When Should You See a Specialist for Ear Problems? What a Neurotologist Does

A neurotologist is a board-certified ear, nose, and throat (ENT) specialist with two additional years of advanced training focused specifically on ear conditions, including hearing loss, chronic infections, and complex disorders affecting the ear and skull base. If you've been struggling with persistent ear problems, your general ENT doctor might refer you to one of these specialists for more targeted care.

When Should You See a Neurotologist?

Most patients don't start with a neurotologist—they typically see a general ENT specialist first, who then refers them for specialized care if needed. You might be referred to a neurotologist if you're experiencing any of the following:

• Hearing Loss: You've noticed a decline in your ability to hear clearly, whether in one or both ears.
• Hearing Aid Failure: Your hearing aids are no longer providing adequate benefit or have stopped working effectively.
• Single-Ear Hearing Loss: You notice hearing loss in only one ear, which may indicate a different underlying cause than age-related hearing loss.
• Chronic Ear Drainage and Infections: You experience ongoing drainage and recurrent infections from the ear that don't resolve with standard treatment.

What Complex Ear Conditions Do Neurotologists Treat?

Neurotologists address issues affecting any part of the hearing pathway—from the ear canal and eardrum through the three tiny bones in the middle ear, the inner ear, and the nerves connecting the ear to the brain. These specialists handle conditions that general ENTs may not have the expertise to manage.

Some of the most common complex conditions neurotologists treat include ear bone problems, where the small bones attached to the eardrum become disconnected or stuck in place. These bones can often be surgically repaired or replaced to help restore hearing. Neurotologists also treat tumors on the hearing or balance nerve, which can cause hearing loss. At specialized centers, neurotologists work closely with neurosurgeons to perform combined skull-based surgeries, carefully working around these nerves to prevent further hearing loss.

Another important area is facial nerve disorders. The nerve responsible for facial movement runs through a complex pathway in the ear, and damage to this nerve can result in facial weakness that resembles a stroke. Neurotologists are trained to diagnose and treat these conditions.

How Do Neurotologists Address Tinnitus and Ringing Ears?

Tinnitus—that persistent ringing, buzzing, or hissing sound in the ears—affects about 15 to 20 percent of Americans, and it's a challenging condition to treat. When you visit a neurotologist with tinnitus, they take a comprehensive approach to diagnosis and treatment.

"For any patient with tinnitus, we provide a comprehensive head and neck and ear exam, review the whole history of symptoms, and conduct a hearing test," explains Dr. Richard K. Gurgel, a neurotologist at University of Utah Health. If a patient has tinnitus with or without hearing loss, imaging may be needed for an accurate diagnosis. A specialized microscope can capture a detailed view of the ear, including the eardrum, signs of infection or inflammation, and all the nerves of the head and neck.

What's the Most Common Condition Neurotologists Treat?

Hearing loss is by far the most common condition that neurotologists treat. For severe hearing loss where a hearing aid is no longer helpful, neurotologists may offer a cochlear implant—an electrical device that stimulates the cochlear nerve to restore hearing.

Cochlear implants can be used by patients of all ages, including infants born deaf and older adults who have lost their hearing later in life. "The implants work incredibly well and are one of the greatest advances in modern medicine we've seen," Dr. Gurgel says. "That's because we can restore a lost neurological sensation with hearing and bring that back to someone's life".

Beyond just restoring the ability to hear, treating hearing loss through neurotology can prevent serious secondary health consequences. Untreated hearing loss is linked to depression, anxiety, social isolation, increased fall risk, and cognitive decline. By addressing hearing loss early with a neurotologist, patients can avoid these cascading health problems and maintain better overall quality of life.