Diagnosis of cochlear Ménière's disease with electrocochleography

The existence of cochlear Ménière's disease, once considered a variant of classic Ménière's disease but without vertigo, has been questioned due to 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 cochlear Ménière's disease in order to determine the presence or absence of endolymphatic hydrops using TT ECoG. A total of 7 patients were identified with at least a 2-year follow-up. Using established norms for the summating potential to action potential ratio with click stimulus, 67% of the ears examined demonstrated values consistent with endolymphatic hydrops. Fluctuating aural pressure and tinnitus were present in all patients and medical therapy of diuretics and salt restriction seemed to stabilize or improve the condition in about 80% of the patients. Theoretical considerations are discussed, and a case history of 1 of the study patients is presented to illustrate a typical example of this variant of Ménière's disease.