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| Neuro-otology
is a subspecialty that encompasses disorders of the peripheral and
central auditory and vestibular systems. Neuro-otology is a field
similar to neuro-ophthalmology in that it is defined by its
practitioners. Most neuro-otologists have come from the field of
otolaryngology. The focus has been on the organ that is presumably
abnormal, that is, the ear. This emphasis resembles the early history of
neuro-ophthalmology, which concentrated primarily on the eye; only later
when central visual and ocular motor connections and symptomatology were
considered, the field began to involve those dealing with the brain,
namely neurologists. Similarly, neuro-otology initially concentrated
upon the primary functions of the ear, vestibular and auditory, without
reference to central auditory processing within the central nervous
system (CNS) or to those neurologic conditions which could produce
unsteadiness, dizziness, vertigo, as well as alterations in hearing.
When the multiple symptoms of dizziness or disequilibration are
considered, it is clear that there are neurological and systemic
conditions that can produce disorders of balance. Thus, neurologists
have become increasingly involved in the evaluation of patients
reporting dizziness. Just as retinal disorders remain primarily the
province of the ophthalmologist, so hearing disorders, which are
primarily peripheral, remain largely the province of the Otolaryngologist.
We have divided this chapter into two major sections: the first on vestibular disorders, and the second on auditory disorders. Each section reviews the essential aspects of the history and the office examination. Because vestibular symptoms are often accompanied by auditory complaints, neurologists who choose to deal with dizzy patients should be familiar with both vestibular and auditory testing. Therefore, we include a brief review of pertinent tests for vestibular and auditory disorders. Finally, we introduce therapeutic strategies for patients with dizziness and hearing loss.
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