Neurotology and skull base surgery slowly emerged out of a confluence of interrelated disciplines and technologies over the past century to become the field that we know today. Its formation required the marriage of neurosurgery and otology, the introduction of the operating microscope, and advances in surgical technique, anesthesia, and radiology. Along the way, the field also began involving specialists within ophthalmology and craniofacial and plastic and reconstructive surgery. Lastly, and perhaps most importantly, the formation of neurotology and skull base surgery required pioneering surgeons who were willing to push the boundaries of their training, sometimes under the ridicule or scorn of the medical establishment. This historical overview focuses upon the origins of the specialty, from the birth of otology and neurosurgery up through the last quarter century.