture silicon electrodes to study hearing and balance. Once he became a doctor, he started helping patients with hearing and balance loss. The first cochlear implants were rudimentary, but feedback helped to improve them. Today, they help not only people with near-zero hearing but also those with less severe hearing loss.

Walking on a balance beam. Dina Litovsky

Yet these patients need some time to adjust to them. The sounds they hear might seem electronic or robotic at first. It can be months before the brain learns how to take in this new input and interpret it in a useful way. When Stephens fell over in bed that first weekend, Della Santina suspected the same process was occurring in his balance system. “Your brain is thinking, ‘What the heck is going on?’” Della Santina reassured his patient. “It has to adapt to that and learn how to interpret these new inputs. We know that people get really good at that with repeated practice.”

Because Stephens had spent years coping by the time he got his implant, he knew what to do. He lay down to rest for the night, and the next morning, he sat in the back seat of the car and closed his eyes or looked sideways out the window. If he looked straight ahead, his entire field of vision would bounce every time the car went over a pothole or accelerated at a green light.

At the clinic, Della Santina put Stephens through the usual set of tests. He applied different patterns of electrical impulses to the vestibular nerve and asked Stephens what he felt. A vestibular implant can’t exactly replicate the complex patterns an organic vestibular nerve receives, each of which signals a particular direction, speed and timing of head motion. But a technician can usually find a pattern that feels natural enough for the patient’s brain to accept as a useful signal.

Attempts to stand heel to toe — A patient attempts to stand heel to toe, as Kelly Lane lends a steadying arm. Dina Litovsky

After Stephens went home with his device, his improvement was steady. The main benefit for Stephens and the other patients who received the implant after him seems to be an improved ability to walk independently. None of the patients are using the canes or walkers they came in with, Della Santina said.

It’s been five years since implantation, and the tremors in Stephens’ eyes are becoming much rarer. He says he’s returned to about 75 percent of his typical functionality. He was able to restore his driver’s license. He even started resuming some of his strength training and running and is in better physical shape than most 60-somethings. His old cane is permanently hanging on the coat rack at his gym, where it’s been for years.

“I think running is about as challenging a task as we could ask anyone to do,” Della Santina says. “Every time your heel hits the ground, everything you see is bouncing.” He marvels that Stephens is now able to carry out this complex activity again, thanks to a device that sends signals to his inner ear. “It’s really amazing.”

Editors’ note, July 7, 2025: A previous version of this article misstated Michael Laframboise’s condition; it has been corrected to reflect that he lost vestibular sensation, not hearing, in his 20s and 50s.

Can a Medical Device Restore Your Balance?

Key takeaways: What are vestibular disorders?

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