Unstable distortion-product otoacoustic emission phase in Menière's disease

The presence of endolymphatic hydrops as a marker of Menière's disease (MD) suggests abnormal pressure in the intralabyrinthine compartments of patients and excessive stiffness of sound-sensitive structures. Otoacoustic emissions (OAEs) have been reported to respond to changes in the ear's stiffness, including those produced by intracranial pressure steps, by a characteristic phase shift around 1 kHz, thereby suggesting a noninvasive means of monitoring MD. Here, body tilt was used for modulating intracranial pressure in forty-one patients with definite MD who were tentatively measured at two stages, with and without active symptoms. Their distortion-product OAEs (DPOAEs) were dynamically monitored around 1 kHz every few seconds in response to body tilt. In a control sample of thirty normal ears, the maximum phase rotation of DPOAEs produced by body tilt was between -18° and +37°. In MD ears with the complete set of symptoms, the posture-induced phase shifts in 32 out of 35 tests fell outside the normative interval, and in 10 tests, although DPOAEs were well above noise floor, their phase was always so abnormally erratic that body tilt produced hardly any additional effect. When MD ears were asymptomatic, nine out of 32 posture tests were abnormal. The excessive DPOAE phase shift is consistent with either a too stiff cochlear partition or a displacement of the operating point of outer hair cells by endolymphatic hydrops.