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Neurosciences

Treatment

What conditions do neurotologists treat?

We treat conditions including:

  • Hearing loss and deafness
  • Tinnitus
  • Dizziness
  • Vestibular (balance) diseases, such as Meniere’s disease and vestibular neuronitis
  • Infectious and inflammatory diseases of the ear
  • Facial nerve disorders, including paralysis
  • Congenital malformations of the ear
  • Tumors of the ear, hearing nerve and skull base
  • Vestibular Schwannoma tumors
  • Disease and disorder management of the cranial nerves and skull bas

 

How are neurotological conditions treated?  

Many neurotological conditions are treated through surgery. Often, when a patient is referred to a neurotologist, he or she needs complex surgery of the inner ear not typically performed by general otolaryngologists. These surgical treatments include:

  • Removal of complex cholesteatoma
  • Labyrinthectomy
  • Cochlear implant surgery
  • Microsurgery of the ear with reconstructions
    Most ear surgery is microsurgery performed with an operating microscope to enable the surgeon to view the very small structures of the ear. The use of minimally invasive laser surgery for middle ear procedures is growing. Laser surgery reduces the amount of trauma due to vibration, enhances coagulation, and enables surgeons to access hard to reach places in the middle ear. Types of ear surgery include stapedectomy, tympanoplasty, myringotomy ear tube surgery, tympanomastoidectomy surgery to repair a perforated eardrum, cochlear implants and tumor removal.
  • Laser stapedectomy
    Stapedectomy is a microsurgical procedure of the middle ear, performed through the ear canal with the aid of a laser. The purpose of this procedure is to improve hearing.  When the stapes footplate is in a fixed position, rather than being normally mobile, a conductive hearing loss results. In both of these situations, it is possible to improve hearing by removing the stapes bone and replacing it with a micro prosthesis, a stapedectomy. The results of this surgery are generally most reliable in patients whose stapes has lost mobility because of otosclerosis. Nine out of ten patients who undergo the procedure will come out with significantly improved hearing while less than 1% will experience worsened hearing acuity or deafness.
  • Perfusion and endolymphatic sac surgery (to manage vertigo)
    Until recently, surgical options for treatment of Meniere’s disease were limited. However, in the last 10 years minimally invasive office surgical treatments, including perfusion and endolymphatic sac surgery, have become the most common procedures to control Meniere’s disease when medical therapy is unsuccessful.

    Perfusion
    Perfusion treatments involve the injection of medication through an anesthetized eardrum. The medication passes into the inner ear through a membrane, resulting in controlling the vertigo attacks in most patients. It also improves hearing in some patients.

    Endolymphatic Sac Surgery
    Endolymphatic sac decompression (ELS) is one of the most frequently recommended procedures. The inner ear contains an endolymphatic sac that drains fluid. This surgical procedure involves opening the mastoid and decompressing and removing the bone over this sac.

 

What if I need hearing aids or cochlear implants?

If a patient’s hearing cannot be preserved or restored, we provide hearing rehabilitation options such as hearing aids, cochlear implants, and hybrid devices (a combination of a cochlear implant and conventional hearing aid).

 

How are dizziness and balance disorders diagnosed?

Our labs offer advanced testing capabilities for diagnosing and treating dizziness and balance disorders.

VNG (Video Nystagmography)
This is the most common test administered to patients with dizziness and/or balance disorders. This battery of tests records quantitative measurements of the nystagmus and provides objective documentation of vestibular function, the vestibular ocular reflex and central vestibular pathologies.
VNG testing is considered the new standard for testing inner ear functions because it uses video to measure the movements of the eyes directly through infrared cameras (instead of measuring the mastoid muscles around the eyes with electrodes like the previous Electronystagmography (ENG) version). VNG testing is more accurate, more consistent, and more comfortable for the patient.

Rotational Testing (VHIIT)
Rotational chair testing determines if the vestibular (inner ear) or the neurological system is the cause of a balance disorder. When a person turns his or her head, the vestibular system sends continuous signals to the brain, updating it on the head's position. In turn, additional signals are sent to the muscles of the eyes via the vestibular ocular reflex (VOR). For every head movement in one direction, there is eye movement in the opposite direction. This phenomenon is the basis for rotational testing.

Evoked Potentials
Evoked potentials measure electrical activity elicited in response to stimulating, sound. Stimuli delivered to the brain through these senses evoke minute electrical signals, which travel along the nerves and through the spinal cord to specific regions of the brain.  There, they are picked up by electrodes, and then amplified and recorded on a graph. This action enables measurement of inner ear and gravity centers.