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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The diagnostic process in neurotology uses a combination of advanced imaging and functional testing. Since the structures of the inner ear and skull base cannot be examined directly, doctors rely on technology to visualize the anatomy and assess how well the nerve pathways are working. This data-driven approach ensures accurate identification of where the problem is located.
Magnetic Resonance Imaging (MRI) is the cornerstone of neurotological diagnosis. Standard brain scans are often not enough. Specific scans focusing on the internal auditory canals (the passages that contain your hearing and balance nerves) are required. The use of gadolinium contrast (a special dye) is essential to highlight small tumors, inflammation, or disruptions in the blood-brain barrier within the temporal bone.
Diffusion weighted imaging is utilized to differentiate between cholesteatomas and other lesions. This sequence detects the restricted motion of water molecules within the dense skin cyst. It allows for the non invasive diagnosis of recurrent disease in patients who have previously undergone surgery.
Computed Tomography (CT) provides the necessary roadmap of the bony architecture. While MRI shows the nerves, CT shows the hard bone that encases them. This imaging is critical for surgical planning, revealing the thickness of the skull base, the aeration of the mastoid, and the integrity of the bony labyrinth.
Angiography (CTA or MRA) is added when vascular lesions are suspected. These scans create a 3D model of the blood vessels, helping to identify the feeding arteries of glomus tumors or the position of the carotid artery relative to the surgical field.
To understand the source of a patient’s dizziness, the vestibular system is interrogated through a battery of physiological tests. Videonystagmography (VNG) uses infrared cameras to track eye movements in response to visual and thermal stimuli. This identifies whether the problem is in the ear or the brain.
Rotary chair testing evaluates the vestibular system across a range of frequencies that mimic natural head movement. The patient sits in a motorized chair that rotates gently in the dark. This is particularly useful for detecting bilateral vestibular loss and monitoring compensation over time.
Electrophysiology measures the electrical output of the auditory and vestibular nerves. The Auditory Brainstem Response (ABR) tracks the speed of sound signals from the ear to the brainstem. Delays in wave latency can pinpoint the exact location of a neural blockage or tumor.
VEMP testing is unique in its ability to assess the otolith organs, which sense gravity and tilt. By measuring the reflex response in the neck or eye muscles to loud sound, clinicians can detect thinning of the bone over the balance canals (dehiscence) or damage to the inferior vestibular nerve.
Beyond standard hearing tests, functional audiometry assesses the real world impact of the disorder. Speech perception tests in noise provide insight into how the auditory nerve is processing complex information. This data is vital for determining candidacy for advanced technologies like cochlear implants.
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The MRI shows the soft tissues like nerves and tumors, while the CT scan shows the bone details. The surgeon needs both to create a complete 3D mental map of your anatomy before surgery.
The caloric test (warm and cool air/water) stimulates the inner ear and creates a temporary sensation of vertigo. Nausea is possible, but the sensation usually passes within a few minutes.
The VEMP test checks the function of the otolith organs (gravity sensors) and can help diagnose Superior Canal Dehiscence Syndrome by detecting if the ear is hypersensitive to sound.
It is generally recommended to avoid heavy meals before vestibular testing to reduce the risk of nausea. You may also need to stop certain dizziness medications 48 hours prior.
Modern CT scanners use optimized low dose protocols. While there is some radiation exposure, the diagnostic value for planning safe surgery typically outweighs the minimal risk.
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