Myths in neurotology

For many diseases the etiology of disordered function is unknown and therapy is either symptomatic or empirical. The empirical approach to therapy is acceptable to many physicians, particularly if a treatment can be based on some attractive, although unproven, concept of pathogenesis. A hypothetical explanation of disordered function can become widely popular in spite of a serious lack of scientific support. When evidence emerges that refutes the logic of a concept of pathogenesis, then that concept becomes a myth. Human temporal bone studies have identified several myths in neurotology that deserve our attention. Among these myths are the following: (1) cochlear otosclerosis is a common cause for sensorineural hearing loss, (2) idiopathic sudden sensorineural hearing loss is a vascular disorder that should be treated as a medical emergency, (3) the conductive component of hearing loss in Paget's disease is caused by ossicular fixation and therefore should be surgically correctable, (4) vascular loops should be considered as a possible cause for otherwise unexplained otologic symptoms, (5) surgical manipulations on the endolymphatic sac are scientifically sound therapies for selected cases of Meniere's disease, and (6) perilymph fistulas are a common cause for audiovestibular symptoms that are not related to a stressful incident.