Oinical complaints in otology and neurotology represent a diverse spectrum of disorders with many overlapping symptoms.

For this reason, otolaryngologists must carefully and appropriately evaluate patients with otologic complaints to achieve timely diagnosis of potentially treatable and reversible pathologic processes. The history is an essential component of the evaluation of patients with otologic disorders and includes defining the onset and timing of hearing loss, tinnitus, vertigo, otalgia, or otorrhea. Associated symptoms, particularly those related to the central nervous system (CNS) or cranial nerve dysfunction, should be sought. Prior history of noise exposure, potential ototoxic medication exposure, head trauma, family history of ear disease, or meningitis should be elicited. The presence of any associated medical conditions such as autoimmune disorders or diabetes is critical in the assessment. The foundation of diagnosis in otology and neurotology rests with the clinical examination. The examination begins with a general otolaryngologic assessment, consisting of an examination of the overall facial and skull features to identify potential congenital or acquired asymmetry, integument, or pigment abnormalities. The otologic examination consists of initial visual inspection of the auricle and mastoid process. Microscopic examination of the external auditory meatus and canal is followed by subsequent inspection of the tympanic membrane. Pneumatic otoscopy with a Siegel pneumatic speculum allows visualization of tympanic membrane mobility under the microscope. Standard rhinologic, oral, and neck examination should follow. Particular attention should be given to the cranial nerve examination, as many otologic and neurotologic processes can affect cranial nerve function. 1\Jning fork examination, most commonly using a 512 and 1024Hz tuning fork, provides a rough but simple method of determining auditory function within the clinic. The two tests commonly performed are the Weber test and

the Rinne test of air conduction determination. Together these tests can rapidly differentiate a conductive from a sensorineural loss and can determine which ear is likely affected. Evaluation of hearing should be performed using objective testing. Hearing loss can occur at any stage of the auditory pathway, from the ear canal to the auditory cortex. Although simple otoscopy can identify obvious pathology in the external and middle ear, the ability to determine the cause and nature of hearing loss, particularly the evaluation of the cochlea, may not be possible by physical examination alone. The standard objective measure of hearing is audiometry. Pure tone threshold audiometry, the most fundamental of all diagnostic hearing tests, is a behaviorally based measure of hearing that is used