What is Neurotology?

Neurotology / otoneurologyneuro-otology is a branch of medical science which studies and treats neurological disorders of the ear. It is a subspecialty of  both otolaryngology – head and neck surgery as well as neurology.The discipline is specialised in the diagnosis and treatment  of disorders of the balance and auditory systems. Patients suffering from vertigo or head spinning, imbalance or instability, disorders of hearing related to the inner ear and the auditory nerves and neural pathways in the brain and patients suffering from tinnitus (a buzzing sound in the ears or in the head) all come under the purview of neurotology and all such patients are best managed by specialist neurotologists. Neurotologist is a specialist who diagnoses and medically and surgically manages neurological diseases of the ear brain. Though traditionally ENT doctors practised in neurotology the trend is very fast changing now and a general ENT doctor is not expected to have the competence and expertise that is required to handle these patients. A proper management of a neurotological disorder requires a multi-speciality approach and neurotological patients are best treated by a team of doctors with special interest in balance disorders  comprising of a minimum of a neurologist, a ENT specialist and a psychiatrist and if possible also a psychologist,  a physiotherapist and a doctor of internal medicine. Sometimes it involves a neurosurgeon and an ophthalmologist or a cardiologist also as many eye disorders and many cardiological conditions like  neuro-cardiogenic syncope often present to the doctor complaining of just ‘vertigo’. But such facilities with so many different specialists together in one table treating one patient are difficult to get and not viable / feasible; hence one person who acquires a working knowledge on all these subjects and has a special interest, knowledge and experience in treating balance disorder patients is called a neurotologist  and this person is best suited for handling neurotological patients. Neurotological disorders present unique problems which are not limited to one particular discipline and the treating doctor has to have special skills and expertise to handle such patients. Neurotology comprises all disorders that involve the temporal bone and the structures in the base of the skull as well as the cerebellum, the brainstem, the midbrain the 3rd 4th, 5th, 6th, 7th and 8th cranial nerves and even the limbic system and the hippocampus in the brain most of which is beyond the purview of ENT. Doctors trained only in the ear, nose and throat and who practice in general ENT are not expected to have the requisite expertise to handle these unique patients and managing such patients requires a unique set of skills and expertise that has to be slowly acquired . Only about half, or even less than half  of the patients presenting to the doctor with so called  ‘vertigo’, actually have problems related to the ear like BPPV (positional vertigo), Meniere’s disease, Vestibular neuritis , Labyrinthitis, perilymph fistula etc,  and a huge chunk of such patients  have disorders like Migraine, seizures, disorders of the extrapyramidal systems that present with vertigo but  are primarily neurological disorders or some psychic condition like phobic postural vertigo or a persistent perceptive  postural dizziness which are basically psychiatric disorders but present with vertigo or imbalance.  Hence vertigo or balance disorder patients are not limited to ENT disorders only. Neurological  and neurosurgical disorders like Acoustic Neuromas, Basilar Skull and Temporal Bone Fractures, Chondrosarcomas in the base of the skull, Encephalocele / Meningoceles, Facial Paralysis from Facial Nerve Tumors, Facial Paralysis from Middle Ear Infections, Paragangliomas, Petroclival Meningiomas, Petrous Apex Cholesterol Granulomas, Glomus Jugulare, Epidermoids in the Petrous apex, Ramsay-Hunt Syndrome, Bell’s Palsy, Traumatic Facial Paralysis  are all basically neurological / neurosurgical disorders  and not standard ENT disorders that all come under the purview of neurotology even if all of them may not be having vertigo as the primary symptom.