Otology versus Otosociology

Abstract

Otology concerns the biological study of ear alterations and diseases, solely. So, the diagnosis of audiovestibular diseases tends to be idiopathic or is based on theoretical concepts such as idiopathic sudden deafness, Ménière disease, benign paroxysmal positional vertigo, tinnitus, hyperacusis, or idiopathic facial paralysis. The treatment for these pathologies is symptomatic. Otosociology takes the aetiology and pathogenesis of the ear and situates them within the social and cultural environment of the patient. Then, audiovestibular disease is based on evidence, and the treatment options seek to solve the causes and consequences produced. Otosociology should be considered as a new discipline. Otosociology came into being since otology does not provide definitive solutions for the audiovestibular alterations produced from the point of view of the ear, whereas otosociology finds these solutions within the social/cultural environment of the patient. Where otology emphasises the diseases of the ear, otosociology deals with social manifestations. Where otology deals with idiopathic diseases, otosociology deals with causes and pathogeny produced by interactions in the social and cultural surroundings of the patient. Where otology offers symptomatic treatment, otosociology offers treatment of causes and consequences. Otosociology can fill significant voids in audiovestibular processes from the perspective of the patient's social environment.

Figure 1

Social and cultural interactions of a person as generators of psychosocial stress. The interactions of the social and cultural environments with the person can produce diseases. The intensity of social and cultural stressors or their reiteration can undermine the resilience or resistance of a person, making him/her vulnerable. Psychosocial stress can generate a series of audiovestibular symptoms through the pathogenic mechanism of ischaemia (sudden deafness, Ménière disease, benign paroxysmal positional vertigo, tinnitus, and hyperacusis).

Figure 2

Mechanisms of action related to ischaemic stress that causes audiovestibular symptoms. ACTH: adrenocortical releasing factor. CRF: corticotrophin releasing factor. HPAC axis: hypothalamic-pituitary-adrenocortical axis. HSAM axis: hypothalamic-sympathetic-adrenomedullary axis. PRF: prolactin releasing factor. Rα: receptor alpha. Rβ: receptor beta.

Figure 3

Methodology of otology and otosociology. Otology considers audiovestibular symptoms (deafness, vertigo, tinnitus, hyperacusis, and aural fullness) and places their aetiology, pathogenesis, diagnosis, and treatment within the ear. Otosociology places them within the ear and the individual's environment. ENT: ear-nose-throat. FLAIR: fluid attenuated inversion recovery. NMR: nuclear magnetic resonance.