Cochlear Hydrops Analysis Masking Procedure Research Articles

Usefulness Assessment of Cochlear Hydrops Analysis Masking Procedure Test in Progress of Ménièreʼs Disease

Usefulness Assessment of Cochlear Hydrops Analysis Masking Procedure Test in Progress of Ménièreʼs Disease

Effect of hearing loss, age, and gender on the outcome of the cochlear hydrops analysis masking procedure.

The aims of the study are to investigate the effect of hearing loss, age, and gender on the outcome of the cochlear hydrops analysis masking procedure (CHAMP) and to assess the clinical utility of CHAMP for the diagnosis of Ménière's disease (MD). Prospective observational study. Otolaryngology department of a tertiary referral hospital. We recruited MD patients (MD, 12 subjects) and hearing loss patients (HL, 10 subjects). Control subjects (NC, 43 subjects) were matched for gender and age. CHAMP was performed in the patients and control subjects. The mean difference in latency between the wave V for the click alone response and wave V for the 0.5-kHz high-pass masking noise condition was compared among groups, and the effects of gender and age on the results were analyzed in the NC group. Both the MD group and the HL group had a smaller difference in latency compared to the NC group. The MD group and HL group showed no significant difference in latency. In the NC group, there were no significant differences in latency depending on gender and age. Hearing level seems to significantly affect the CHAMP results, making it unreliable to differentiate between MD patients and non-MD hearing loss patients. Therefore, the diagnostic value of CHAMP might be limited in MD.

Relative Efficiency of Cochlear Hydrops Analysis Masking Procedure and Cervical Vestibular Evoked Myogenic Potential in Identification of Meniere’s Disease

Cervical vestibular evoked myogenic potential (cVEMP) and cochlear hydrops analysis masking procedure (CHAMP) have both shown sensitivity in identifying Meniere’s disease. However none of the previous reports have compared the two tests for their relative efficacy in identifying Meniere’s disease. Hence the present study aimed to compare the efficiency of cVEMP and CHAMP in evaluating Meniere’s disease. The study included 58 individuals with unilateral definite Meniere’s disease and an equal number of age and gender matched healthy individuals. cVEMP corresponding to 500 Hz tone burst was recorded from ipsilateral sternocleidomastoid muscle and CHAMP was acquired from the conventional electrode sites for single channel auditory brainstem response recording using a default protocol of the Biologic Navigator Pro evoked potential system. Both cVEMP and CHAMP showed statistically significant differences between the groups (P<0.05). The receiver operating curves revealed 100% sensitivity and specificity for CHAMP as against 70.7% sensitivity and 100% specificity for cVEMP in identifying Meniere’s disease. Therefore, CHAMP appears to be the test of choice provided the degree of hearing loss does not exceed a moderate degree. cVEMP could be used for all degrees of hearing losses, but with slight constraint on the sensitivity.

Electrophysiologic Diagnosis of Meniere’s Disease

Meniere’s disease was first described in 1861 by Prosper Meniere. The exact pathophysiology is still unclear. The history taken by the physician in combination with audiometric testing are still the most important diagnostic tools, however multiple electrophysiological tests have been described to aid in the diagnosis of Meniere’s disease. These tests are used because of their presumed sensitivity to structural and/or electrochemical changes brought about by endolymphatic hydrops, although the precise relationship between hydrops and the symptoms of Meniere’s disease is still uncertain. Here we discuss the electrophysiologic tests that are currently used clinically in Meniere’s disease, namely vestibular evoked myogenic potentials, electrocochleography, and the cochlear hydrops analysis masking procedure. At the current state-of-the-art, results of these tests must be considered corroborative rather than diagnostic.

Clinical Observation on Acute Low-Frequency Hearing Loss Without Vertigo

Even though it is currently not possible to prove a pathological diagnosis for inner ear disease, acute low-frequency hearing loss (ALFHL) without vertigo could be caused by inner ear hydrops because progression into the clinical spectrum of endolymphatic hydrops (EH) frequently occur among patients with the initial clinical presentation. Therefore, audiological measures representative of inner ear hydrops, such as the cochlear hydrops analysis masking procedure (CHAMP) test, may be used to predict the prognosis of ALFHL without vertigo. To test this hypothesis, we prospectively investigated patients with ALFHL unaccompanied by vertigo and examined whether the CHAMP test generated more useful information for prediction of progression into clinical spectrum of EH compared with other neurotologic parameters. A prospective clinical study of 28 patients who initially presented with ALFHL without vertigo was conducted. Detailed neurotologic findings from pure-tone audiometry, electrocochleography, CHAMP, spontaneous nystagmus, head-shaking nystagmus, vibration-induced nystagmus, the bithermal caloric test, and the rotatory chair test were recorded at the time of initial presentation. A regular audiological and clinical examination was conducted until either the last follow-up at our clinic or on the day on which secondary audiovestibular symptoms occurred. The rates of progression to Ménière's disease (MD) or clinical presentation compatible with isolated cochlear hydrops during the study period were calculated by the log-rank test and relative risk. A receiver operating characteristics curve was plotted to determine the prognostic value of CHAMP. Of 28 patients, 15 (53%) showed improvement in hearing on pure-tone audiometry. Seven patients (25%) showed hearing fluctuation and nine (32%) developed a vertigo attack during the observation period. Of these, three patients experienced both vertigo and a hearing fluctuation. Abnormal results of electrocochleography and neurotologic tests reflecting vestibular ocular reflex on yaw plane were common at the time of diagnosis of ALFHL in many patients, but these parameters were not associated with an increased risk of progression of clinical spectrum of EH. In contrast, patients with an abnormal complex amplitude ratio (CAR) on CHAMP had a 2.6-fold increased risk of progression to a clinical spectrum of EH (either hearing fluctuation or MD). The hazard ratio of developing MD for patients with normal CAR as compared with those with an abnormal CAR was 0.137 (95% confidence interval 0.03-0.57; p < 0.001), which indicates an 84.3% reduced risk of developing MD in those with normal CAR. A CAR value of 0.975 or less indicated the possibility of developing either a hearing fluctuation or vertiginous episode with a sensitivity of 82% and a specificity of 73% by receiver operating characteristics curve analysis. The results of the study suggest that CHAMP measurement may be useful for determining the prognosis of patients with ALFHL without vertigo. A CAR value of 0.975 or less indicates the possibility of developing fluctuating hearing loss or vertigo in patients with ALFHL unaccompanied by vertigo.

A comparison of electrocochleography and high-pass noise masking of auditory brainstem response for diagnosis of Ménière's disease

Objective: To study differences between electrocochleography (ECochG) and cochlear hydrops analysis masking procedure (CHAMP) in diagnosis of Ménière's disease. Design: Retrospective case review from a tertiary referral center. Study sample: Thirty patients suspected to have Ménière's disease were assessed by ECochG and CHAMP tests. Results: Positivity of ECochG with SP/AP amplitude ratio >.40 or >.35 was compared with CHAMP V-delay or CHAMP R × D. Positive ECochG results were found in 43% (>.40 SP/AP ratio) and 63% (>.35 SP/AP ratio) of patients, comparing to positive CHAMP V delay in 27% and CHAMP R × D in 30% of patients. A significant difference (p <.01) was found between ECochG and CHAMP in diagnostic sensitivity. Also, a positive inter-aural correlation was found in CHAMP results (p <.003), but not in ECochG (p =.082) results. Conclusions: ECochG is a more sensitive test than CHAMP in detecting the presence of endolymphatic hydrops in Ménière's patients. CHAMP covaried interaurally in unilateral Ménière's patients whereas ECochG did not.

Diagnostic Efficiency of the Cochlear Hydrops Analysis Masking Procedure in Ménière’s Disease

To determine whether cochlear hydrops analysis masking procedure (CHAMP) has diagnostic value in patients with definite Ménière's disease (MD) comparing the diagnostic validity index of CHAMP with those of electrocochleography (ECoG). A prospective study. Tertiary referral center. One hundred eight patients were classified into 3 groups: the "definite MD" group (MD group, n = 47); the "non-MD" group (n = 41) of other vestibular diseases including vestibular neuritis, and benign paroxysmal positional vertigo; and the control group (n = 20), which included patients without dizziness. CHAMP and extratympanic ECoG were performed in all patients. Sensitivity, specificity, and definitions of abnormal values were less than 0.3 ms in latency delay (0.5 kHz high pass noise [HPN]-click alone) and less than 0.95 in compound amplitude ratio (click alone-0.5 kHz HPN/click alone) in CHAMP and 0.4 for the summating potential/action potential ratio in ECoG. The mean latency delay and amplitude ratio of CHAMP in the MD group significantly differed from these values for other groups, whereas the mean summating potential/action potential ratio of ECoG did not. In ECoG, sensitivity was as low as 21%, specificity was 97%, and diagnostic accuracy was 62%. Sensitivity, specificity, and diagnostic accuracy of CHAMP were 64%, 98%, and 80%, respectively, in latency delay and 91%, 83%, and 88%, respectively, in amplitude ratio. The sensitivity and diagnostic accuracy of CHAMP were significantly higher than the corresponding values for ECoG. CHAMP is more valuable in detection of definite MD than extratympanic ECoG.

Study of characteristic of the cochlear hydrops analysis masking procedure in normal adults

To study the characteristic of the cochlear hydrops analysis masking procedure (CHAMP) in normal adults, and to evaluate the diagnostic values of its parameters for membranous labyrinth hydrops. Twenty otologically normal adults were recruited (male:female = 10:10), and their auditory brainstem responses (ABR) were obtained to six stimulus conditions using Bio-logic auditory evoked potential system: clicks presented alone (unmasked condition) and clicks presented with ipsilateral pink noise high-pass filtered at 8, 4, 2, 1, and 0.5 kHz respectively. The wave V latency of ABR to the high-pass masking pink noise clicks were longer than ABR to clicks alone. The latency delays of wave V for clicks presented with ipsilateral pink noise high-pass filtered at 8, 4, 2, 1, and 0.5 kHz compared to clicks alone were (0.30 ± 0.18), (0.97 ± 0.43), (1.65 ± 0.64), (3.21 ± 0.56), (4.66 ± 0.37) ms respectively. The complex amplitude ratio between ABR to click + 0.5 kHz high-pass noise and click alone was 0.95 ± 0.11. CHAMP is a promising diagnostic method for membranous labyrinth hydrops, and the latency delay of wave V might be used as the normal criterion. The specificity of the complex amplitude ratio need further evaluation in clinical work.

Cochlear Hydrops Analysis Masking Procedure Results in Patients With Unilateral Ménière's Disease

To investigate the usefulness of the cochlear hydrops analysis masking procedure (CHAMP) as an additional diagnostic test in patients with definite unilateral Ménière's disease. Prospective validation study for a diagnostic test. Tertiary referral center. Subjects (n = 22) with definite unilateral Ménière's disease. The CHAMP test was performed in both ears of the patients. Difference in latency delay between the affected and the unaffected ears. In 20 subjects, latency delays could be measured in both ears. The mean latency delay for the affected ears (0.55 ms; standard error, 0.12 ms) differs significantly from that for the unaffected ears (3.36 ms; standard error, 0.43 ms). With the standard criterion to separate ears with an abnormally short delay (<0.3 ms) from ears with a normal delay, in only 7 of 20 affected ears, an abnormally short delay was measured. All 33 other ears produced a normal delay. With the less than 0.3 ms criterion and including the ears in which no delay could be measured, the sensitivity of the CHAMP is 32% (7/22). Pooling CHAMP latency delays for 235 ears from this work and the literature yielded 2 clearly distinct distributions, with a separation at 2 ms. Defining abnormal delays as shorter than 2 ms gave an abnormal delay for 18 of 20 affected ears and for 7 of 20 unaffected ears. Abnormal latency delays for CHAMP are delays shorter than 2 ms. Earlier results with CHAMP should be reconsidered using this criterion, instead of 0.3 ms.

An Analysis of Difference in Age and Gender of Stacked Auditory Brainstem Response and Cochlear Hydrops Analysis Masking Procedure in Korean Normal Adults

Background and ObjectivesZZThe stacked auditory brainstem response (SABR) was introduced to collect the low frequency information using the conventional ABR. The cochlear hydrops analysis masking procedure (CHAMP) was developed to discriminate an active Meniere's disease from others. This investigation was aimed to provide data through analyzing age and gender effects of SABR and CHAMP in Korean normal adults. Subjects and MethodZZNormal hearing Korean adults (34), aged 30 to 67 participated in this study. The number of subjects for different age groups of 30s, 40s, 50s and 60s were 10, 9, 8, and 7, respectively. SABRs were tested at 60 dB nHL stimuli level of constant noise and masking clicks of high pass noise ranging at 8, 4, 2, 1 and 0.5 kHz. CHAMP responses were simply obtained for further analysis of SABR measurements. SABR amplitude, SABR interaural difference (IAD), CHAMP latency delay, and CHAMP complex amplitude ratio were analyzed and compared. ResultsZZThe mean SABR amplitude was 683 nV showing statistical difference for age but not for gender effects. The mean SABR IAD was 6.4% with no statistical significances for both age and gender effects. The mean CHAMP latency delay and complex amplitude ratio were 4.47 ms and 0.97 with statistical significance for the effects of age but not for gender. ConclusionZZThe results agreed with the foreign data in SABR and CHAMP except for the age effect of complex amplitude ratio. In order to improve clinical efficacy, investiga tions should be performed with more and diverse participants. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:603-8

Diagnostic Test Validation

To determine the diagnostic value of the cochlear hydrops analysis masking procedure (CHAMP) in patients with definite Ménière's disease. Prospective validation study for a diagnostic test, study phase 2. Tertiary referral centers. Subjects with definite Ménière's disease (Group 1), differential diagnosis (Group 2: another audiovestibular diseases or neurologic disorders), and normal hearing (Group 3) were included. Sample sizes were calculated. Study test (CHAMP) was compared with the current clinical criterion standard described by the guidelines of the American Academy of Otolaryngology-Head and Neck Surgery. Sensitivity, specificity, and other indicators of diagnostic validation. One hundred ten cases completed the follow-up, and their results are presented. Sensitivity at 31.3% and specificity at 100% were found in subjects with definite Ménière's disease, features that are more helpful in confirming the diagnosis than in rejecting it. Group 1 showed significantly shorter latency delays than Groups 2 and 3 (p < 0.001). If definite Ménière's disease is suspected, an abnormal result confirms the diagnosis; however, a normal result does not rule out the Ménière's disease diagnosis.

Diagnostic Value of Cochlear Hydrops Analysis Masking Procedure in Meniere's Disease

Background and ObjectivesZZThe diagnosis of Meniere’s disease is based on audiological test and clinical symptoms. Cochlear Hydrops Analysis Masking Procedure (CHAMP) was introduced as a test for detecting changes in physical characteristics of basilar membrane by hydrops of endolympahtic system. The aim of this study is to evaluate the diagnostic value and usefulness of CHAMP tests for detection of endolymphatic hydrops. Subjects and MethodZZThis study was performed on 11 cases of Meniere’s disease and 10 cases of vestibular neuritis who visited ENT outpatient clinic and 25 cases of normal healthy volunteers. We defined the positive value as being less than 0.3 ms in latency delay (0.5 kHz HPN-click alone) and less than 0.95 nV in compound amplitude ratio (click alone 0.5 kHz HPN/ click alone) regardless of age or sex. ResultsZZThere were significant latency delays in the Meniere’s disease group compared with the vestibular neuritis and normal control group. The amplitude ratio gave significant differences between the Meniere’s disease group and the normal group but there were no differences between the Meniere’s disease group and the vestibular neuritis group. Without assuming the test failure, the sensitivity and specificity of latency delay was 81% and 100%, respectively, and the sensitivity and specificity of amplitude ratio was 100% and 84%, respectively. In 8 of 54 cases (14.8%), we couldn’t get interpretable wave. ConclusionZZCHAMP test is a clinically useful method that can detect endolymphatic hydrops and it can be used as an objective test for the diagonosis of Meniere’s disease. Korean J Otorhinolaryngol-Head Neck Surg 2009;52:956-60 Key WordsZZCochlear hydrops analysis masking procedure·CHAMP·Meniere’s disease.

RESPONSE TO "LACK OF DIAGNOSTIC VALUE OF HIGH-PASS NOISE MASKING OF AUDITORY BRAINSTEM RESPONSES IN MÉNIÈRE'S DISEASE BY CLAUDIA F. J. DE VALCK, GERD M. E. CLAES, FLORIS L. WUYTS, AND PAUL H. VAN DE HEYNING. OTOLOGY &amp; NEUROTOLOGY 2007;28:700-7"

In the recent paper “Lack of Diagnostic Value of High-Pass Noise Masking of Auditory Brainstem Responses in Meniere’s Disease” by De Valck et al. (2007), the authors concluded that, due to its low sensitivity (31%) and low specificity (28%), the ABR high-pass noise masking technique (Don et al., 2005), commercially known as CHAMP (Natus/Bio-logic Corp.), had “…no discriminative value in differentiating Meniere’s from non-MD subjects with otovestibular symptoms” (p. 706). In reviewing their data and analyses, we found errors that led to misleading and inappropriate conclusions. This response will briefly review the errors and suggest that once these errors are corrected, the revised values of 100% sensitivity and 80% specificity are consistent with the excellent sensitivity and specificity described in the original paper (Don et al., 2005). Before discussing the errors, it is important to note that the authors state, “…when only definite MD patients were included, and only the interpretable tests were used, a 100% sensitivity was obtained as in the study of Don et al. (11).” (p.705) In addition, they state, “…none of our definite MD patients had a test within normal ranges.” (p. 706) Thus, as in our study (Don et al., 2005), these authors found that in all the patients with definite Meniere’s disease (MD) and measurable responses, the test results were abnormal. So, what errors led De Valck et al. (2007) to their erroneous conclusion about the value of the CHAMP test?

S235 – Diagnostic Test Validation: CHAMP in Endolymphatic Hydrops

Objectives The Cochlear Hydrops Analysis Masking Procedure (CHAMP) has been reported with a high sensibility and specificity for the diagnosis of endolymphatic hydrops (ELH). Nevertheless, a complete validation of CHAMP with precise methods has not been done. Our objectives: To determine whether CHAMP has a diagnostic value in patients with definite, probable/possible diagnosis of Meniere's disease or endolymphatic hydrops, based on the criteria of the AAO-HNS. Methods Prospective validation study for a diagnostic test: phase II. Latency of wave V was assessed using CHAMP. We classified subjects in 5 groups: 1-Definite ELH, 2-Probable ELH, 3-Possible ELH, 4-subjects with other otovestibular symptoms, 5-normal hearing subjects. We included cases (groups 1–4) with an episode of vertigo with duration equal or longer than 20 minutes, with or without other otovestibular symptoms. Results We included 67 cases (132 ears). 38 cases (76 ears) completed the follow up and their results are presented. In group 1, the sensibility of CHAMP was 43% and its specificity was 100%. In groups 2–3, the sensitivity was 20% and the specificity 100%, with 0% false positive and 80% false negative results. Other indicators of validity for this diagnostic test are presented. Conclusions CHAMP has a high specificity and low sensibility for the diagnosis of ELH when the delay in wave V latency is used. Future studies may assess the relationship between wave amplitudes to improve the clinical value of CHAMP.

Principles of the Cochlear Hydrops Analysis Masking Procedure(CHAMP)

Principles of the Cochlear Hydrops Analysis Masking Procedure(CHAMP)

Lack of Diagnostic Value of High-Pass Noise Masking of Auditory Brainstem Responses in Ménière's Disease

Different electrophysiologic tests were developed to ascertain or detect endolymphatic hydrops (ELH). Recently, Cochlear Hydrops Analysis Masking Procedure (CHAMP), a new auditory brainstem response (ABR) technique, proved to be able to separate normal controls from definite Ménière's disease (MD) with 100% sensitivity and 100% specificity. To evaluate the applicability and diagnostic value of CHAMP in a series of MD and non-MD patients with otovestibular complaints. An observational retrospective study. Tertiary referral centre. Forty-five patients, of which 28 patients had MD. Cochlear Hydrops Analysis Masking Procedure test was conducted, and audiometric data and clinical information were collected. All responses were blindly evaluated and divided into three categories: (1) test suggestive for cochlear/ELH, (2) test within normal ranges, and (3) test not interpretable. Sensitivity and specificity, evaluation of diagnostic value. Forty-nine percent of the tests were found to be not interpretable. Of the remaining responses, 13 tests were suggestive for ELH, and 16 tests were within normal ranges. This yields a sensitivity of 31% and a specificity of 28%. There was no significant difference between the mean latency difference (mean [SD]) for Wave V of the MD group (0.43 ms [0.37]) and the non-MD group (0.65 ms [0.44]). Using logistic regression analysis, we found that CHAMP test did not contribute to the ability to discriminate between hydropic and nonhydropic ears. In contrast to studies assessing CHAMP performance in Ménière patients and normal controls, the present study revealed this new test offers no discriminative value in differentiating Ménière's from non-MD subjects with otovestibular symptoms.