Audiology 16: 389-401 (1977) Clinical Electrocochleography in the Diagnosis and Management of Meniére’s Disorder! W.P.R. Gipson, D.A. Morrar and R.T. RAMSDEN Department of Otolaryngology, London Hospital, London Key Words, Blectrocochleography « Menitre's disorder Action potential - Summating potential - Endolymphati sac surgery Abstract. Patients with a fluctuating hearing loss, episodic vertigo and tinnitus with no knowin aetiological cause were investigated as cases of Menitre’s disorder, Transtympanic clectrocochleography was found to be helpful in reaching the diagnosis of am inner ear disorder. In 65% of the patiats, a large DC potential was recorded which caused an apparent widening of the summating potentalfaction potential (SP/AP) waveform, This ‘potential was thought o be an SP which was enhanced relative tothe AP component, and believed to be related directly to the presence of endolymphatic hydrops. A method is 0.0005) between the SP/AP width and the diagnostic scores. In fact, every case with a diagnostic score of 8 or 9 showed some enhancement of the SP, Relation between the SP and the Success of Saccus Surgery In 28 of the affected ears, an operation was undertaken oa the saccus endolymphaticus using the method described by MORRISON [1976]. Apart,396 CGimso/Morrar/RAMsDES Giageste sexe Wenn o ASP ELS 67 8 Sb owions 7 es z tiearosene | teense) : ip Taw _ Zab 63 8 8D om Wms 67 t 3 {ace ro sone Peis sdovitaba) IEE ERE PSE SS FBS} onions = sé TElERTS KH El fe Tease (9 09 sEBEERE RE SE Bie | [é] 234 5 6 7 8 9 10 owrtOns ig. 2. A histogram relating the ‘diagnostic score (Se table 1) to the width of the SPJAP waveform a8 measured across the main limbs of the response atthe level of the baseline, F = Failure of saccus surgery; § = suooess of saccus surgery. from the authors this surgery was also performed by Mr. A. MORRISON and by Me. J.B, BooTH. The results of this form of surgery have been found to be excellent espe- cially within the frst year after the surgery, but after a further period of time relapses can occur. For this reason, modifications of the surgical technique are constantly being made to find a means of keeping the tube patent within the saceus, In this series, the operation is reported as successful if the attacks of vertigo ceased for a period of 1 year after surgery: the frequently occurring benefits of improved hearing and cessation of tinnitus are not counted as criteria for success in this paper. The results ofthis limited look at the effect of saceus surgery are shown in figure 2, It may be noted that there was alestrocochleography in Menitre's Disorder a7 significant correlation between the width of the SP/AP waveform and the success or failure of this form of surgery. In general, patients without an enhanced SP waveform did not benefit from the procedure of saccus drainage. Discussion and Conclusions It would appear that the more typical the history of Meniére’s disorder, the more likely there is to be an enhanced SP. This finding can probably be related directly to the presence of endolymphatic hydrops. Von BEKESY [1950] and other workers have found that displacement of the basilar membrane alters the amplitude and polarity of the SP recorded by intra-cochlear electrodes. An alternative theory is that ischaemia, caused by spasm of the stria vascularis alters the resting endolymph potential and so causes an alteration of the SP amplitude. Indeed these two theories are not completely antagonistic and both mechanisms may affect the SP. The finding of an ‘enhanced promontory-recorded SP provides useful confirmation of the diag~ nosis whenever Meniére’s disorder is suspected correctly. Some of the patients have been tested using ECochG on more than one ‘occasion and it has been noted that the relative size of the SP component may vary considerably depending on whether the patient is suffering from frequent attacks or is tested during a remission. Usually, the SP/AP wave- form appeared to be more normal during remissions. The ECochG results shown in the Appendix and mentioned in the text are all recorded ftom patients that were being tested for the first time whilst their condition was active. ‘The results of saccus surgery in patients with abnormal SP/AP waveforms ‘appears impressive. It must be added however that relapses in this group after 1 year were not uncommon, and that spontaneous remissions for at least 1 year were also not uncommon in non-operated patients with abnormal SP/AP waveforms. This paper does not enter the arguments concerning the merits of saccus surgery but merely states that such surgery is likely to be followed by a remission of vertiginous symptoms in patients having this particular ECochG abnormality. Réstené Un certain nombre de malades se plaignant de symptOmes d'étologie inconnue tls aque baisse d’audition a caractée fuctuant, de vertiges épisodiques ou de bourdonnements398 ‘Gmson/Morear/RAMsDeN ‘oreile, ont &é considérés par nous comme atents d'une maladie de Menidre; chez eux Pélectrocochléographie transtympanique #est montrée utile dans la mesure oi elle permet ‘alhiemer une atteinte de Voile icone. Dans 65% des cas, un potenti DC trts ample 1 is enregistré, avec un élargssement de onde PS/PA (potentie! de sommation/potentiel action). Ce potenil correspond vaisemblablement& Vaddition du poteniel anormal PS et est sans doute en relation directe avec Ia présence d'un hydrops endolymphatique auteur déerit une méthode d'analyse de Uhistoie clinique permettant de classr les iférentseritéres de a maladie de Mentre; les cas ayant les scores les plus élevés (cortes- ‘pondant aux aspect les plus typiques de la maladie) présentent une onde PS/PA anormale Les résultats de la chirurgie du sac endolymphatique ont éré revus, avec un recul d'un an, dans 28 cas: les malades dont I'lectrocochléographie avait mis en évidence une onde ‘normale PS/PA avant intervention ont obtenu des résultats statstiquement meilleurs. Acknowledgements ‘We would like to thank ANDREW Mornisox, Jou Boor and Pere MCKsLvis for their help and co-operation! during this study. Rocex THORNTON very kindly helped with the statistics and Dr. Hen Perr gallantly translated the abstract. Appendix: Patients “Diagnostic scoring’ letrocochlsogram —Saccus initals Vergo pearing tinaitws wal © APISP.—CM, uv "USE lows with GA 2 2 38 T 2 5 SA 338 4 3 8 a 1 2 4 20 <1 FBR 1 32 6 ae ee sh) 3 2s MBO 3037 2 <4 F MBO 200 2037 3s ee sos 2 4 ac 2 3 2 fF s 12 eee se cole so FO 1 $2 oa Gos 3 2 8 sos vo 2 2 2 6 nil 03 KG Rit 3 328 10 s mis 3 2 8 10 s we 28 T 42 sPatient's initials DE EE. TE RF. JG. Right Lett AH, DH. EH. on, LH. LH, LH El. Fu. ws. WJ. Right Left AK, 4K. PK. RK, EL FL. AM, AM, Right Let EM. Richt Left LM. MM. MM. MM. RN, VN. 10, EP vertigo Electrocochleography in Menitre's Disorder Appendix (continued) iagnostcsoring’ hearing loss tinnitus total Eletrocochleosram om, uW AP/SP width| 14 10 «I 03 «l 10 os os oa 8 Saccus surgery (Gaultea- sound)400 Ginson/MOrraT/RAMSDEN Appendix (continued) Patients scoring” Electrocochleogram Saccus Initials Vertigo hearing tinnitus otal APSP CM, uv SHEE loss wide GP. Right 3 ° ° 3 2 Let 3 0 ° 3 2 ae. 1 1 2 4 2 8 ve. 3 3 2 8 7 2 DR. 2 0 3 3 0, ER 3 2 3 8 5 03S Ds. 1 2 2 3 10 1 8 ES. 3 2 2 7 6 1 ES. 2 3 3 7 6 s MS. 1 3 1 5 8 2 RS. 1 1 1 3 2 AS. ° 2 1 3 2 ws. 2 2 2 6 3 1s i 1 2 i ‘4 2 4 Pa. 1 1 1 3 6 2 Tr. 2 3 2 7 3 2s W. ° 3 2 5 2 s AW 3 3 2 8 nil 07S AW. Right 1 2 ° 3 2 8 Left 1 2 1 4 2 8 DW. 2 2 2 6 310 Patients initials are given merely for identification purposes. ‘Diagnostic scoring” is. given in points for each sym9tom of vertigo, tinnitus and hearing loss according to table Electrocochleogram refers to the responses obtained using a wideband click stimulus of 100 us electrical duration with maximal energy acoustically at 3 kHz at an intensity of 110 6B HI (see text for further details of apparatus). The AP/SP width refers toa measure~ ‘ment in milliseconds between the main descending and ascending limbs ofthe response at the level of the baseline. The CM is measured as its maximal peak-to-peak amplitude in ‘microvolts. The result of the endolymphatic sac surgery is shown as S indicating success or F indicating failure. If patient had no attacks of vertigo following surgery fora period of I year, the result of surgery is tabled a a success). F = Failure), References Braciey, HLA, and Gisson, W.PR.: The cochlear-microphonic in ECochG. 4th Symp. ‘of IERASG, London 1975.401 ‘Bixssv, G. voN: D-C potentials and energy balance ofthe cochlear partition. J. acous ‘Soc. Am. 22: 576-582 (1980). Cawationns, TLE, and Hewcerr, A.B: Meni (1954), EOGERvont, J.J. and Srook, A.: Cochlear adaptation in guinca pigs. Audiology 12: 193-220 1973). uaentino, C. and Satowow, G.: Electrical potentials from the inner ear im man in response (0 transient sounds generated in closed acoustic system. Revue Lar. Otol Rhinol, supp, pp. 691-707 (1971). Gmsox, W-P.R. and Bracti, H.A.: Transtympanic electrocochleography in the investi- ‘gation of retto-cochlear disorders, Revue Lat. Otol. Rhinol. 97: suppl, pp. 53-62 (1976). 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