Section: 
Otiology
OtiologyCombined application of binaural acoustic stimulation and virtual reality methods for vestibular rehabilitation. Report ii. Efficacy in individuals with persistent bilateral peripheral vestibular hypofunction
E. N. Kravtsova (1), A. Yu. Meigal (2), L. V. Shchegoleva (3), L. I. Gerasimova-Meigal (4), V. V. Dvoryanchikov (5)
(1), (2), (3), (4) Petrozavodsk State University, Petrozavodsk, 185910, Russian Federation, (5) Saint Petersburg Institute of Ear, Throat, Nose and Speech, Saint Petersburg, 190013, Russian Federation
UDK: УДК 616.281-008.5-073.175:612.858.8:616.28-008.177:534.2
DOI: https://doi.org/10.18692/1810-4800-2026-2-69-76
ABSTRACT
Abstract. Introduction. Persistent bilateral vestibular hypofunction (BVH) leads to severe postural control impairment and a significant reduction in quality of life. Standard vestibular rehabilitation (VR) in patients with BVH is aimed at developing central compensation but does not restore vestibular function. Sensory substitution and noninvasive neuromodulation techniques are promising approaches. Objective. To evaluate the effectiveness of a combined VR protocol, including virtual reality training with biofeedback (BFB) and synchronous binaural acoustic bone conduction stimulation (110 Hz), on postural stability parameters in patients with persistent BVH. Patients and methods. For diagnosis, a complex of otoneurological examination was used, the results of which were verified using videonystagmography (VN415, Interacoustics, Denmark) and bithermal caloric testing, which revealed subnormal values of the slow phase nystagmus velocity (<6°/s on both sides). As part of a six-week course of combined VR, patients received: 1) daily virtual reality training on the Kinect platform with a gradually increasing duration (5–20 min); 2) concomitant binaural acoustic stimulation (110 Hz, 45–65 dB) during periods of physical and cognitive-motor activity. The effectiveness of VR was assessed before and after the VR course using computer stabilometry (ST150 stabiloplatform, Mera, Russia) in four conditions: open/closed eyes on a hard/soft surface (OH, CH, OS, CS). The trajectory length (L, mm) and statokinesiogram area (S, mm?) of the general center of pressure, as well as the weighted contribution of the sensory systems (visual Wvis, proprioceptive Wpro, vestibular Wvest) were analyzed. To test the statistical significance of differences between the parameters before and after VR, a paired Student’s t-test was used. Differences were considered statistically significant at p < 0.05. Data processing was performed using the R software package. Results. After the VR course, a statistically significant (p < 0.05) improvement in postural control was revealed: a decrease in L in all conditions (the greatest in the CS: from 1738.24±1008.16 mm to 1101.36±418.07 mm, ?36.8%) and S in the OH and CS conditions (in the CS: from 2599.24±2393.84 mm? to 1410.16±704.46 mm?, ?45.8%). Analysis of the sensory contribution showed a significant increase in the role of proprioception (Wpro by L: from 0.36±0.16 to 0.43±0.16, p < 0.05) and a decrease in dependence on vision (Wvis by L: from 0.31±0.17 to 0.23±0.11, p<0.05). The contribution of the vestibular system (Wvest) did not change significantly. Conclusion. The combined VR protocol with binaural acoustic bone conduction stimulation (110 Hz) significantly improves postural stability in patients with BVH through adaptive reorganization of sensory input, enhancing proprioceptive control, and reducing visual dependence. This method is promising for the correction of postural disorders in irreversible vestibular insufficiency.?
Publication date:
15.04.2026
Keywords:
bilateral vestibular hypofunction, vestibular rehabilitation, postural control, stabilometry, acoustic stimulation, bone conduction, virtual reality, sensory substitution For citation:
Kravtsova E. N., Meigal A. Yu., Shchegoleva L. V., Gerasimova-Meigal L. I., Dvoryanchikov V. V. Combined application of binaural acoustic stimulation and virtual reality methods for vestibular rehabilitation. Report ii. Efficacy in individuals with persistent bilateral peripheral vestibular hypofunction. Russian Otorhinolaryngology. 2026;25(2):69-76. (In Russ.) https://doi.org/10.18692/1810-4800-2026-2-6