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 otorhinolaryngology 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 the treatment of inner ear conditions or hearing and balance disorders. These specialists also work with audiologists and related sensory specialists.

Training and Description
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 such such as tympanoplasties or reconstruction of ear drums. Otologic surgery also includes treatment of conductive hearing loss by reconstructing the hearing bones as a result of infection or by replacing the stapes bone with a stapedectomy for otosclerosis.

Neurotology encompasses more complex surgeries of the inner ear not typically performed by general otolaryngologists, such as removal of complex cholesteatoma, labyrinthectomy, surgery of the endolymphatic sac for Ménière'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 no 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.

Field of Work
Conditions treated by neurotologists include: Many of these conditions also relate to otology
 * Vestibular (balance) diseases, such as Ménière's disease and vestibular neuronitis
 * Skull base tumors, such as vestibular schwannoma (acoustic neuroma)
 * Facial nerve disorders, including facial nerve paralysis
 * Hearing loss and deafness
 * Certain conditions relating to the skull base