Diagnosis of Vestibular Menière's Disease with Electrocochleography

The existence of vestibular Menière's disease, once considered a variant of classic Menière's disease, but without hearing loss, has been questioned because of lack of objective evidence that endolymphatic hydrops is involved with the disease process. Transtympanic electrocochleography (TT ECoG) has emerged as a useful tool for electrophysiologic monitoring of the inner ear, and is especially valuable in assessing endolymphatic hydrops. A retrospective chart review was performed to identify those patients with a diagnosis consistent with vestibular Menière's disease in order to determine the presence or absence of endolymphatic hydrops using TT ECoG. A total of 15 patients were identified. Using established norms for the summating to action potential ratio (SP:AP) with click stimulus, 73 percent demonstrated values consistent with endolymphatic hydrops. The most commonly associated symptom was aural fullness (60%), followed by tinnitus (33%), and the disease was bilateral 53 percent of the time. The similarities between this clinical entity and classic Menière's disease are noted, and theoretic considerations are made.