Neurology diagnoses and treats disorders of the nervous system, including the brain, spinal cord, and nerves, as well as thought and memory.
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Neurotological disorders often start with subtle symptoms but can become very disruptive to daily life. Patients frequently report a disconnect between their senses, experiencing motion when they are still or hearing sounds that do not exist. Recognizing the specific patterns of these symptoms is important for early detection and preventing permanent nerve damage.
Vertigo is the main symptom of balance problems. It feels like you or the room is spinning when nothing is actually moving. In neurotology, the type of vertigo provides clues to where the problem is located. Spinning vertigo often points to the semicircular canals (the curved tubes in your inner ear) or nerve, while a sense of tilting or rocking may indicate issues with the otolith organs (balance sensors) or central connections in your brain.
Balance is a complex integration of vision, proprioception, and inner ear data. When the vestibular nerve is compromised by a tumor or inflammation, this integration fails. Patients may compensate visually during the day but find themselves unable to walk steadily in the dark or on uneven surfaces.
Hearing loss in neurotology is distinct from the conductive loss seen in middle ear infections. It is typically sensorineural, originating in the cochlea or the auditory nerve. Asymmetric hearing loss, where one ear is significantly worse than the other, is a primary red flag for retrocochlear pathology like an acoustic neuroma.
Tinnitus is another prevalent symptom, often preceding hearing loss. In neurotological cases, the quality of the sound matters. High pitched ringing is common with nerve compression, while pulsatile tinnitus, which beats in time with the heart, triggers an immediate investigation for vascular tumors or malformations.
As lesions in the skull base expand, they can encroach upon adjacent cranial nerves. The facial nerve is most at risk, leading to subtle twitches or weakness. Compression of the trigeminal nerve can cause facial numbness or loss of the corneal reflex, while involvement of the lower nerves may affect swallowing and voice.
Headaches associated with skull base issues are often localized to the back of the head or behind the ear. They may worsen with straining or changes in position. In advanced cases, large tumors can obstruct the flow of cerebrospinal fluid, leading to hydrocephalus and cognitive changes.
While many neurotological tumors are sporadic, genetic factors play a significant role in a subset of patients. Neurofibromatosis Type 2 (NF2) is a hereditary condition characterized by the development of bilateral vestibular schwannomas. Patients with this genetic profile require lifelong surveillance and specialized management strategies.
Biological factors such as skull anatomy also contribute to risk. Individuals with naturally thin bone over the superior semicircular canal are at higher risk for dehiscence syndrome. Vascular anatomy, such as a high riding jugular bulb, can predispose patients to pulsatile tinnitus and surgical challenges.
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Sudden hearing loss is defined as a rapid decline in hearing occurring over 72 hours or less. This is considered a medical emergency and requires immediate evaluation to attempt to save the hearing.
This is called pulsatile tinnitus. It often indicates that a blood vessel is near the eardrum or that there is increased blood flow in the skull base, which requires imaging to rule out vascular tumors.
Occasional twitching from stress is normal, but persistent twitching on one side of the face can be a sign of irritation to the facial nerve and should be evaluated by a neurotologist.
Stress acts as a powerful amplifier. While it rarely causes the root mechanical problem, it significantly worsens the symptoms of vestibular disorders and makes compensation more difficult.
NF2 is rare, occurring in about 1 in 33,000 births. However, if you have a parent with NF2, there is a 50% chance of inheriting the condition.
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