Discipline - Otology

 

Otology is a surgical subspecialty that focuses on the diagnosis and treatment of disorders of the ear. Otologists (ear surgeons) manage a range of conditions affecting the hearing and balance of both children and adults. Issues related to the ear are many and varied, and can include congenital conditions, hearing loss, infections, cholesteatoma, traumatic injuries and tumours involving the ear.

The ear is a complex organ divided into three parts: the outer ear, the middle ear, and the inner ear. Each part plays a critical role in the optimal function of hearing and balance.

The outer ear consists of the pinna (the visible part of the ear) and the ear canal, which directs sound waves toward the eardrum (which separates the outer from the middle ear)

The middle ear contains three tiny bones called ossicles (the malleus, incus, and stapes) that amplify sound vibrations and transmit them to the inner ear. The middle ear is ventilated by the eustachian tube, which runs from the back of the nose to the ear and maintains the ideal pressure within the ear.

The inner ear houses the cochlea, a spiral-shaped organ responsible for converting sound vibrations into neural signals that the brain can interpret, and the vestibular system, which helps maintain balance.

Ear Conditions

Otologists manage a varied number of conditions, some of the most common include:

Otitis Media

Otitis media is inflammation or infection involving the middle ear. This condition is common in children, often following a common cold. Whilst the vast majority of episodes resolve by themselves, in some cases medications (such as antibiotics) or surgery (such as insertion of grommets) may be required, especially if the condition is recurrent or becomes chronic.

Hearing loss is divided into conductive (involving the outer or middle ear) or sensorineural (involving the inner ear or the nerves that transmit signals to the brain). The causes of hearing loss are numerous, including congenital (babies born with hearing loss), infections, cholesteatoma, noise exposure, tumours and normal ageing, to name but a few.

Otologists use a variety of diagnostic tools, including hearing tests and imaging studies, to assess the degree and cause of hearing loss. Treatment options may range from simple microscopic clearance of wax and debris from the ear canal, to coordinating the fitting of hearing aids. Surgical options include placement of ventilation tubes (grommets), repair of perforations of the ear drum, removal of tumours and other destructive processes, repair or replacement of the small bones of hearing, and implantable devices such as bone conducting hearing aids and cochlear implants.

Hearing Loss

Cholesteatoma

An abnormal skin growth in the middle ear behind the eardrum, is a serious condition managed by the otologist. These growths can cause chronic infections, damage to the structures of the ear, and in extreme cases destroy the underlying hearing and balance, affect the facial nerve and extend into the brain.

Otologists typically manage cholesteatoma through surgical removal to prevent complications and stabilise the hearing.

A symptom that is described as a ringing or buzzing sound heard by the patient. Tinnitus may be a symptom of an underlying ear condition and otologists support patients in understanding the cause of tinnitus and directing management as indicated.

Otologists are responsible for medically assessing excluding the presence of any serious underlying causes.. They are then responsible for coordinating a multidisciplinary approach to tinnitus management. This includes the involvement of audiologists who may use a combination of sound therapy and hearing aids and clinical psychologists specialising in tinnitus retraining therapy to help patients manage their symptoms and improve their quality of life.

Tinnitus

Vertigo and Balance Disorders

The symptom of dizziness or imbalance can be caused by a number of different conditions, including in some cases dysfunction of the balance system within the inner ear. The vestibular system in the inner ear plays a crucial role in maintaining balance and spatial orientation. When this system is disrupted, it can lead to vertigo, dizziness, and balance issues.

Conditions such as benign paroxysmal positional vertigo (BPPV), Ménière's disease, and vestibular neuritis are among the disorders that otologists diagnose and treat. Management may include vestibular rehabilitation therapy (vestibular physiotherapists) medications, and sometimes surgical intervention to alleviate symptoms and improve balance. In this complex area otologists work closely with their neurology and cardiology colleagues, amongst others, as there are many causes of dizziness that must be considered.

A vestibular schwannoma (acoustic neuroma) is  a benign tumour of the hearing and balance nerve, which runs between the inner ear and the brain. These tumours typically present with hearing loss in one ear and are diagnosed with an MRI scan. Otologists guide their patients in the management of these tumours, which can involve surveillance scans, surgery or radiotherapy.

A further  subspecialisation within otology is that of skull base surgery and neurotology. This involves the management of tumours both benign and malignant at the interface between the ear and the brain. The most common of these tumours is known as a vestibular schwannoma (acoustic neuroma).

Vestibular Schwannoma