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 treatment of neurotological disorders varies widely, ranging from observation and medication to complex microsurgery and rehabilitation. The choice of treatment depends on the specific condition, the severity of symptoms, and your overall health goals. The main objective is to eliminate disease while preserving function and quality of life.
Microsurgery is the primary treatment for many skull base tumors and structural defects. These procedures are performed under high magnification using specialized microscopes, often involving a team of neurotologists and neurosurgeons. The surgical approach is selected based on the need to preserve hearing and the location of the problem relative to the brainstem.
In the Translabyrinthine approach, the surgeon drills through the balance canals to access the tumor directly. This provides excellent exposure of the facial nerve but sacrifices residual hearing. It is often the safest route for large tumors or when hearing is already lost.
The Middle Fossa and Retrosigmoid approaches are hearing preservation techniques. They allow the surgeon to remove the tumor or repair the nerve while leaving the inner ear intact. These are technically demanding procedures reserved for patients with good pre operative hearing and smaller lesions.
For patients who are not surgical candidates or prefer a non invasive option, stereotactic radiosurgery (such as Gamma Knife or CyberKnife) offers a way to control tumor growth. This technique delivers a single, high dose of radiation to the tumor with sub millimeter accuracy, sparing the surrounding healthy brain tissue.
Radiosurgery is particularly useful for small to medium sized vestibular schwannomas and meningiomas. It turns the disease into a chronic, stable condition rather than an acute surgical problem. Long term follow up is required to ensure the tumor remains dormant.
When hearing cannot be preserved or is already lost, neurotology offers advanced rehabilitation options. Cochlear implants are used to stimulate the auditory nerve directly, bypassing damaged hair cells. In cases where the auditory nerve itself is severed (e.g., NF2), an Auditory Brainstem Implant (ABI) may be placed directly on the brainstem.
Osseointegrated bone conduction devices are excellent for single sided deafness. They transmit sound through the skull from the deaf side to the hearing ear, eliminating the “head shadow” effect. Modern implants use magnetic coupling to minimize skin complications and improve aesthetics.
Recovery from neurotological surgery or disease involves active brain retraining. Vestibular Rehabilitation Therapy (VRT) is a specialized physical therapy program designed to promote compensation. The brain learns to rely on visual and proprioceptive cues to replace the lost vestibular input.
Therapy is customized to the patient’s specific deficit. It requires daily practice and a willingness to push through mild dizziness to achieve results. The brain must experience the error signal (dizziness) to recalibrate the balance system effectively.
Not all neurotological conditions require surgery. Meniere’s disease and vestibular migraines are often managed medically. This involves a combination of dietary modifications, diuretics to control fluid pressure, and rescue medications for acute attacks. Intrathecal injections of steroids or gentamicin can also be used for refractory cases.
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Surgery removes the tumor physically, while Gamma Knife uses radiation to stop the tumor from growing. Surgery has a higher initial risk but eliminates the mass; radiation is lower risk but leaves the tumor in place.
An ABI does not restore normal hearing. It provides environmental sound awareness and aids in lip reading, but speech understanding is generally lower than with a cochlear implant.
Most patients see significant improvement within 6 to 12 weeks of consistent therapy. However, the timeline varies based on the severity of the damage and the patient’s activity level.
There is no cure for Meniere’s, but it can be effectively managed. Most patients can control their vertigo attacks with diet, medication, or minor office procedures.
The internal part is under the skin. The external processor is visible but is similar in size to a large Bluetooth earpiece and can be hidden under hair.
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