Neurotology is a highly specialized division of otolaryngology that focuses on anomalies of the inner ear.
The inner ear is made up of the cochlea, semicircular canals, and vestibule. Taken altogether, the parts of the inner ear convert the mechanical energy of sound into electrical energy and assist with our sense of balance.
Neurotologists complete an additional two-year fellowship in order to focus specifically on medical conditions related to the inner ear. The Neurotologist on staff at Specialty Physician Associates uses state-of-the-art technology and techniques like microsurgery, reconstructive surgery and cochlear implantation. We are able to diagnose and treat conditions such as:
- Sensorineural hearing loss and deafness
- Meniere’s disease and labyrinthitis (both vestibular diseases, causing balance issues)
- Acoustic neuroma
- Facial nerve paralysis and other disorders of the facial nerves
The two main types of hearing loss are conductive and sensorineural, with the third being a combination of the two called mixed hearing loss. Conductive hearing loss is related to problems in the outer or middle ear, whereas sensorineural hearing loss has to do with the inner ear. Sensorineural hearing loss is the type we typically associate with aging and noise exposure, and about 1 out of 1,000 babies are born with it. For patients with profound sensorineural hearing loss, a neurotologist can surgically implant a device called a “cochlear implant.”
The cochlear implant effectively bypasses the patient’s existing cochlea, sending electrical auditory information directly to the auditory nerves. Cochlear implants require a 2–3 hour outpatient surgery under general anesthesia. Once the patient has healed from surgery, in about 3–6 weeks, the audiologist can fit and program the sound processor.
It takes time to adjust to cochlear implants. Children who are born with profound hearing loss tend to be better candidates for cochlear implants than adults, as a child’s neuroplasticity allows them to more easily adapt to the implants. Children with cochlear implants tend to have better vocal quality and speech intelligibility than those who only have hearing aids.
For less-than-profound hearing loss, hearing aids are still the best option. Our skilled audiologists on staff will evaluate to determine what is the best plan of action of each individual patient.
Acoustic neuroma, or vestibular schwannoma, is a tumor that develops on the vestibular nerve, which carries balance and auditory information to the brain. The tumor is noncancerous and typically slow-growing, but can put pressure on the nerve which can cause hearing loss, tinnitus and loss of balance. The condition is genetic, but only about 5% of cases are inherited.
An acoustic neuroma typically develops in patients between the ages of 30–60. Symptoms tend to worsen as the tumor grows, and in some cases it can become life-threatening if it is allowed to progress untreated. Typical symptoms include:
- Gradual hearing loss that occurs only on one side, or is more pronounced on one side. In some cases, hearing loss will be sudden.
- Tinnitus (ringing) in one ear
- Problems balancing, feeling unsteady, falling down
- Dizziness (vertigo)
- Facial numbness
- In rare cases, weakness or loss of muscle control
Early treatment can prevent total hearing loss and other complications, so it is important to see an Otolaryngologist immediately when symptoms arise. Treatments include regular monitoring, radiation and surgery.
Symptoms of Meniere’s disease are similar to acoustic neuroma, with the difference that they tend to be episodic rather than consistent. The cause of Meniere’s disease is a buildup of excessive fluid in the labyrinth, called “endolymph.” This interferes with normal balance and hearing signals as pressure anomalies in the labyrinth affect the function of the entire inner ear. Meniere’s disease tends to affect people between the ages of 40–60, and is most often a lifelong condition, though it changes through stages, and the severity of vertigo tends to lessen over time.
Diagnosis is based on medical history and the presence of the following symptoms:
- Temporary hearing loss
- Feeling of “fullness” in the ear
- At least two episodes of vertigo persisting for at least 20 minutes each
Patients often report stress issues due to the episodic nature of the condition. Not knowing when a debilitating bout with Meniere’s may strike can leave people feeling helpless. There are a range of treatments available for Meniere’s disease. While some focus on medical treatment of the condition, others involve dietary changes and therapeutic coping strategies. It is not clear what causes Meniere’s disease, but it does appear to run in families.
If you suffer from symptoms including hearing loss and balance issues, you have seen an ENT, and your condition has not improved, make an appointment with a neurotologist at Specialty Physician Associates for a consultation about your condition today. We have five locations in Allentown, Bethlehem, Quakertown and Wind Gap to serve you better and are rated the #1 practice for ENT doctors in Lehigh Valley.