Abstract

Neurotology exists at the intersection of neurology, otolaryngology, and neurosurgery, encompassing disorders of the inner ear and the central pathways governing vestibular, cochlear, and auditory function. This contemporary review major neurotologic conditions encountered in clinical practice: benign paroxysmal positional vertigo (BPPV), vestibular neuritis, Ménière disease, superior semicircular canal dehiscence, autoimmune inner ear disease, vestibular schwannoma, central vestibulopathies from brainstem and cerebellar pathology, vestibular migraine, and persistent postural-perceptual dizziness (PPPD). Special emphasis is placed on the neurotologic relevance of posterior fossa stroke, advanced imaging (3T endolymphatic hydrops MRI, ultra-high-resolution CT), quantitative vestibular function testing (video head impulse testing, vestibular evoked myogenic potentials), and the evolving therapeutic landscape including intratympanic pharmacotherapy, vestibular rehabilitation, cochlear gene therapy, and radiosurgery. A structured seven-step diagnostic algorithm for the clinician managing the dizzy patient is presented, accompanied by five evidence-referenced clinical tables. This article serves as a comprehensive, clinically actionable reference for otolaryngologists, neurologists, audiologists, and allied health professionals engaged in neurotologic care.

Keywords

neurotology, vertigo, BPPV, Ménière disease, vestibular neuritis, vestibular schwannoma, HINTS examination, cochlear gene therapy, central vestibulopathy, posterior fossa stroke, persistent postural-perceptual dizziness