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Otonevrologist

There are many diseases, the treatment of which requires combining medical specializations, this category includes otoneurology - a direction combining the fundamentals of neurology and otolaryngology. Otoneurologia as a new specialization took shape in the XIXth century, although references to vestibular diseases can be found even in the writings of Hippocrates. The first scientific publications belong to Peru of audiologists, neuropathologists of the XIXth century, these are Khilov, Bekhterev, Voyachek, Zhukovich and other outstanding doctors of the time. In Ukraine, a doctor-otoneurologist as an expert appeared in the middle of the last century, this served as scientific works and the opening of the chair by the efforts of Kotlyarevskaya, Kulikova, Kiseleva, doctors who studied vestibular disorders in pathologies requiring neurosurgical intervention. Currently, otoneurology is engaged in elucidating the causes of vertigo (vertigo), imbalance, which can be associated with internal ear pathologies, central nervous system, peripheral nervous and endocrine system diseases, cardiovascular dysfunctions.

Who is the otoneurologist?

How to understand who is a otoneurologist, and who is a neurologist? What is the difference between them?

Any disturbance of the vestibular apparatus, associated with the inflammatory process of the brain, TBI (craniocerebral trauma), diseases of the ear, central nervous system, may be accompanied by dizziness. Such conditions are engaged in otoneurologist.

The neurologist specializes in the diseases themselves, which provoke vertigo, dizziness - lesions of the central nervous system and peripheral nervous system, and also treats neuralgia, neuritis, neoplastic diseases of the brain, encephalitis.

An otoneurologist can become a doctor with a higher medical education, this specialization is chosen mainly by neurologists, audiologists, since these areas are very close and do not require a long retraining. The course of re-profiling includes the theory of otoneurology, practice under the supervision of an experienced specialist. At retraining the doctor should master such topics, directly concerning the future specialization: 

  • Disturbance of taste, smell.
  • Disturbance of innervation of muscle-constrictors, tubal-pharyngeal, shillopharyngeal, non-pharyngeal muscles (muscles of pharynx and larynx).
  • Vestibular symptoms in diseases of the central nervous system.
  • Auditory disorders in diseases of the central nervous system.
  • Symptoms, diagnosis and treatment methods of neurinoma of the auditory nerve.
  • Oilylvorea, nasal liquorrhea.
  • Endoscopic plastic of liquor fistulas (endonasal method).
  • Endoscopic method of endonasal diagnostics.
  • Methods of treatment of abnormalities of the base of the skull (inflammation, tumor).
  • Vertigo (dizziness).
  • Causes and methods of treatment of noise in the ears.
  • Injury of the pyramid pars petrosa (temporal bone).
  • Cochlear prosthetics (implantation).
  • Sinusites.
  • Headache.

Thus, the question - who is a otoneurologist, you can answer so - this is a doctor who determines the cause of vestibular disorders and owns methods of treating such diseases

When should I contact a otoneurologist?

There are certain specific symptoms that directly indicate the need for urgent diagnosis and treatment with the help of an otoneurologist.

When should I contact a otoneurologist? 

  • Involuntary eye movements are nystagmus.
  • Dizziness.
  • Violation of equilibrium.
  • Change gait, impaired coordination of movements.
  • Vegetative symptoms - dizziness, accompanied by suffocation, anxiety, nausea.
  • Non-curable chronic runny nose.
  • Tinkling, noise in the ears.
  • Pain in the maxillary sinuses of an unknown etiology.
  • Pain in the ears (in the ear) without a visible, objective reason.
  • Painful perception of sounds.
  • Unilateral hearing impairment, deafness.
  • Crunch, discomfort in the TMJ - temporomandibular joint.
  • Changed perception of sounds.
  • Numbness of limbs of unclear etiology.
  • Constant headache.
  • Pain in the neck.
  • Injuries of the tympanic membrane.
  • Injury of the ear (ears).

What tests do I need to take when I contact a otoneurologist?

What tests, preliminary examinations, it is necessary to pass at the reference to the otoneurologist, most often determines the treating local doctor or neurologist. This is due to the fact that most often the primary examination, the detection of uncomfortable manifestations, symptoms occurs exactly in the offices of these doctors. The list of possible analyzes that can be assigned: 

  • UAC is a general blood test.
  • Blood test for clotting.
  • Blood on RW.
  • Bakposove from the ear.
  • Determination of sensitivity to antibiotics of different groups.
  • Determination of intensity of production of tear fluid (Schirmer test).
  • Definitions of static ataxia (Romberg's test).
  • A trial on diadochokinesis (dyadochokinesis) - the definition of symmetrical, synchronous movements (pronation, supination of the hands).

In addition, to answer the question - what additional tests should be given when referring to otoneurologist, such studies help: 

  • Ultrasound, dopplerography of cerebral vessels.
  • Vestibular tests.
  • Posterography.
  • Vestibulometry.
  • Craniography.
  • CT scan.

The list of methods, analyzes that help the otoneurologist to determine the true cause of vestibular disorders is great, but as a rule, complex diagnostics takes no more than one week.

What diagnostic methods does the otoneurologist use?

The methods used by otoneurologist in their practice mainly concern neurology, specific methods for diagnosing vestibular dysfunctions are also effective, but to date not all medical institutions have the opportunity to purchase such equipment. Therefore, traditionally, at the first stage of diagnosis, the otoneurologist undertakes such actions: 

  • Talk with the patient, anamnesis.
  • Identification of subjective complaints by the patient.
  • Consultation of a neurologist and a hearing therapist, possibly an ophthalmologist.
  • Ultrasound examination of cerebral vessels (main blood flow of the head, cervical region, including functional tests).
  • Dopplerography of vessels.
  • Electroencephalography, including induced somatosensory, auditory and visual potentials.
  • Radiography of the skull (craniometry).
  • According to indications - computed tomography and (or) MRI.

What diagnostic methods does the otoneurologist use as specific tests and tests? 

  • Determination of parameters and disorders of the vestibular analyzer (vestibulometry).
  • Audiometry is the study of the parameters of hearing.
  • Neuro-ophthalmologic studies - diagnostics of glaucoma, hyperopia, myopia, vitreous status, retina.
  • Electro-chlo- ography is the determination of the absence or presence of dropsy of the labyrinth of the auditory canal (the detection of the hydrops).
  • Timpanometry and definition of auditory reflex - acoustic impedance measurement.
  • Stabilometry (post-metry) - fixation of the parameters of the vestibulospinal system.
  • Radiography of the skull (craniometry).

What does Otonevrologue do?

Oto-neurologist studies and treats diseases associated with the larynx, brain, nasopharynx, ear, if these pathologies are accompanied by specific symptoms - dizziness and impaired coordination. The reasons that provoke vertigo are diverse and can be such: 

  • Vestibular dysfunction.
  • Hearing impairment of various etiologies.
  • Inflammation of the pharynx, nose, ear (acute and chronic).
  • Vertigo caused by cervical osteochondrosis.
  • Vertebrobasilar vascular insufficiency.

What heals, what does Otonevrologue do?

  • All diseases of the inner and middle ear - hydrolysis, hemorrhage (hemorrhage), inflammation, embolism, thrombosis, trauma, spasm of labyrinth arteries, neuroinfections, intoxication.
  • Tumor diseases of the brain accompanied by vertigo.
  • Tumors of the auditory nerve.
  • Diseases of the central nervous system, peripheral system, accompanied by dizziness.
  • Violation of innervation of all ENT organs.

The main task of the otonevrologist is to identify the cause of the symptoms with the help of instrumental examination, diagnosis. To do this, the oral cavity is examined, the mobility of the soft palate, the sensitivity of the nasal mucosa are determined, the function of the vestibular apparatus, hearing, smell, taste is examined. Timely diagnosis and identification of the cause of vertigo, disruption of coordination and balance help to identify many tumor, inflammatory pathologies in the early stages, and also provide an opportunity to effectively treat them.

What diseases are treated by otoneurologist?

Otonevrology as a separate medical direction connects the theory and practice of otolaryngology and neurology, this determines the range of diseases falling within the competence of a doctor-otoneurologist. Most often, a primary treatment for a specialist is about dizziness, which may be true - a vertigo, but can develop as a vestibular symptom of the underlying disease. Statistics say that vestibular disorders occur much more often than vertigo, they are provoked by a number of pathologies, the list of which reaches 80 nosological units. More than half of the causes are associated with CNS disorders and diseases of the inner ear. Therefore, it is rather difficult to answer the question what diseases otonevrolog is treating, we will give a brief list of the main, most common pathologies: 

  • Meniere's syndrome is a disease of the inner ear, accompanied by a significant increase in fluid in the cavity and an increase in intra-labyrinth pressure.
  • Inflammation of the nervus vestibulocochlearis (vestibular nerve), vestibular neuritis.
  • DPPH is a benign paroxysmal positional dizziness (otolithiasis).
  • Basilar hemicrania (migraine).
  • Orthostatic hypotension.
  • Osteochondrosis of the cervical spine.
  • Psychogeny.
  • Vertebrobasilar insufficiency.
  • Hearing loss of various genesis.
  • A brain tumor.
  • Herpetic infection.
  • Violation of coordination of movements, balance.
  • Sinusitis, rhinitis.
  • Otitis.
  • Autophony (gaping of the auditory tube).
  • Otosclerotic pathologies.
  • Sensoneural deafness.
  • Spontaneous otoacoustic emission.
  • Cervicalgia.
  • Sclerosis of the tympanic cavity (tympanosclerosis).
  • Injuries or tumors of lobus temporalis (temporal lobe of the brain) - meningioma, astrocytoma, glioblastoma.
  • Injuries, damage to the hearing.

Advice of a doctor

What can advise otonevrolog for prevention of diseases of the inner ear, violations of the vestibular apparatus?

First of all, when you get dizzy, you should not panic and especially not make yourself a diagnosis. Quite often the head is spinning for such reasons, which have nothing to do with serious pathologies: 

  • Sharp change of posture after a long static position of the body.
  • Sharp transition from lying to a vertical position.
  • Disturbance of coordination during movements in conditions of complete darkness.
  • Excessive auditory load when visiting mass entertainment events.
  • Chronic cough, tension.
  • Water sports without proper preparation - diving.
  • Long trip (transportation).
  • Violation of diet - hunger.
  • Alcohol abuse.
  • Stressful situation.
  • Premenstrual syndrome in women.

If the otoneurologist diagnosed as a disturbance of the vestibular apparatus associated with the pathology of the central nervous system, other organs, apart from traditional methods of treatment, there are specific exercises that help to "train" vestibulum and significantly reduce the severity of the symptomatology. Such methods include the following complexes: 

  • The Brandt-Daroff method (the patient can apply the method on his own).
  • The maneuver of Demont is under the supervision of the medical staff, the doctor.
  • Maneuver Epley - with the help of an otoneurologist.
  • Maneuver Lempert - with the help of a doctor.

Advices of a doctor of a otoneurologist also concern such actions of patients suffering from persistent dizziness: 

  • Try to limit movement in open spaces, avoid crowding people, mass events.
  • Choose the most convenient position for a horizontal position.
  • In the morning hours or at any rise from the bed try to rise sideways, avoid sudden movements.
  • It is not recommended to drive vehicles independently.

The most important advice is this - when you display anxious symptoms from the vestibular system, you need to get to the doctor as early as possible for timely diagnosis and obtaining effective care.

Otonevrolog at the present time is a rather rare specialty, in this specific medical direction there are still a lot of unresolved and controversial topics, questions. Similar problems are caused by the relatively recent history of the development of otoneurology as a separate specialization, and the absence in the hospital institutions of the necessary equipment designed to accurately diagnose violations of the vestibular apparatus. Nevertheless, every year narrow specialists engaged in vestibular and auditory dysfunctions are becoming more and more sophisticated methods of examining and treating patients. This gives us hope that very soon every polyclinic will have its own surdologist and otoneurologist office, where every person suffering from dizziness, violation of coordination of movements and other diseases connected with problems of the inner ear and central nervous system will be able to apply.

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Medical expert editor

Portnov Alexey Alexandrovich

Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"

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