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Endolymphatic Duct Blockage as a Surgical Treatment Option for Ménière's Disease

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Predictive nomograms and an algorithm for managing patients with probable Meniere's disease.

Roee Noy¹, Eran Fridman¹, Ayelet Eran²

¹Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.

American Journal of Otolaryngology

|August 6, 2024

Summary

Diagnostic tests like electrocochleography (ECochG) and MRI with MD-protocol accurately reclassify probable Meniere

Keywords:

Electrocochleography Endolymphatic hydrops Magnetic resonance imaging Meniere's disease Prediction nomogram Vestibular evoked myogenic potentials Video head impulse test

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Area of Science:

Neurotology
Diagnostic accuracy in otolaryngology
Vestibular disorders

Background:

Meniere's disease (MD) diagnosis can be challenging, often relying on clinical criteria.
Accurate reclassification of probable MD cases is crucial for appropriate management.
Evaluating the efficacy of diagnostic tests is essential for improving diagnostic precision.

Purpose of the Study:

To assess the accuracy of diagnostic tests in reclassifying patients with probable Meniere's disease (MD).
To differentiate between definite MD, probable MD, and non-MD categories.
To determine the most reliable diagnostic approach for probable MD.

Main Methods:

Retrospective cohort study at a neurotology clinic (1/2016-5/2022).
Patients underwent a battery of diagnostic tests.
Calculation of sensitivity, specificity, predictive values, and likelihood ratios; development of prediction nomograms.

Main Results:

Electrocochleography (ECochG) showed the highest sensitivity (92%).
MD-protocol Magnetic Resonance Imaging (MRI) demonstrated the highest specificity (100%).
The combined approach reclassified 86% of probable MD cases, with 57% confirmed as definite MD and 29% as non-MD.

Conclusions:

Combining ECochG and MD-protocol MRI offers a reliable method for reclassifying probable Meniere's disease (MD).
Vestibular tests may be less reliable for definitive diagnosis as they reflect functional status.
Findings support supplementary diagnostic tests to enhance current clinical-only criteria for MD.