Expert: Harriet B Jacobster, Au.D. - 8/21/2008

Question
Hello,

I'm not sure if you can help me with this or not, but I thought I'd ask anyway since you have knowledge of ears and dizziness.

I went to my ENT again today regarding my dizziness and ETD.  The ENT has not performed any tests, other than hearing.  He said that my left ear was fine when he looked at it, even though I have days of bad pain and ear popping which has been going on since February (flying with a cold).  I've always had problems equalizing my ETs while flying, but he won't take the time to investigate why.    

He said that he had no way of checking the ET to see what is going on and that it just had to get better on it's own which could take months.  I'm not sure how true this is as I've heard there are tests that can be done.  

He said he was going to refer me to a Neurologist to rule out anything central since there could be miscommunication between the back of the eyes and the brain, amongst other things, and then if nothing was found, he'd then refer me to a Neurotologist.  

I have the option of going directly to a Neurotologist if I would like through the referral of another clinic and was wondering, in your opinion, which would be the best way to go.  The Neurologist takes a very long to get in to see, whereas, if I go directly to a Neurotologist, it will be much sooner, but I bypass the Neurologist.  I know both of them do CT scans and MRIs.  Can you please tell me if both specialists (Neurologists and Neurotologists) would look for the same things on an MRI for someone with chronic dizziness?  This will help me decide which route to go.

Thanks,

Pam

Answer
Hi Pam,
Neuro-otologists and neurologists look for different things when looking at MRI/CT scans and evaluating dizziness.  In general, the neuro-otologist looks for disorders of the inner ear and vestibular systems and tumors of the vestibular (VIII) nerve.  Scans ordered by a neuro-otologist concentrate on the "inner auditory canals." These are referred to as "peripheral" disorders.  Neurologists, on the other hand, will look for more "central" disorders, that is, disorders of the spinal cord and brain.  Some examples would be multiple sclerosis, or degenerative diseases of the cerebellum.  In a total evaluation of dizziness, you would probably do best to see both.  I would recommend, therefore, starting with the neuro-otologist, since he is the one you can see first, and then follow-up with the neurologist.
Hope this helps.
Harriet B. Jacobster, AuD
Board Certified in Audiology