Otology, Neurotology and Skull Base Surgery

Overview

Otology, neurotology and skull base surgery research into hearing disorders at Mayo Clinic is currently centered on three general concepts: hearing preservation, hearing restoration and auditory rehabilitation.

Incremental advances in the understanding of the molecular and physiologic basis for hearing loss — gained through basic science research and clinical studies — have led to new and improved therapeutic options for patients. These advances are made possible through close collaboration with expert colleagues in neurophysiology, behavioral neurotology, neurology, internal medicine, radiology and audiology.

Primary focus areas include Meniere's disease, vestibular schwannoma tumors and hearing rehabilitation.

Meniere's disease

People with Meniere's disease experience disabling vertigo and progressive hearing loss. The causes of this disease are not entirely clear, though there is increasing evidence that migraine and migraine-associated dizziness are, at minimum, commonly seen in the Meniere's disease population. In addition, many people with Meniere's disease also experience a condition called chronic subjective dizziness, which often develops due to the recurrent nature of these disease processes.

Investigators are currently studying — from an epidemiologic perspective — the interrelated nature of these diseases. A better understanding of the disease presentation and who it affects may lead to better treatment opportunities.

Vestibular schwannoma tumors

Mayo researchers have an interest in finding the best way to treat vestibular schwannoma tumors, which often negatively affect hearing and balance. Clinical studies are under way to discern what clinical presentations may be best suited to the current treatment options of observation, stereotactic radiotherapy or surgery.

There is also an interest in developing systemic medical therapies for people with neurofibromatosis 2 (NF2)-associated vestibular schwannomas where standard therapies have failed. Identifying targeted therapies that stop the growth of vestibular schwannoma tumor cells in the laboratory may help decide which therapies to advance into the clinical setting.

Hearing rehabilitation

If hearing cannot be preserved or restored, then hearing rehabilitation options such as hearing aids, cochlear implants, brainstem implants and hybrid devices (a combination of a cochlear implant and conventional hearing aid) must be considered. Mayo's cochlear implant team is well established and is currently investigating — under Food and Drug Administration (FDA) oversight — the most advanced devices available. These areas of research are discussed further in the audiology section.

Other projects

In addition to the above-mentioned primary areas of interest, numerous smaller projects are under way, like studying the application of new imaging techniques such as 3-D magnetic resonance imaging (MRI) and special MRI sequences for the early detection of cholesteatoma recurrence.

Additionally, researchers are trying to develop a diagnostic test to demonstrate the presence of eosinophils within pathologically present middle ear fluid in a subset of people clinically affected by eosinophilic otitis media. Better diagnostics for people with eosinophilic otitis media may lead to clearer treatment options.