Otoneurologist

There are many diseases, the treatment of which requires a combination of medical specializations, such as otoneurology - a direction that combines the basics of neurology and otolaryngology. Otoneurologia as a new specialization was formed in the 19th century, although references to vestibular diseases can be found in the works of Hippocrates. The first scientific publications belong to the pen of audiologists, neuropathologists of the 19th century, these are Khilov, Bekhterev, Voyachek, Zhukovich and other outstanding doctors of that time. In Ukraine, an otoneurologist as a specialist appeared in the middle of the last century, this was due to scientific works and the opening of the department by the efforts of Kotlyarevskaya, Kulikova, Kiseleva, doctors who studied vestibular disorders in pathologies requiring neurosurgical intervention. Currently, otoneurology deals with the clarification of the causes of vertigo (dizziness), balance disorders, which may be associated with pathologies of the inner ear, central nervous system, diseases of the peripheral nervous and endocrine systems, and cardiovascular dysfunctions.

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Who is an otoneurologist?

How to understand who is an otoneurologist and who is a neuropathologist? What is the difference between them?

Any disorder of the vestibular apparatus associated with an inflammatory process of the brain, TBI (traumatic brain injury), diseases of the ear, central nervous system, can be accompanied by dizziness. Such conditions are treated by an otoneurologist.

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

An otoneurologist can be a doctor with a higher medical education; this specialization is chosen mainly by neurologists and audiologists, since these areas are very close and do not require long-term retraining. The retraining course includes the theory of otoneurology, practice under the supervision of an experienced specialist. During retraining, the doctor must master the following topics directly related to future specialization:

• Impaired sense of taste and smell.
• Disruption of the innervation of the constrictor muscles, the tubopharyngeal, styloglossal, and palatopharyngeal muscles (muscles of the pharynx and larynx).
• Vestibular symptoms in diseases of the central nervous system.
• Hearing impairment in diseases of the central nervous system.
• Symptoms, diagnosis and treatment methods of acoustic neuroma.
• Otoliquorhea, nasal liquorrhea.
• Endoscopic plastic surgery of cerebrospinal fluid fistulas (endonasal method).
• Endoscopic method of endonasal diagnostics.
• Methods of treatment of pathologies of the skull base (inflammation, tumors).
• Vertigo (dizziness).
• Causes and methods of treatment of tinnitus.
• Trauma of the pars petrosa (temporal bone).
• Cochlear prosthetics (implantation).
• Sinusitis.
• Headache.

Thus, the answer to the question - who is an otoneurologist - can be as follows - this is a doctor who determines the cause of vestibular disorders and has mastered the methods of treating such diseases.

When should you see an otolaryngologist?

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

When should you see an otolaryngologist?

• Involuntary eye movements - nystagmus.
• Dizziness.
• Disturbance of balance.
• Change in gait, impaired coordination of movements.
• Vegetative symptoms – dizziness, accompanied by suffocation, anxiety, nausea.
• Untreated chronic rhinitis.
• Ringing, noise in the ears.
• Pain in the maxillary sinuses of unclear etiology.
• Pain in the ears (in the ear) without any apparent, objective cause.
• Painful perception of sounds.
• Unilateral hearing loss, deafness.
• Crunching, discomfort in the TMJ - temporomandibular joint.
• Altered perception of sounds.
• Numbness of the limbs of unknown etiology.
• Constant headache.
• Pain in the neck.
• Trauma to the eardrum.
• Trauma to the ear(s).

What tests should be taken when visiting an otolaryngologist?

What tests and preliminary examinations need to be taken when visiting an otoneurologist are most often determined by the attending local doctor or neurologist. This is due to the fact that most often the initial examination, detection of discomfort manifestations, symptoms occurs in the offices of these doctors. The list of possible tests that may be prescribed:

• OAC – complete blood count.
• Blood clotting test.
• Blood on RW.
• Ear culture.
• Determination of sensitivity to antibiotics of various groups.
• Determination of the intensity of tear fluid production (Schirmer test).
• Definitions of static ataxia (Romberg test).
• Diadochokinesis test – determination of symmetrical, synchronous movements (pronation, supination of the hands).

In addition, the following studies help answer the question of what additional tests need to be taken when visiting an otoneurologist:

• Ultrasound, Doppler ultrasonography of the cerebral vessels.
• Vestibular tests.
• Posturography.
• Vestibulometry.
• Craniography.
• Computed tomography.

The list of methods and tests that help an otoneurologist determine the true cause of vestibular disorders is large, but as a rule, a comprehensive diagnosis takes no more than one week.

What diagnostic methods does an otoneurologist use?

The methods used in the practice of an otoneurologist mainly concern neurology, specific methods of diagnosing vestibular dysfunctions are also effective, but today not all medical institutions have the opportunity to purchase such equipment. Therefore, traditionally, at the first stage of diagnostics, the otoneurologist takes the following actions:

• Conversation with the patient, collecting anamnesis.
• Identification of subjective complaints from the patient.
• Consultation with a neurologist and audiologist, possibly an ophthalmologist.
• Ultrasound examination of the cerebral vessels (main blood flow of the head, cervical region, including functional tests).
• Doppler ultrasonography of blood vessels.
• Electroencephalography, including somatosensory, auditory and visual evoked potentials.
• X-ray of the skull (craniometry).
• According to indications – computed tomography and/or MRI.

What diagnostic methods does an otoneurologist use such as specific tests and samples?

• Determination of parameters and disorders of the vestibular analyzer (vestibulometry).
• Audiometry is a study of hearing parameters.
• Neuro-ophthalmological examinations – diagnostics of glaucoma, hyperopia, myopia, determination of the condition of the vitreous body, retina.
• Electrocochleography – determination of the absence or presence of hydrops of the labyrinth of the auditory canal (detection of hydrops).
• Tympanometry and determination of the auditory reflex – acoustic impedancemetry.
• Stabilometry (posturometry) – recording of parameters of the state of the vestibulospinal system.
• X-ray of the skull (craniometry).

What does an otoneurologist do?

An otoneurologist studies and treats diseases associated with the larynx, brain, nasopharynx, ear, if these pathologies are accompanied by specific symptoms - dizziness and impaired coordination. The causes that provoke vertigo are varied and can be as follows:

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

What does an otoneurologist treat and what does he do?

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

The main task of an otoneurologist is to identify the cause of symptoms using instrumental examination and diagnostics. For this purpose, an examination of the oral cavity is carried out, the mobility of the soft palate, the sensitivity of the nasal mucosa are determined, the function of the vestibular apparatus, hearing, smell, and taste are examined. Timely diagnostics and identification of the cause of vertigo, impaired coordination and balance help to identify many tumor and inflammatory pathologies at early stages, and also make it possible to effectively treat them.

What diseases does an otoneurologist treat?

Otoneurology as a separate medical field combines the theory and practice of otolaryngology and neurology, this determines the range of diseases that fall within the competence of an otoneurologist. Most often, the initial visit to a specialist concerns dizziness, which can be true - vertigo, but can develop as a vestibular symptom of the underlying disease. Statistics say that vestibular disorders are much more common than vertigo, they are provoked by many pathologies, the list of which reaches 80 nosological units. More than half of the causes are associated with disorders of the central nervous system and diseases of the inner ear. Therefore, it is quite difficult to answer the question of what diseases an otoneurologist treats, we will provide a short 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 intralabyrinthine pressure.
• Inflammation of the nervus vestibulocochlearis (vestibular nerve), vestibular neuritis.
• BPPV - benign paroxysmal positional vertigo (otolithiasis).
• Basilar hemicrania (migraine).
• Orthostatic hypotension.
• Osteochondrosis of the cervical spine.
• Psychogeny.
• Vertebrobasilar insufficiency.
• Hearing loss of various origins.
• Brain tumor.
• Herpes infection.
• Impaired coordination of movements and balance.
• Sinusitis, rhinitis.
• Otitis.
• Autophony (gaping of the auditory tube).
• Otosclerotic pathologies.
• Sensorineural hearing loss.
• Spontaneous otoacoustic emission.
• Cervicalgia.
• Sclerosis of the tympanic cavity (tympanosclerosis).
• Injuries or tumors of the lobus temporalis (temporal lobe of the brain) – meningioma, astrocytoma, glioblastoma.
• Trauma, damage to hearing organs.

Advice from an otolaryngologist

What can an otoneurologist advise for the prevention of inner ear diseases and vestibular disorders?

First of all, if you feel dizzy, you should not panic and especially not diagnose yourself. Quite often, dizziness occurs for reasons that have nothing to do with serious pathologies:

• A sudden change of posture after a long static position of the body.
• A sudden transition from a lying position to a vertical position.
• Impaired coordination when moving in complete darkness.
• Excessive auditory stress when attending mass entertainment events.
• Chronic cough, tension.
• Water sports without proper training – diving.
• Long trip (transport).
• Violation of the diet - hunger.
• Alcohol abuse.
• Stressful situation.
• Premenstrual syndrome in women.

If an otoneurologist has diagnosed a vestibular disorder associated with CNS pathologies or other organs, in addition to traditional treatment methods, there are also specific exercises that help to “train” the vestibulum and significantly reduce the severity of symptoms. These methods include the following complexes:

• Brandt-Daroff method (the patient can use the method independently).
• Semont's maneuver - under the supervision of medical personnel, a doctor.
• Epley maneuver - with the help of an otolaryngologist.
• Lempert maneuver - with the help of a physician.

The advice of an otolaryngologist also concerns the following actions for patients suffering from persistent dizziness:

• Try to limit movement in open spaces, avoid crowds and mass events.
• Choose the most comfortable position when lying horizontally.
• In the morning hours or when getting out of bed, try to get up sideways and avoid sudden movements.
• Independent driving of vehicles is not recommended.

The most important advice is this: if alarming symptoms from the vestibular system appear, you need to see a doctor as soon as possible for timely diagnosis and effective assistance.

An otoneurologist is currently a rather rare specialty; there are still many unresolved and controversial topics and questions in this specific medical field. Such problems are caused by the relatively recent history of the development of otoneurology as a separate specialization, and the lack of the necessary equipment in hospitals for the accurate diagnosis of vestibular disorders. Nevertheless, every year there are more and more specialists dealing with vestibular and auditory dysfunctions, and the methods of examination and treatment of patients are being improved. This gives hope that very soon each clinic will have its own office of an audiologist and otoneurologist, where every person suffering from dizziness, impaired coordination of movements and other diseases associated with problems of the inner ear and central nervous system can go.