Neurootology

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The Neurootology is the medical specialty of the healthy and the diseased impaired function of the head senses, in 1970 by Claus-Frenz Claussen at the Free University of Berlin was founded.

definition

Modern neurootology today includes four medical sub-areas:

  1. Balance and equilibrium function tests ( equilibriometry ): This subheading includes symptoms of dizziness, dizziness, vertigo with age, tendency to fall, disorientation, motion sickness including seasickness, etc.
  2. Hearing and hearing disorders ( audiometry ): The following symptoms fall into this area: deafness, impaired hearing, noise damage, ringing in the ears ( tinnitus ), etc.
  3. Taste and taste disorders ( gustometry ): The clinical disorders in this field include taste blindness, taste distortion, taste confusion and taste illusions, etc.
  4. Odor and odor disorders ( olfactometry ): These include the blocking odor loss due to nasal congestion, the sensory odor disorder, the mistaken smell and the odor hallucination, e.g. B. in epilepsy .

Historical development

Historically, neurootology has developed based on ear, nose and throat medicine at the borders between ophthalmology and neurology , as well as under the influence of internal medicine and orthopedics .

The ear, nose and throat doctor Róbert Bárány (1876–1936) received the first Nobel Prize in this field in 1914 for his pioneering studies on nystagmus analysis and vestibular balance function . At the end of the First World War, the ophthalmologist Ohm developed the fundamentals of optokinetics , i. H. of the nystagmas caused by the eyes. The Viennese neurologists Spiegel and Sommer gave the entire area at the borders of the above-mentioned subjects the name that this area now bears worldwide through their trend-setting publication “Ophthalmo- and Otoneurology” in 1931. At the Air Force and NASA in the United States, the field of "neurootology" experienced a strong surge in aerospace and space medicine application-related applications during and after World War II , which expanded into many other theoretical and clinical areas through the pioneering work of Ashton Graybiel , an internist radiated.

The professional and advanced training regulations for physicians in Germany also recognize such developments at the boundaries of specialist areas due to the systematics of particular diseases for other established specialist areas, such as internal medicine.

In the newer ear, nose and throat medicine, which only emerged after the First World War through the scientific mergers of otologists (ear doctors), rhinologists (nose and face doctors) and laryngologists (ear and larynx doctors) associations with special emphasis on invasive Diagnostic and surgical therapy methods developed, the conservative, more neurophysiological and diagnostic-oriented areas represent special areas, which are nevertheless connected with a large, patient-related area of ​​responsibility. In ear, nose and throat medicine, largely independent departments for voice disorders ( phoniatrics ), language disorders ( speech therapy ) and children's hearing disorders ( pediatric audiology ) were initially created. These are scientifically structured by special professorships, practically by clinical departments and in further training for doctors by a sub-area designation in the further training regulations.

This was followed by the first independent habilitation in neurootology at German universities from 1970. Today there are already the first chairs and special clinics worldwide for the field of neurootology, which is defined by special diseases and their systematic detection and treatment, in Europe, America and Asia.

The medical specialty "Neurootology" was founded in Germany in 1970 by Claus-Frenz Claussen . Between 1970 and 2004 he set up a department in the head clinic of the University of Würzburg and headed it for three decades. After his retirement in 2004, his student, Privatdozent Schneider, took over the management of this department.

Clinical scientific basis of neurootology

The related metric examination procedures, which are used to examine and treat the head senses (with an emphasis on hearing, balance, smell and taste), are also summarized under the term “neurootometry”. It is the basis of equilibriometry , i. H. the measurement of the equilibrium function, audiometry , d. H. the measuring detection of the hearing function, gustometry , d. H. the measurement of the taste function, olfactometry , d. H. the measurement of the olfactory function, the olfactometry and its pathological changes.

The presentation space for modern neurootometry is the biometrically verified function of sensory tracts with their functional characteristics z. B. the vestibular equilibrium from the ear to the cerebral cortex and its numerical reaction measurement. Classical pathological topodiagnostics is strongly linked to the anatomical images of the human sensory and brain structures. To do this, however, it is necessary to obtain an operative, other invasive or autopsy report. However, modern neurootology has succeeded in developing successful, non-invasive neurootometric functional diagnostics using the neurootological network technology of brain sensory path analysis. The process is similar to the detection of errors in modern computer networks; this is where the term network analysis comes from.

With the expertise in the field of sensory research using pathological, pathophysiological, clinical symptomatological, etc. methods, which has grown over the past 150 years and is known to neurootologists, modern neurootology has succeeded in establishing a connection between the two important visualization spaces, namely vital function and anatomy . These IT connections between human software and hardware disorders are used in neurootology for the benefit of the patient by means of the neurootological network technology of the brain sensory path analysis. Typical for this non-invasive cerebral pathway analysis is also a consistent modern diction of reports and diagnoses that better describes the actual circumstances.

Combined neurootological disorders

The neurootological disorders can occur not only individually but also in combination. Morphologically detectable diseases with vertigo (dizziness), nausea ( nausea ), tinnitus (ringing in the ears) and hearing impairment, which either show the entire spectrum of these subjective symptoms and objective findings or only individual components, are shown in the following table using examples. In cases of combined disorders with simultaneous damage in several sensory tracts, one speaks today of so-called multisensory neurootological functional disorders. The following table contains topographically ordered examples of both functionally and morphologically detectable diseases with vertigo, nausea, tinnitus and / or hearing impairment.

List of clinical pictures according to functional anatomical disease area:

Neurootological examination procedures

Due to the scientific and clinical developments, the neurootologist has today further developed the range of methods he uses compared to classical ENT medicine. Both the classic otological inspection methods of the ear, nose, eyes and ears as well as audiometry, which is widely used in ENT medicine, occupational medicine, paediatrics, physiology, neurology, etc., are among the examination methods used. Similarly, the meaningful examination procedures of equilibriometry are used and further developed in a targeted manner, although they are also used in other areas such as physiology, aerospace medicine, ophthalmology, neurology, orthopedics, occupational medicine, etc. with special issues.

Completely new diagnostic insights into the neurootological functioning of entire sensory pathways are provided by the neurosensory measurement series, which are tapped from the head surface with electrodes and processed with modern computers, using the methods of evoked brain potentials (EP) and brain electrical activity mapping (BEAM).

While the patient's daily demand for neurootological network examinations including audiometry, equilibriometry and the associated evoked brain potentials is very high due to the diseases to be treated, the gustometric and olfactometric examinations are carried out less frequently due to the significantly lower number of diseases.

If one goes into the pathogenesis of the head disorders to be treated, it is true for the German patients that about every second neurootological illness occurred in connection with a heart and / or circulatory disease. From here, the external and transcranial Doppler sonography of the brain-supplying vessels in the hands of neurootologists has recently been increasingly indicated.

Carrying out the necessary, mutually supporting neurootometric diagnostics is socially inexpensive if you consider that this will initiate a case-oriented, outpatient therapy that z. B. prevents hospital treatment or hospitalization and at the same time improves the patient's quality of life.

See also

literature

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