Neurotology

Neurotology or neuro-otology is a branch of clinical medicine which studies and treats neurological disorders of the ear. It is a subspecialty of otolaryngology-head and neck surgery, and is closely related to otology, and also draws on the fields of neurology and neurosurgery. Otology generally refers to the treatment of middle ear disease and resultant conductive hearing loss, whereas neurotology refers to treatment of inner ear conditions, or hearing and balance disorders. These specialists also work with audiologists and related sensory specialists.

Neurotologists are physicians who have specialized in otolaryngology and then further specialized in neurological conditions of the ear and related structures. Many general otolaryngologists are trained in otology or middle ear surgery, performing surgery such as a tympanoplasty, or a reconstruction of the ear drum, when a hole remains from a prior ear tube or prior infection. Otologic surgery also includes treatment of conductive hearing loss by reconstructing the hearing bones, or ossicles, as a result of infection, or by replacing the stapes bone with a stapedectomy for otosclerosis. Neurotology encompasses more complex surgery of the inner ear not typically performed by general otolaryngologists, such as removal of complex cholesteatoma, labyrinthectomy, surgery of the endolymphatic sac for meniere's disease and cochlear implant surgery, because of the additional risk of hearing loss, vertigo, and facial nerve paralysis. It is more and more common in the United States as well as around the world for otolaryngologists to obtain additional advanced training in neurotology, which requires an additional one or two years of fellowship training after five years of residency.

Historically neurotology fellowship programs have only been one additional year. Currently most one-year programs are non-accredited programs, but offer training in a wide variety of otologic and neurotologic procedures. Many non-accredited programs do not emphasize surgery of the lateral skull base, but many do offer training in acoustic neuromas, glomus jugulare and other skull base surgeries. These non-accredited neurotology fellowships are also referred to as advanced otology fellowships. Two-year accredited programs have become a growing trend in the last 5-10 years, and are more geared towards academic training, with the additional year often being more focused on research. The advantage of the additional accreditation, separate from otolaryngology, is to emphasize training in the skull base procedures and qualify these trainees for intracranial surgery.