Herman Kingma Herman Kingma Foto: Sacha Ruland

Towards an artificial vestibular system

In Body
Written by  Femke Kools Thursday, 12 May 2011 10:48

Ig Nobel Prize winner Herman Kingma

It sits in our ears. It helps us see clearly when we walk. It’s crucial for our sense of balance, so that we don't fall, and it tells our conscience where we’re in a room. The vestibular system is so fundamental to daily life that people with major vestibular disorders are severely handicapped – to the extent that some decide to end their own lives. For almost 30 years, Maastricht University’s Professor Herman Kingma has sought to improve the diagnostics and treatment of vestibular disorders. One of the top vestibular disorder specialists – or vestibulologists – in the world, he also travels far and wide to share his knowledge. Read on for an interview with the winner of the 2011 Ig Nobel Prize for Physics.

The Ig Nobel Prizes are awarded annually at Harvard University to researchers who “first make people laugh, and then make them think”. The name is derived from the word ignoble, meaning “despicable” or “lowly”. Kingma and his colleagues at the University of Nancy in Lorraine, France, won the prize for their research on dizziness in discus throwers and shot putters. “Discus throwers often complain about dizziness after their throw, but shot putters don’t, whereas they make pretty much the same movement. We wanted to find out what was going on.”

Fixation point

The researchers filmed discus throwers and shot putters, and carefully analysed the images. They discovered that, for a split second, the discus throwers lose contact with the ground when they rotate. They also hold the discus behind their back, preventing them from seeing it during their throw. Shot putters, on the other hand, are firmly planted on the ground when they rotate, and can see their hands at all times. This means that – like ballerinas and ice dancers doing a pirouette – they have a visual fixation point which prevents them from getting dizzy.

Kingma: “It may not sound particularly socially relevant, but as researchers you simply want to understand how it works. We wanted to find out whether we knew the vestibular system well enough to explain this difference. And it turned out that we did. The research didn’t contribute any new knowledge, but it did confirm what we already knew. And that in itself is extremely relevant in science.”
Kingma was not entirely convinced by the first email he received about his Ig nomination. “I’d never heard of the prize, and thought it was spam. But after they called and explained how it worked, I was thrilled. Mainly because it’s an opportunity to create more publicity for vestibular disorders and the contribution we’re trying to make here in Maastricht. Lack of information is a real problem when it comes to the vestibular system, among the general public but even among ear, nose and throat (ENT) doctors and neurologists.”

Worldwide expert

Over a period of almost thirty years, Kingma has become one of the top worldwide experts in the field of vestibular disorders. In 1983, the ENT department of Maastricht academic hospital (azM) invited him to set up a diagnostic laboratory for Balance Disorders and lead its research on vestibular disorders. A PhD in quantum biophysics, he was trained as clinical physicist and specialist vestibulologist. “The azM saw this niche as an opportunity to distinguish itself, and it succeeded: we’re now among the top five in the world in the field of vestibular diagnostics.”

Kingma is not a medical doctor, but he spends one and a half days each week seeing patients with serious vestibular problems at the azM’s ENT outpatient clinic. He gets three new patients a week whose vestibular system no longer works on one side or the other (bilateral vestibular areflexia). A quarter of people above 65 have a poorly functioning vestibular system, which is the leading cause of falls. And about one in five people will at some point in their life suffer from benign, but extremely unpleasant, paroxysmal positional vertigo.

Patient contact

Kingma makes diagnoses and, if treatment is possible, advises ENT doctors and surgeons on the best treatment or medication. “The contact with patients motivates me enormously. Also, my background as a physicist provides the ideal basis for introducing sophisticated research equipment into the clinic.”

An example of this is the vibration belt for people with bilateral vestibular areflexia that he developed together with the Maastricht Instrumental Development Engineering & Evaluation (IDEE) Department. “The belt has 12 equally distributed vibration devices. When you tilt too far forward, for example, the belt gives off a vibration at the front, allowing you to correct the movement. Of the 100 patients who have tested this in a clinical setting, 80 were extremely enthusiastic. We’re going to have five of these patients take a belt home in an effort to prove its effectiveness. Hopefully we’ll be able to convince healthcare insurers that it needs to be listed as a medical aid. There’s a big chance we will.”

First implant

Kingma has also been working with colleagues on the first ever artificial vestibular system. Professor Robert Stokroos will soon perform the first experimental implant. “Here in Maastricht, we have a unique situation where multidisciplinary teams work in close collaboration. We have ENT doctors and clinical physicist-audiologists working on cochlear and brainstem implants; Professor Stokroos and Janny Hof, both neuro-otologists and ENT surgeons, who perform the most complex otological surgeries; neurosurgery researchers who work with deep-brain stimulation; and all sorts of large-scale developments and investments with Brains Unlimited. We actually have everyone and everything we need on hand, which helps us to push ahead.”

During operations on deaf people with cochlear implants whose vestibular systems no longer worked, the researchers succeeded in stimulating the vestibular nerve. The good news: the nerve still appears to work. The ENT team is planning to implant permanent electrodes, which they will then use to try to stimulate this nerve once the patient has regained consciousness. “The first goal is gaze stabilisation, so being able to see clearly during movement. The patients know that this operation won’t give them a new vestibular system or any other immediate advantages, but it’s a first step in the right direction. And they’re highly motivated to participate: they’re happy with anything that could offer them better prospects for the future. Before I retire – that is, within four years – I aim to have helped to create a working artificial vestibular system that can be implanted in humans. We’re making pretty good progress.”

Education

However, the reputation of his research group, Kingma says, is mainly due to the training it provides at a national and international level on all things related to the vestibular system. Kingma personally initiated the training course delivered by the international Bárány Society, named after the man who won the real Nobel Prize in 1914 for his research on vestibular disorders. This course brings together the world’s top ENT doctors, neurologists and scientists. In Maastricht, Kingma also gives popular training courses and master classes. “The physiologies and disorders of the vestibular system are technical and multidisciplinary phenomena that few doctors know anything about. This is why some patients don’t find out what’s wrong with them until quite late, which puts them in a very unpleasant and uncertain situation.” Kingma also enjoys giving lectures for medical residents every five weeks. “Teaching is extremely rewarding. You’re opening the eyes of the doctors of today and tomorrow, who can then provide better help to their patients. That’s what I do it for.”

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Herman Kingma is professor of Vestibulology at the Maastricht University Faculty of Health, Medicine and Life Sciences, and a vestibulologist and head of vestibular diagnostics within the Ear, Nose and Throat Department at the Maastricht University Medical Centre +, where he leads the research on vestibular disorders.

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