Transtympanic Electrocochleography for the Diagnosis of Ménière's Disease

Abstract

This paper evaluated the diagnostic power of electrocochleography (ECochG) in detecting Ménière's disease (MD) as compared with two subjective assessment methods, including the clinical guidelines provided by the American Academy of Otolaryngology—Head and Neck Surgery Committee on Hearing Equilibrium and the Gibson score. A retrospective study of 250 suspected MD cases was conducted. The agreement between the three assessment methods was found to be relatively high, with a total reliability being higher than 70%. Participants who tested “positive” with ECochG exhibited a higher occurrence rate of asymmetric hearing threshold as well as the four MD symptoms, namely, vertigo, hearing loss, tinnitus, and aural fullness. The “positive” ECochG group also showed a high correlation between the ECochG measures in response to stimuli at adjacent frequency ranges, suggesting that the interfrequency ECochG correspondence may be sensitive to the presence of endolymphatic hydrops and thus may serve as a useful diagnostic marker for MD.

Validity and Reliability of the Diagnostic Tests for Ménière's Disease

“…The second limitation of the medical history is the confounding effect of the counter ear's symptoms. Because bilateral disease can occur with the involvement of the opposite ear in 50% of patients in the advanced disease, it is generally impossible to understand which ear causes the complaints that develop after a long remission period by only considering the patient's medical history (6).…”

“…Another diagnostic method based on medical history, is the Gibson scoring system (6,8). In this scoring system, which evaluates the symptoms of vertigo with the feeling of rotation of the surrounding environment, hearing loss, tinnitus, and aural fullness, a score of 7 and above is required for the diagnosis of MD, whereas a score below 3 excludes MD.…”

“…ECoG may not correlate with the stage of disease, duration of symptoms, patient history, and audiometric findings all the time (6,(36)(37)(38). Moreover, even if vertigo attacks disappear completely after treatment, the SP/AP ratio does not recover (38).…”

“…Moreover, even if vertigo attacks disappear completely after treatment, the SP/AP ratio does not recover (38). Besides that, ECoG is an informative test, in prediction of when the disease will be bilateral, decision of treatment choices, or renewal of the treatment method (6,36,37). The sensitivity of the ECoG test in the diagnosis of MD variants, vestibular MD (recurrent vestibulopathy) and cochlear MD (acute low tone sensorineural hearing loss), were reported to be 62.5% and 67%, respectively (39).…”

Investigation of a New Weighted Averaging Method to Improve SNR of Electrocochleography Recordings

“…Thus ET-ECOG typically requires averaging of ~1000 evoked responses (ER's) [5]. Historically, the primary application of ECOG has been for the diagnosis, assessment, and monitoring of Meniere's Disease (MD)/Endolymphatic hydrops (ELH) [1,6]. However, recent advances have led TT-ECOG to be employed as an intraoperative tool [7] to determine the level of anaesthesia [8], and for real-time quantitative measurements of the efficacy of cochlear implants during surgery [9].…”