Neurotology

Neurotology

What is neurotology

Neurotology is a medical speciality that focuses on diagnosing and treating disorders related to the ears and the nervous system, particularly those involving the inner ear and balance.

Neurotologists are trained to manage conditions such as vestibular schwannoma, vertigo, dizziness, hearing loss, and disorders affecting the inner ear, facial nerve, and brainstem.

They also perform surgical procedures to treat these conditions, such as cochlear implants or surgical treatments for benign paroxysmal positional vertigo (BPPV).

William House, the father of neurotology

William (Bill) House was a pioneering otolaryngologist and the father of neurotology, a specialized field within otolaryngology that focuses on disorders of the inner ear and auditory nerve. House was instrumental in developing the cochlear implant, a groundbreaking technology that has transformed the lives of individuals with severe hearing loss. His innovative work and dedication to improving the field of neurotology have left a lasting impact on the medical community and the lives of countless patients.

In the 1960s, House began experimenting with the idea of implanting electrodes into the cochlea to stimulate the auditory nerve directly, bypassing the damaged hair cells in the inner ear. After years of research and development, he performed the first successful cochlear implant surgery in 1961 on a patient who had lost his hearing due to meningitis.

House’s contributions to the field of otolaryngology were not limited to the cochlear implant. He also pioneered the development of the vestibular nerve section procedure for treating vertigo and Menière’s disease, surgical approaches for removing vestibular schwannomas, and the development of the first successful facial nerve reanimation surgery.

His pioneering work in the field of skull base surgery revolutionized the treatment of vestibular schwannomas. His surgical technique involves removing the tumor while preserving the patient’s hearing and facial nerve function, thus greatly improving the outcomes for patients with this condition.

Dr William F House, the father of neurotology.
Dr William F House, the father of neurotology.

What a neurotologist is not.

A neurotologist is not a neurologist. A neurotologist does not perform the work that a neurologist does nor replace a neurologist’s services. It is required from a neurotologist to know the applicable neurological conditions and be able to perform the surgery as it relates to these conditions. 

A neurotologist is not a neurosurgeon, either. In the USA, a further two-year specialization is required after becoming an otorhinolaryngologist(ENT), and a board-certified examination is needed. In South Africa, it has not been possible to superspecialize in neurotology.

Neurotology training is not even possible in the majority of countries worldwide.

My experience in neurotology.

I have had the privilege to work exclusively in the field of neurotology for more than 20 years. I have trained and worked under neurotologists and ENT surgeons trained in neurotology, and I have acquired all the skills and surgical expertise expected from a trained board-qualified neurotologist. My mentor was the late Professor Herman Hamersma, with whom I worked for 15 years. He taught me middle cranial fossa surgery and the transtemporal supralabyrinthine approach to the skull base. I gained much experience from attending the late Prof Ugo Fisch in Zurich, who developed this approach.

I have also performed many vestibular examinations under the guidance of the late Dr Fritz van der Laan and still perform videonystagmography (VNG) testing on numerous of my patients.

Neurotologists provide medical and surgical treatment to adult and paediatric patients. It can be seen as the area where neurology (study of the brain) and otology (study of the inner and middle ear) overlap. Neurotological surgery is complex and not usually performed by general ENT surgeons. I can perform all the major neurotological procedures, including middle fossa surgery and am currently in 2024 the only practising neurotologist in Sub-Sahara Africa.

Neurotology conditions

Some of the neurotology conditions I manage include: