Otolaryngology: Open Access
Open Access

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Neurotology or neuro-otology may be a subspecialty of otolaryngology head and neck surgery, also referred to as ENT (ear, nose, and throat) medicine. Neuro-otology is closely associated with otology, clinical neurology and neurosurgery.

Otology may ask ENT physicians who "...[study] normal and pathological anatomy and physiology of the ear (hearing and vestibular sensory systems and related structures and functions) ...", and who treat diseases of the ear with medicine or surgery. In some instances, otology and neurotology are considered together—as so closely related that a transparent demarcation between the subspecialties won't exist. for instanc the University of Maryland center uses the term, "otologist/neurotologist".

Otologists and neurotologists have specialized in otolaryngology then further specialized in pathological conditions of the ear and related structures. Many general otolaryngologists are trained in otology or tympanic cavity surgery, performing surgery like a tympanoplasty, or a reconstruction of the eardrum, when a hole remains from a previous ear tube or infection. Otologic surgery includes treatment of conductive deafness by reconstructing the hearing bones, or ossicles, as a results of infection, or by replacing the stapes bone with a stapedectomy for otosclerosis. Otology and neurotology encompass more complex surgery of the internal ear not typically performed by general otolaryngologists, like removal of complex cholesteatoma, labyrinthectomy, surgery of the endolymphatic sac for Meniere's disease and cochlear implant surgery.

In neurotology, one functional vestibular syndrome has been formally defined, namely persistent postural-perceptual dizziness (PPPD), which is supported by 30 years of clinical and physiologic research (ICD-11 beta draft. A second functional vestibular syndrome has been suggested on the idea of clinical observations of atypical and invariant vestibular symptoms (e.g., kaleidoscopic motion in multiple directions, chronic unchanging vertigo), but this has not yet gelled into a proper definition. PPPD is included within the beta draft version of the International Classification of Diseases, 11th edition under the category of chronic vestibular syndromes.

It had been defined by the Behavioral Subcommittee of the Committee for the Classification of Vestibular Disorders of the Bárány Society and vetted through the ICD-11 Neurology Workgroup before being added to the ICD-11 beta draft. The origins of PPPD are often traced to the primary description of phobic postura, through investigations of space–motion discomfort and visual vertigo within the 1990s, to chronic subjective dizziness within the 2000s. The evolution of PPPD and reviews of possible treatments are detailed elsewhere. The ICD-11 beta draft definition of PPPD is: persistent non-vertiginous dizziness, unsteadiness, or both lasting three months or more. Symptoms are present most days, often increasing throughout the day, but may wax and wane. Momentary flares may occur spontaneously or with sudden movement. Affected individuals feel worst when upright, exposed to moving or complex visual stimuli, and through active or passive head motion. These situations might not be equally provocative. Typically, the disorder follows occurrences of acute or episodic vestibular or balance-related problems. Symptoms may begin intermittently, then consolidate. Gradual onset is rare.