TLNS for balance and vestibular disorders

Medically reviewed by Evgenii Bugorskii, MD, Founder of RehaLine Group · Scientific supervision: Yuri Danilov, PhD, TCNL, University of Wisconsin–Madison · Updated September 2026

Translingual neurostimulation (TLNS) is a non-invasive method that delivers patterned electrical impulses to the surface of the tongue while the patient performs balance exercises. Balance disorders are where the method began: the first clinical use of tongue stimulation, at the University of Wisconsin–Madison in the early 2000s, was electrotactile vestibular substitution for patients who had lost vestibular function. This page explains how the method developed from that work and what the studies show.

Who this page is for

TLNS is used in chronic balance disorders of peripheral and central origin: bilateral vestibular loss after ototoxic antibiotics such as gentamicin, uncompensated unilateral vestibular loss, chronic unsteadiness after vestibular neuritis, and central balance deficits related to the brainstem or cerebellum, including cerebellar ataxia. Typical complaints are unsteadiness in the dark or on uneven ground, oscillopsia, intolerance of busy visual environments and fear of falling. The method is considered when standard vestibular rehabilitation has stopped producing progress.

How TLNS helps in balance disorders

The tongue is innervated by the trigeminal and facial nerves, whose fibres terminate in the trigeminal and solitary nuclei of the brainstem, next to and densely interconnected with the vestibular nuclei, the cerebellum and the reticular formation, the structures that integrate visual, vestibular and proprioceptive input into posture and gait. The original BrainPort concept (Tyler, Danilov, Bach-y-Rita, 2003, PMID 15011268) fed head-tilt information to the tongue as a pattern of stimulation, closing the loop for a patient with vestibular loss. The unexpected finding was that the effect outlasted the device: patients stood and walked better for hours, then days, after stimulation stopped. This residual effect led to the present method, in which patterned stimulation without a feedback signal is combined with balance training. Functional MRI in balance-impaired subjects (Wildenberg et al., 2010, 2011, 2013) localised the effect to the trigeminal nucleus and nearby pontine nuclei and showed that a course of stimulation calms the over-active visual-motion network typical of these patients. Stimulation is always paired with exercise; the balance tasks performed during the session are what the nervous system relearns.

What the evidence shows

These are open-label series and imaging studies rather than large randomized trials; they consistently show that improvement persists after stimulation ends. The randomized evidence for the same protocol comes from traumatic brain injury, where the deficit measured was also balance: two trials with 44 and 122 participants, about two-thirds responders, gains maintained at 12 weeks. A case report describes improved gait and balance in cerebellar degeneration (Bastani et al., 2018, PMID 29556411). The full list is on our Scientific publications page.

How a course is organised

A session is 20 minutes of stimulation combined with balance exercises, 2–3 times a day: standing with eyes closed, on foam, with head movements, walking with head turns, and tasks that reproduce the situations the patient finds difficult. The first two weeks are supervised in a clinic; the following 12 weeks are continued at home, for a total of 14 weeks. The device stays with the patient, and our specialists follow progress remotely. Outcomes are measured with the Sensory Organization Test, Berg Balance Scale and Dynamic Gait Index.

Who is a candidate

• Adults and adolescents with chronic balance deficit of peripheral or central origin that has persisted despite vestibular rehabilitation; treatable causes such as benign positional vertigo should be addressed first.
• Able to stand with or without support, to exercise daily and to hold the electrode in the mouth for 20 minutes.
• Not used during pregnancy, with known sensitivity to nickel, gold or copper, with active or suspected malignancy, with open wounds or bleeding in the mouth, or with absent sensation of the tongue.
• Active Meniere's disease with frequent attacks, or an untreated cause of dizziness, is a reason to postpone.

Where TLNS for balance disorders is available

The RehaLine TLNS device is registered in Russia, Mexico (COFEPRIS), Uzbekistan and New Zealand; registration is in progress in Brazil, Vietnam and the Philippines. Courses are run in our own rehabilitation centers in Moscow and Tashkent and by partner clinics. The device is not cleared by the U.S. FDA and is not offered in the United States. Clinics that want to add TLNS to their services can read about our partnership program.

PoNS® is a separate commercial TLNS device from the same scientific school, cleared by the U.S. FDA for gait deficit in mild-to-moderate MS and chronic stroke and authorised by Health Canada for MS, TBI and stroke, adults only; vestibular disorders are not among its indications. List price $28,270 per the manufacturer's FAQ. RehaLine's system covers more indications, including vestibular disorders and a pediatric program, the device stays with the patient, and a course costs several times less. PoNS® and PoNS Therapy® are trademarks of their respective owner; 4STIM is not affiliated with Bioness Medical, Helius Medical Technologies or their partners.

Frequently asked questions