Chapter 1 provides an introduction to relevant inner ear anatomy and physiology, and clinical aspects of Ménière's Disease (MD).
In Chapter 2, we assessed the diagnostic value of the Travelling Wave Velocity (TWV) test in Ménière's disease. TWV measures were obtained in 28 normal subjects. In 9 MD patients, we found a clear correlation between the result of the TWV test and Transtympanic Electrocochleography (TT-ECoG).
Chapter 3 investigates diagnostic value of the Cochlear Hydrops Analysis Masking Procedure (CHAMP). Previous reports showed high accuracy of CHAMP in distinguishing definite MD patients from normal subjects. Twenty-eight MD patients and 17 non-MD patients with otovestibular complaints were evaluated. The present study revealed CHAMP offers no discriminative value in differentiating Ménière's from non-MD subjects, mostly due to a large number (49%) of non-interpretable results.
In Chapter 4, diagnostic value of transtympanic electrocochleography is evaluated in a retrospective analysis. Audiometric and electrocochleographic data of 131 tested ears were collected and analyzed. Using binary logistic regression, we constructed the Ménière's Disease Index (MDI) as a multidimensional parameter based on a linear combination of three variables (air conduction threshold at 125 and 8000 Hz, and TT-ECoG summation potential amplitude at 4000Hz) that showed a good correlation with the clinical diagnosic criteria of MD.
In Chapter 5, we investigated audiometric and electrocochleographic parameters in 21 patients with only cochlear symptoms but without vertigo. Calculating mean MDI in this "cochlear MD" group revealed an intermediate MDI value, suggesting these patients may represent a separate clinical entity with Ménière-like pathophysiology.
Chapter 6 investigated the value of MRI after intratympanic gadolinium administration. Patients underwent TT-ECoG, followed by intratympanic gentamicin and intratympanic gadolinium injection. Only 5 of 12 patients showed gadolinium accumulation in the inner ear. Based on our data, a correlation between the result of TT-ECoG and hydrops grading on MRI images can be suggested.
In chapter 7, use of ocular vestibular evoked myogenic potentials (oVEMP) in unilateral definite Ménière's disease patients is evaluated. The results show that oVEMP testing does not seem to offer additional diagnostic value in Ménière's disease, and is unable to predict the side of lesion.