Advances in the Objective Diagnosis of Ménière’s Disease

Abstract

Program Description:

Ménière’s disease is currently diagnosed by the AAO-HNS Equilibrium Committee Guidelines (1995), which are used worldwide. In the guidelines a “Certain” diagnosis requires histopathological confirmation of endolymphatic hydrops, with no provision for any in vivo test which might confirm that. This seminar will present one well established test (tone burst electrocochleography) and two newer techniques (vestibular evoked myogenic potential [VEMPs] and magnetic resonance imaging [MRI] inner ear imaging with intratympanic gadolinium) for demonstrating hydrops, and their basis for advancing knowledge of the pathophysiology of Ménière’s disease. Practical examples of the AAO-HNS guidelines underdiagnosing Ménière’s disease and its use in distinguishing Ménière’s disease from vestibular migraine are presented.

Educational Objectives:

1) Relate the basis and validity of tone burst electrocochleography as a sensitive and specific test for hydrops and its methodology as a simple office test. 2) Demonstrate that during a Ménière’s attack, the cervical VEMP amplitude is unchanged but the optical VEMP increases, implying a mechanical change in the membranous labyrinth as opposed to an ionic change. 3) Show that MRI inner ear imaging can visually demonstrate hydrops in the cochlea and vestibule.