Neuro-otology: Diagnosis and Management of Hearing and Balance Disorders

Neuro-otology is a subspecialty of otolaryngology (and neurology) focusing on disorders of the auditory and vestibular systems and their central connections.

Core Conditions

• Vestibular migraine – Episodic vertigo, photophobia, phonophobia.
• Ménière’s disease – Triad: episodic vertigo, fluctuating hearing loss, tinnitus, aural fullness.
• BPPV – Canalithiasis (posterior canal > horizontal); Dix-Hallpike + Epley.
• Vestibular neuritis / labyrinthitis – Acute vertigo ± hearing loss; viral/post-viral.
• Superior canal dehiscence (SCDS) – Sound/pressure-induced vertigo, autophony.
• Acoustic neuroma (vestibular schwannoma) – CPA tumor; asymmetric hearing loss.
• Autoimmune inner ear disease (AIED) – Rapid bilateral loss; steroid-responsive.
• Central vertigo – Brainstem/cerebellar stroke, MS, tumor.

Diagnostic Toolkit

• Audiometry – Pure-tone, speech, tympanometry, OAE, ABR.
• VNG/ENG – Caloric, positional, saccade, pursuit, optokinetic.
• vHIT – Video head impulse test (all 6 canals).
• VEMP – cVEMP (saccule), oVEMP (utricle).
• Imaging – MRI IACs (gad), CT temporal bone.
• Posturography (CDP) – Sensory organization, motor control.

Treatment Modalities

• Repositioning maneuvers (Epley, Semont, BBQ roll).
• Vestibular rehabilitation therapy (VRT) – Habituation, adaptation, substitution.
• Medications: betahistine, diuretics, steroids, antiemetics, migraine prophylactics.
• Surgical: endolymphatic sac decompression, labyrinthectomy, vestibular nerve section, tumor resection.

Multidisciplinary (neuro-otologist, audiologist, vestibular PT, neurologist) yields best outcomes.