New Tools Emerge to Diagnose Ménière’s Disease

VANCOUVER—Meniere’s disease continues to be a vexing challenge for otolaryngologists to diagnose, even though the disorder was first described 150 years ago. The National Institutes of Health estimate that it affects more than 600,000 people in the U.S. Fortunately, experts in the field have developed and are continuing to refine new approaches to objectively diagnose the disease, including a more reliable testing approach and advances in magnetic resonance imaging of the endolymphatic space. New insights into physiologic changes during attacks have also emerged.

At a mini-seminar here at the American Academy of Otolaryngology-Head and Neck Surgery Annual Meeting, held Sept. 29–Oct. 2, William Gibson, MD, professor of otolaryngology at the University of Sydney in Australia, said that using a tone-burst method of transtympanic electrocochleography (TT ECochG) gives a better indication of endolymphatic hydrops (EH). This method, which has been studied in thousands of patients over more than a decade, he said, can verify Meniere’s with a sensitivity of 81 percent and a specificity of 90 percent.

Dr. Gibson uses long tone bursts of 16 ms rather than click stimuli. This approach is especially helpful at frequencies of 500 Hz, 1 kHz and 2 kHz, he said. Using click-evoked summating potential versus action potential ratios, he said, has not significantly differentiated between populations of Meniere’s disease patients and non-Meniere’s patients.