Preface_2005_Neurotology

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Preface
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
Otolaryngology.
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
introduced.
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
internet.
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
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