The evolution of Electrovestibulography technique and safety considerations

Over the past decade, the number of papers reporting the use of the Electrovestibulography (EVestG) technique has tripled compared to the previous decade. Moreover, EVestG has been employed in clinical trials for diagnostic purposes and monitoring treatment efficacy. The key drivers behind the expansion of such work could be linked to both the progress achieved in the EVestG technical development as well as the fact that EVestG has proved to be a safe and tolerable technology with promising diagnostic capabilities. Compared to existing vestibular and neurophysiological assessments, EVestG provides a non-invasive and objective method to directly measure vestibular responses and indirectly assess neurophysiological brain activity, with potential for early diagnosis. This contribution reviews the technical evolution and safety considerations of EVestG over the last decade. Areas of development that together contributed to the current state of the art are discussed. These include the design of low-noise electrodes, the electrode placement protocol, and improvements in signal acquisition during recording. Additionally, participant attrition rates and withdrawal reasons are presented. Findings highlight advancements in signal quality, user comfort, and diagnostic reliability, reinforcing EVestG's clinical viability. Lastly, potential developments and challenges toward a miniaturised and portable EVestG technology are discussed.