Neurotology 2nd ed - R. jackler, D. Brackmann (Elsevier, 2004) WW.pdf

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Second Edition
Copyright © 2005 by Mosby, Inc. All rights reserved.
ISBN: 0-323-01830-0
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Previous edition copyrighted 1994.
Library of Congress Cataloging-in-Publication Data
Neurotology/[edited by] Robert K. Jackler, Derald E. Brackmann.—2nd ed.
p. ; cm.
ISBN 0-323-01830-0
1. Vestibular apparatus—Diseases. 2. Vestibular apparatus—Surgery. 3. Auditory
pathways—Diseases. 4. Auditory pathways—Surgery. I. Jackler, Robert K. II. Brackmann,
Derald E
[DNLM: 1. Vestibular Nerve. 2. Vestibulocochlear Nerve Diseases. 3. Skull Base
Neoplasms. WL 330 N497 2004]
RF260.T49 2004
Acquisitions Editor:
Rebecca Schmidt Gaertner
Developmental Editor:
Anne Snyder
Publishing Services Manager:
Joan Sinclair
Project Manager:
Mary Stermel
Printed in the United States of America
Last digit is the print number:
To Laurie and Charlotte
In the early 1990s, the first edition of this text helped to
define the body of knowledge encompassed by neurotol-
ogy, which was then a relatively new field. Over the past
decade, major strides have been realized on a number of
fronts. In terms of specialty organizations, the American
Neurotology Society has grown to over 500 members.
Across the Atlantic, neurotology has been organized through
the European Academy of Otology and Neurotology, an
active group of some 300 members.
Perhaps no aspect of neurotology has undergone a greater
degree of maturation than training. In the United States, two-
year post-residency fellowships are now formally accredited
by the American Council of Graduate Medical Education.
As of early 2004, approximately 20 fellowship programs
are active, 10 of which have completed the accreditation
process. In a major milestone, neurotology has become the
first subspecialty of Otolaryngology–Head and Neck Surgery
to achieve board certification by the American Board of
In the clinical realm, a sizable and ever increasing num-
ber of practitioners are focusing their professional efforts
in neurotology. In the operating room, microsurgical tech-
nology continues to evolve with improved microscope and
drill systems, image guidance, and more capable neuro-
physiologic equipment to mention just a few advances. In
tumor surgery, the emphasis continues to be on develop-
ment of minimally invasive techniques that maximize
tumor control while optimizing neural preservation.
Innovative radiotherapy methods, particularly stereotactic
techniques, have developed a role in selected neurotologic
tumors. In the vestibular field, numerous new therapies
have been devised for BPPV and entire new diagnoses,
such as superior semicircular canal dehiscence, have been
Research in the field is robust. The National Institute of
Deafness and Other Communication Disorders budget
has risen from $166.8 million in 1995 to $380.4 million in
2004—a large fraction of which is dedicated to investigation
of the ear and auditory nervous system. Among the numer-
ous fruits of this investment are over 60,000 cochlear
implant devices placed worldwide and the continued
refinement of the auditory brainstem implant. Programs
have been initiated in the development of a vestibular pros-
thesis. In genetics, over 100 genes for hereditary hearing
impairment have been localized, a significant portion of
which have been cloned. In neurotologic tumors, great
strides have been made in understanding the molecular
genetic basis for acoustic neuroma, NF-2, paragangliomas,
and papillary adenocarcinomas of the endolymphatic sac.
Functional imaging, in which the chemical processes
within the brain and other tissues are mapped, also has a
promising future. Looking forward a few decades, it seems
probable that the first human sense to be directly coupled
with implanted digital devices on a routine basis will be the
ear. It can be envisioned that man-machine interaction
with computers and communication devices will revolu-
tionize how the ear is used.
The companion surgical atlas to this text, promised in
the preface of the first edition, was published in full color
in 1996 (Jackler RK: Atlas of Neurotology and Skull Base
Surgery. St. Louis, Mosby, 1996). A second edition is being
contemplated at present. With the digital publishing revo-
lution currently in full force, it can be envisioned that
future editions of these works will appear primarily on the
Over the last few decades, neurotology has achieved
critical mass as a field, both through the number of scientists
and clinicians engaged in it as well as through the steady
accumulation of new knowledge and clinical capabilities.
The editors hope that this comprehensive resource, as the
primary textbook in the field, will serve to foster excellence
and stimulate innovation in neurotology.
Robert K. Jackler, MD
Derald E. Brackmann, MD
Kedar K. Adour, MD
Director of Research, Senior Consultant, Kaiser-Permanente
Medical Center, Oakland, California; Emeritus President
and Founder, Sir Charles Bell Society, San Francisco, California
Derald E. Brackmann, MD, FACS
Clinical Professor of Otolaryngology–Head and Neck Surgery
and Clinical Professor of Neurosurgery, University of Southern
California School of Medicine; President, House Ear Clinic;
Board of Directors, House Ear Institute; Los Angeles, California
Sumit K. Agrawal, BSc, MD
Resident, Department of Otolaryngology, University of
Western Ontario; Resident, London Health Sciences Centre;
London, Ontario, Canada
Sujana S. Chandrasekhar, MD
Associate Professor of Otolaryngology, Mount Sinai School
of Medicine; Director of Otology/Neurology and Director,
Cochlear Implant Program, Mount Sinai Medical Center;
New York, New York
Stephanie Moody Antonio, MD
Assistant Professor, University of Maryland School of Medicine,
Baltimore, Maryland
Wileen Chang, MS
Audiologist, University of California-San Francisco,
San Francisco, California
John R. Arrington, MD
Professor of Radiology, University of South Florida College
of Medicine; Attending Neuroradiologist, HL Moffitt Cancer
and Research Center; Tampa, Florida
Douglas A. Chen, MD
Clinical Associate Professor, University of Pittsburgh;
Co-Director, Hearing and Balance Center, Allegheny General
Hospital; Pittsburgh, PA
Yasmine A. Ashram, MD, D ABNM
Lecturer, Neurophysiology Division, Department
of Physiology, University of Alexandria, Alexandria, Egypt
Steven W. Cheung, MD
Associate Professor-in-Residence, Otology, Neurotology
and Skull Base Surgery, Department of Otolaryngology–Head
and Neck Surgery, University of California-San Francisco,
San Francisco, California
Robert J. Backer, MD
Division Chief, Neurological Surgery, St. John’s Mercy Medical
Center, St. Louis, Missouri
Thomas J. Balkany, MD
Hodgkiss Professor and Chairman, Department
of Otolaryngology; Professor, Department of Pediatrics;
Professor, Department of Neurosurgery; Chief, Department
of Neurotology; University of Miami School of Medicine; Chief
of Service, ENT, Jackson Memorial Hospital; Miami, Florida
Sung J. Chung, MD
Private Practice, ENT Surgical Consultants, Ltd, Joliet, Illinois
Harold V. Clumeck, PhD
Lecturer, Department of Communication Sciences and
Disorders, California State University, Hayward, California;
Section Chief, Speech Pathology, VA Medical Center,
San Francisco, California
Loren J. Bartels, MD, FACS
Clinical Professor, Department of Otolaryngology, University
of South Florida College of Medicine; Immediate Past Chief
of the Medical Staff, Tampa General Hospital; Tampa, Florida
Newton J. Coker, MD
Professor, Bobby R. Alford Department
of Otorhinolaryngology and Communicative Sciences,
Baylor College of Medicine; Attending Physician,
Otorhinolaryngology, The Methodist Hospital; Attending
Physician, Otorhinolaryngology, Michael E. DeBakey Veterans
Affairs Medical Center; Attending Physician,
Otorhinolaryngology, Harris County Hospital District
(Ben Taub); Attending Physician, Otorhinolaryngology,
St. Luke’s Hospital; Houston, Texas
Nikolas H. Blevins, MD
Assistant Professor, Department of Otolaryngology–Head &
Neck Surgery, Stanford University of Medicine, Palo Alto,
Dennis I. Bojrab, MD
Michigan Ear Institute, Farmington Hills, Michigan
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