Otoneurology

Otoneurology —or neurotology— is the subspeciality that combines otology, which studies the ear, with neurology, which studies the brain and nervous system. It is the consultation where it is identified which part of the balance system is failing and why, whatever the symptom you present with: vertigo, dizziness or unsteadiness.

The otoneurologist doesn't just look at the ear. They also look at the nerves connecting it to the brain, and how that network works alongside vision and the information received from the feet. That is why dizziness lasting for months often ends up here after passing through several clinics.

Vertigo, dizziness and unsteadiness are not the same thing

Hardly anyone arrives saying "I have a vestibular disorder": they arrive feeling dizzy. Giving a name to the symptom is the first step of the investigation.

• Vertigo: a spinning sensation, feeling that yourself or your surroundings are moving. It usually points to the inner ear.
• Dizziness: a more diffuse discomfort — lightheadedness, a foggy head, nausea when moving the head.
• Unsteadiness: feeling unsteady when walking or standing, without a spinning sensation.

All three can have a vestibular origin, but they are neither investigated nor treated in the same way: the treatment for positional vertigo is completely different from that for vestibular migraine.

What is investigated in this consultation

• Benign paroxysmal positional vertigo (BPPV).
• Vestibular neuritis and labyrinthitis.
• Ménière's disease and other syndromes presenting with recurrent vertigo attacks.
• Tinnitus and hearing loss.
• Otosclerosis.
• Vascular disorders and autoimmune inner ear diseases.
• Head injuries affecting balance.
• What we see most: Unsteadiness or dizziness with no clear cause after visiting other consultations.

How it is investigated: the tests

The consultation combines a detailed medical history —how long the episode lasts, what triggers it, what symptoms accompany it— with specific vestibular tests:

• Nystagmus examination, the involuntary eye movement that reveals issues in the vestibular system.
• Videonystagmography (VNG), which records these eye movements with a camera.
• Video head impulse test (vHIT), which assesses the vestibulo-ocular reflex of each canal.
• Vibration-induced nystagmus (VIN).
• Caloric tests, which evaluate the response of each ear separately.
• Vestibular evoked myogenic potentials (VEMP).
• Positional tests, which reproduce the vertigo and identify which canal is affected.
• Computerised dynamic posturography, which measures how balance is maintained while standing.
• Gait assessment.

The aim is not just to give a name to the dizziness: it is to find out where it comes from, because everything else depends on that.

Positional vertigo and manoeuvres

BPPV is a brief, intense vertigo triggered by certain head movements: turning in bed, bending down, looking upwards. When examination confirms that its cause is the displacement of otoliths, the treatment consists of repositioning manoeuvres, which are performed right in the consultation without medication. However, IMPORTANT: positional vertigo can also have a central origin, which is why it must be examined by experienced staff. It is one of the reasons why you should not resign yourself to recurring vertigo.

From diagnosis to training

Diagnosis is the first step and allows us to propose the most suitable treatment for each case. Specific pharmacological treatment is sometimes required, and when balance does not compensate fully on its own, vestibular rehabilitation may be indicated, which is carried out in this very unit. It is not a standardised step: it is evaluated in each case, depending on what the investigation shows.

When to book an appointment

• Spinning sensation or feeling that your surroundings are moving.
• Unsteadiness or feeling unsafe when walking.
• Nausea or vomiting when moving your head.
• Hearing loss or ringing in the ears.
• Difficulty focusing your vision when moving.

The consultation takes place at the centro médico de Málaga (La Rosaleda), within the Unidad Vestibular, under the name of Otoneurología. Book an appointment and we will start by understanding what is happening to you.