MRI Inner Ear Imaging and Tone Burst Electrocochleography in the Diagnosis of Ménière's Disease.

Abstract

ObjectiveTo compare the sensitivity of gadolinium MRI inner imaging with tone burst electrocochleography (EcochG) for diagnosing endolymphatic hydrops.Study DesignA prospective study on patients who were to have an MRI scan to exclude retrocochlear pathology.SettingTertiary care center.PatientsOne hundred and two patients: 57 patients with Possible, Probable, or Definite Ménière’s Disease, 25 with asymmetrical hearing loss, 18 with sudden sensorineural hearing loss, and 2 with unilateral tinnitus had additional MRI inner ear imaging and click and tone burst stimulus EcochG testing.InterventionDiagnostic.Main Outcome MeasureTo compare the sensitivity of the two techniques.ResultsIn 30 patients with symptom-based Definite Ménière’s Disease, tone burst EcochG was positive in 25 (83%) and the click EcochG was positive in 9/30 (30%), and gadolinium MRI imaging diagnosed hydrops in 14 (47%). A positive result for either MRI imaging or tone burst EcochG was seen in 26 patients (87%). In 14 subjects with symptom-based Probable Ménière’s Disease, 10 (71%) had either a positive EcochG or MRI. In 13 with Possible Ménière’s Disease, four (31%) had a positive EcochG or MRI.ConclusionThis study confirms the greatly enhanced diagnostic sensitivity of tone burst EcochG over click response in diagnosing endolymphatic hydrops in Ménière’s disease. Even though adequate MRI imaging was achieved in 90%, tone burst EcochG was a more sensitive test.