ENT Neurotology is a regional subspecialty referral center based in Fort Wayne, that provides a full spectrum of advanced care. Patients with diseases or disorders of the ear, temporal bone, facial nerve, and associated structures are offered comprehensive, compassionate, and specialized care.
ENT Neurotology has first-class clinical facilities, the latest technology and equipment, and a staff of highly trained technicians and specialists with expertise in the related areas of audiology, imaging, neurophysiologic diagnosis, medical and surgical treatment, education, research, and the diagnosis and rehabilitation of balance disorders.
What is Neurotology?
Neurotology is a clinical subspecialty within the field of Otolaryngology (Ear, Nose and Throat) which focuses on the neurology and neurosurgery of the ear. This includes the diagnosis, treatment, and rehabilitation of hearing and balance disorders, the facial nerve, the ear and temporal bone, and related structures such as the skull base and brainstem. Now a well-recognized field within the specialty of Otolaryngology, it is represented by a dedicated society, The American Neurotologic Society (ANS) and a peer reviewed journal, Otology and Neurotology As a comprehensive medical center, ENT Neurotology provides the full spectrum of care within this new and challenging field, including many of the following disorders.
Hearing Loss is a very common problem with many causes. Congenital Hearing Loss is now diagnosed shortly after birth. Infants and children are evaluated for associated syndromes and conditions. Early amplification can allow normal speech and language development. Presbycusis, the hearing loss of aging is often associated with noise-induced hearing loss, both of which are managed with education, prevention, and amplification. Autoimmune hearing loss, a recently identified disorder causes frustrating bilateral hearing fluctuations, but can be controlled with medication or other therapies. A new treatment for sudden sensorineural (nerve) hearing loss involving a series of Decadron Injections has proven very effective. Conductive hearing loss can often be surgically corrected. One of the most common causes of conductive hearing loss is Otosclerosis, which is managed with surgical Stapedectomy. Amplification (hearing aids) are often an option. Semi-Implantable hearing aids (a component of the hearing aid is surgically implanted) are slowly gaining in popularity
An exciting new technology for the restoration of hearing in deaf individuals involves the surgical placement of a cochlear implant within the inner ear to stimulate the hearing nerves directly. This rapidly evolving technology first received FDA approval in 1985. It now provides normal speech and language development in congenitally deaf children and new hope for seriously hearing impaired children and adults.
Tinnitus is the perception or sensation of sound when no external sound is present. Tinnitus can occur in either one or both ears or may be localized “in the head”. It may be described as ringing, buzzing, hissing, roaring, crickets, clicking, fluttering or any number of other sounds alone or in combination. It can be intermittent, continuous or pulsatile and can fluctuate in character and intensity. Tinnitus may or may not be associated with a hearing impairment. It is important to remember that tinnitus is a symptom and not a disease. It is recommended to avoid silence. Tinnitus is generally worse in quiet.
Many people with bothersome tinnitus spend a lot of time and energy searching for a way to quiet or eliminate the tinnitus, which is a perfectly normal and reasonable reaction. Unfortunately, there currently is no therapy that can safely and consistently reduce the loudness of tinnitus. Tinnitus cannot be “cured” but it can be managed. When we say “manage tinnitus” we really mean “manage reactions to tinnitus”. Because we cannot change tinnitus itself, tinnitus management should be interpreted to mean making lifestyle adjustments to reduce any negative reactions to tinnitus. Reactions pertain to any negative effects of tinnitus on quality of life, such as sleep disturbance, concentration difficulties, or any negative emotions that are associated with tinnitus. Managing reactions to tinnitus can make the tinnitus less of a problem.
Here at ENT/The Hearing Center, we use a multi-faceted management approach that is individualized to each patient. The use of sound therapy and counseling has been shown to be the two most important components of any management protocol. If you have hearing loss, environmental sounds alone may not be adequate to conceal the tinnitus. Not only can hearing aids enhance your listening and communication abilities, but they may also provide relief from your tinnitus. If hearing aids alone do not provide the desired relief, other tools that may be used in a tinnitus management protocol include but are not limited to counseling (i.e. Progressive Tinnitus Management and/or Cognitive Behavioral Therapy), stress management, healthy diet/exercise, improve sleep hygiene, and sound therapy
Balance difficulties range from mild imbalance to severe spinning episodes (vertigo). Diagnosis and management recommendations are provided by the ENT Balance Center which utilizes the latest and most comprehensive diagnostic equipment including both video and electro-nystagmography, rotary chair, and dynamic computerized posturography. Medical therapy and Vestibular Rehabilitation Therapy are the mainstays of treatment. Surgical intervention such as Endolymphatic Sac Decompression, Vestibular Nerve Section, Labyrinthectomy, Perilymph Fistula Exploration, and Posterior Semicircular Canal Occlusion provide additional treatment options. A new approach to the management of Meniere’s Disease, Intratympanic Gentamicin Injection, has been very successful. A Fall Prevention Screening Program also helps identify elderly individuals with a high risk for falling and injury.
Facial Nerve paralysis is most often of unknown cause. It usually responds to medication. In rare cases, surgical treatment to decompress the Facial Nerve is required. Other causes of Facial Nerve paralysis include trauma, infection, and metabolic conditions. Diagnostic modalities such as Electroneuronography (ENoG) and Facial Electromyography (EMG) guide both medical and surgical treatments. Comprehensive facial re-animation is also provided with gold weights, nerve grafts, and other static procedures.
Chronic Ear Surgery
Ear infections especially recurrent otitis can sometimes lead to permanent changes in the structures of the middle ear such as retractions, perforations, ossicular discontinuity, and cholesteatoma. These chronic conditions known as Chronic Otitis Media can all lead to chronic drainage, hearing loss or, rarely, complications inside the skull. Surgical procedures such as Tympanoplasty, Mastoidectomy, and Ossicular Chain Reconstruction can eliminate chronic infection and restore hearing. Rarely, complications of Chronic otitis such as coalescent mastioditis, meningitis, brain abscess, labyrinthitis, or facial paralysis require emergent surgical management.
Acoustic Neuroma Program
A rare, benign tumor known as an acoustic neuroma which arises from the balance nerve can cause one-sided hearing loss and balance difficulties. The diagnosis is usually best made with gadolinium-enhanced Magnetic Resonance Imaging (MRI). Treatment options include stereotactic radiation and surgical approaches such as removal of the tumor by suboccipital, translabyrinthine, or middle fossa approach. Surgery is performed by a surgical team consisting of neurosurgeons, neurotologists, and monitoring technicians. Intraoperative Monitoring (IOM) performed by a highly trained Electrophysiologist is a key component in protecting the hearing and facial nerves during surgery.
Skull Base Tumors
Diagnosis and management of rare skull base lesions such as glomus jugularae are managed with a team approach including neurotology, neurosurgery, head & neck surgery, microvascular reconstructive surgery, intraoperative monitoring, and interventional radiography.