The Role of Wideband Tympanometry in the Diagnosis of Meniere's Disease

Abstract

Meniere's disease (MD) is a clinical syndrome characterized by spontaneous recurrent vertigo, usually accompanied by hearing loss, tinnitus, and aural fullness. The cause of MD remains unclear and is generally considered to be associated with endolymphatic hydrops. Studies showed that patients with MD could have eustachian tube dysfunction (ETD). ETD can disrupt the pressure balance between the middle and inner ear and impair the inner ear's function. In recent years, several studies have attempted to identify MD by using wideband tympanometry (WBT). However, there are limited studies in this area. There is no consensus on how to use WBT to diagnose Meniere's disease. Therefore, we endeavored to conduct a narrative review in this aspect based on the latest research findings. Reduction in resonance frequency and absorbance are characteristic of MD and can identify Meniere's disease. The use of an increase in the integrated area of absorbance as an indicator for identifying MD is controversial. WBT seems to be ineffective as a diagnostic tool during the acute episodes of Meniere's disease. Patients with MD may benefit from WBT. WBT has excellent potential for future use in Meniere's disease. However, further large sample sizes, multicenter studies are needed.

Hearing and Vestibular Testing in Menière’s Disease

“…By increasing perilymphatic pressure, ELH can push the stapes footplate toward the middle ear. Thus, it restricts the movement of the ossicular chain and decreases the compliance of the middle ear [11]. This condition is almost similar to the OME (among other middle-ear pathologies).…”

“…From another viewpoint, ELH decreases the impedance of cochlear part, just like large vestibular aqueduct syndrome (LVAS) (among other inner ear pathologies). Consequently, studies showed that resonance frequency of the middle ear decreased in MD [11], LVAS [12], and OME [13]. Moreover, power reflectance in high frequency range (2-4 KHz) increased in MD patients [14].…”

“…Compared to the traditional 226-Hz tympanometry, WBT uses multiple frequencies (ranging from to 8000 Hz) in 1/24 octave intervals through a descending pressure sweep (between +250 and − 350 daPa). Therefore, it is more sensitive to middle-ear transfer function [10,11].…”

Three‐dimensional wideband absorbance immittance findings in young adults with large vestibular aqueduct syndrome

“…Won et al 17 observed that the absorbance of mucus middle ear effusion was lower than that of serous middle ear effusion, especially above the 2 kHz region. In recent years, characteristic manifestations of WAI have been observed in superior semicircular canal dehiscence (SSCD) syndrome, 18 Meniere's disease, 19 and LAVS. 20 …”

“…Won et al 17 observed that the absorbance of mucus middle ear effusion was lower than that of serous middle ear effusion, especially above the 2 kHz region. In recent years, characteristic manifestations of WAI have been observed in superior semicircular canal dehiscence (SSCD) syndrome, 18 Meniere's disease, 19 and LAVS. 20 A previous study found that WAI results in children with LVAS showed an increase in absorbance at low and high frequencies and a decrease at mid-frequencies.…”