Ear Fullness as a Symptom of Endolymphatic Hydrops in non-Ménière’s Patient

Abstract

OBJECTIVE: 1) To determine if unexplained ear fullness might be a symptom of endolymphatic hydrops (EH) by using Electrocochleography (ECochG) SP/AP area and amplitude ratios. 2) To assess if individuals with unexplained ear fullness without vertigo differ significantly from individuals with ear fullness due to Ménière's disease (MD). MATERIALS and METHODS:In a case-control study in our tertiary care center, we evaluated 62 ears across 49 patients, including 18 normal healthy ears across 12 control patients, 26 ears with unexplained ear fullness across 20 patients (6 had bilateral symptoms of ear fullness), and 18 ears with definite MD across 17 patients (1 bilateral disease). Outcome measures were SP/AP amplitude and area ratio, hearing threshold, and air-bone gap. RESULTS:The analysis of auditory thresholds revealed a significant group effect for air conduction [F(2,50)=49.627; p<0.001] and for bone conduction [F(2,50)=45.625; p<0.001]. We observed significant differences between MD (36.36±4.87) and control patients (19.85±2.55) (p=0.015) for amplitude ratio. Moreover, significant differences were noted between MD (5.32±1.06) and controls (1.36±0.07) (p=0.035) and between ear fullness (5.16±1.17) and controls (p=0.026) for the area ratio parameter. No significant correlation was observed between SP/AP area or amplitude ratios and air-bone gap at any of the tested frequencies. The amplitude ratio was not significantly different between the ear fullness and control groups (p=0.406). The area and amplitude ratios did not reveal significant differences between MD and ear fullness (p=1.00). CONCLUSION:EH can be present even in the absence of vertigo and when patients report unexplained ear fullness. This study, to our knowledge, is the first to possibly allow early identification of cochlear EH in patients suffering from ear fullness without vertigo.

Impact of endolymphatic hydrops on DPOAE in subjects with normal to mild hearing loss

“… 37 Even in patients with only ear fullness symptoms and no MD, EH can be estimated using the area ratio parameter of electrocochleography. 38 Additionally, vestibular‐evoked myogenic potentials measured using tuning criteria of specific frequencies showed a similar response to MD in 27% of healthy side, asymptomatic ears with MD. 39 Thus, evaluation of DPOAE in MD patients could provide useful information regarding cochlear function, such as changes in basilar membrane compliance due to EH.…”

“…The combination of summating potential amplitude and summating potential bias ratio at 1 kHz reportedly has an overall diagnostic accuracy of 85% for MD 37 . Even in patients with only ear fullness symptoms and no MD, EH can be estimated using the area ratio parameter of electrocochleography 38 . Additionally, vestibular‐evoked myogenic potentials measured using tuning criteria of specific frequencies showed a similar response to MD in 27% of healthy side, asymptomatic ears with MD 39 .…”