Table Of ContentNeurotology
What Do I Do Now?
SERIES CO-EDITORS-IN-CHIEF
Lawrence C. Newman, MD
Director of the Headache Institute
Department of Neurology
St. Luke’s Hospital Center
New York, NY
Morris Levin, MD
Co-director of the Dartmouth Headache Center
Director of the Dartmouth Neurology Residency Training Program
Section of Neurology
Dartmouth Hitchcock Medical Center
Lebanon, NH
PREVIOUS VOLUMES IN THE SERIES
Headache and Facial Pain
Peripheral Nerve and Muscle Disease
Pediatric Neurology
Stroke
Epilepsy
Neurocritical Care
Neuro-Ophthalmology
Neuroimmunology
Pain
Neuroinfections
Emergency Neurology
Cerebrovascular Disease
Movement Disorders
Neurogenetics
Neurotology
Darius Kohan, MD
Director of Otology/Neurotology
Lenox Hill Hospital and Manhattan Eye Ear Nose and Throat
Hospital, NJ/LIJ
Associate Professor of Otolaryngology
New York University Medical School
President of the New York Otologic Society
Board of Governors, New York Otologic Society
New York, NY
Selena E. Heman-Ackah, MD, MBA
Director of Otology, Neurotology and Audiology
Division of Otolaryngology, Head and Neck Surgery
Beth Israel Deaconess Medical Center
Harvard Medical School
Boston, MA
Sujana S. Chandrasekhar, MD, FACS
Director, New York Otology
Director of the Comprehensive Balance Center of the
New York Head and Neck Institute
Clinical Associate Professor of Otolaryngology
Mount Sinai School of Medicine
New York, NY
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Library of Congress Cataloging-in-Publication Data
Kohan, Darius, 1959– author.
Neurotology / Darius Kohan, Selena Heman-Ackah, Sujana Chandrasekhar.
p. ; cm.
Includes bibliographical references.
ISBN 978–0–19–984398–5 (alk. paper)
I. Heman-Ackah, Selena, author. II. Chandrasekhar, Sujana S., author. III. Title.
[DNLM: 1. Nervous System Diseases—Case Reports. 2. Otorhinolaryngologic
Diseases—Case Reports. 3. Neurotology—methods—Case Reports. WV 140]
RC346
616.8—dc23
2014005477
The science of medicine is a rapidly changing field. As new research and clinical experience broaden our
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Acknowledgments
To Mr. Joseph Agosta and Mr. Jonathan Komisar, whose able assistance
with image procurement makes this text all the more valuable for the
reader.
Preface
My father, Silviu Kohan, a wise physician to whom I dedicate this book,
always emphasized to medical students and residents the importance of
cooperating with their colleagues in a multidisciplinary approach in
order to optimize patient care. His advice is most appropriate when man-
aging patients with complex neurologic/neurotologic signs and symptoms
with an extensive differential diagnosis and treatment options.
In this text we provide a general overview of common and important
neurotologic pathology, and present real cases we all managed at our insti-
tutions. The focus is on hearing loss, tinnitus, vertigo/dysequilibrium,
facial neuropathy, and neurologic complications of otitis media. In each
section an attempt was made to provide a clear diagnostic protocol and
appropriate therapeutic modalities for each neurotologic pathology under
consideration. Current controversies involving the diagnostic evaluation
and treatment options mentioned in the text are reviewed in much greater
detail in the “Further Reading” component of each chapter.
The authors are very grateful to two key individuals, Mr. Joseph Michael
Agosta and Mr. Jonathan Komisar, MS, who provided invaluable aid in
the production of this manuscript. We also thank Lawrence Newman,
MD, Mr. Craig Panner, and Ms. Marni Rolfes for promoting this project
to fruition. Most of all we want to thank you, the reader, for taking care of
patients with neurotologic disorders, which one day could be any one of us.
Darius Kohan, MD
Associate Professor, NYU School of Medicine
Director of Otology/Neurotology-Lenox Hill/MEETH Medical Center
Table of Contents
SECTION I HEARING LOSS
1 Presbycusis 3
Darius Kohan
With the population older than age 65 years being the largest growing
age-group in the United States, the prevalence of presbycusis is on the rise.
Presbycusis is characterized by high-frequency sensorineural hearing loss and
occasionally with deficits in central auditory processing. This chapter reviews
the pathogenesis of presbycusis, the diagnostic evaluation, and current
available treatment modalities.
2 Sudden Sensorineural Hearing Loss 13
Darius Kohan
Sudden sensorineural hearing loss is a condition commonly encountered in
the neurologic and neurotologic practice. The potential etiology, diagnostic
evaluation, and treatment of sudden sensorineural hearing loss are discussed.
3 Noise-Induced Hearing Loss 21
Darius Kohan
The incidence of noise-induced hearing loss is increasing. It is characterized by
high-frequency sensorineural hearing loss with associated nonpulsatile tinnitus.
This chapter reviews the OSHA guidelines for noise exposure, and the phases
of noise-induced hearing loss are described. Additionally, the evaluation,
treatment, and prevention of noise-induced hearing loss are discussed.
4 Ototoxins 27
Darius Kohan
Ototoxin exposure is a common cause or contributing factor in the
pathogenesis of sensorineural hearing loss. This chapter reviews commonly
encountered ototoxins and potential means for reducing effects of ototoxic
agents.
5 Congenital Hearing Loss 33
Darius Kohan
Congenital hearing loss can be characterized as sensorineural, conductive,
or mixed hearing loss. Additionally, congenital hearing loss can be classified
as syndromic or nonsyndromic. This chapter reviews the classification
of congenital hearing loss and its associated differential. The diagnostic
evaluation and management of congenital hearing loss are discussed.
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