Inner Ear, Meniere Disease, Medical Treatment Workup

  • Author: John C Li, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: May 18, 2011
 

Laboratory Studies

  • A panel of blood tests is used to rule out obvious metabolic imbalances, infections, and hormonal problems. Tests of the following should be performed:
    • Thyroid stimulating hormone (TSH), T4, and T3 to rule out hyperthyroidism and hypothyroidism
    • Glucose to rule out diabetes
    • Sedimentation rate and antinuclear antibody to rule out autoimmune disorders
    • Urine to rule out proteinuria and hematuria and indicators of otorenal syndrome
    • CBC count to rule out anemia and leukemia
    • Electrolyte levels to rule out salt/water imbalance
    • Fluorescent treponemal antibody (FTA-ABS) to rule out neurosyphilis and Lyme disease
  • Allergy testing is needed for allergy-mediated Ménière disease.
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Imaging Studies

  • MRI of the brain is used to detect the following:
    • Abnormal masses or anatomy, specifically, acoustic neuromas or other cerebellopontine angle lesions
    • Other lesions (eg, multiple sclerosis, Arnold-Chiari malformations)
    • Tumors (rarely found but should be ruled out)
  • CT scans are used to detect the following:
    • Dehiscent superior semicircular canals
    • Widened cochlear and vestibular aqueducts
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Other Tests

  • Audiometry is particularly helpful to document present hearing acuity and subsequent fluctuations. Occasionally, patients fail to notice loss at specific frequencies.
    • A low-frequency or mixed low- and high-frequency loss may develop. Typically, lower frequencies are affected more often than higher frequencies because of preferential sensitivity of the apex to hydrops.
    • Administering multiple hearing tests to document fluctuating hearing loss is helpful in diagnosing Ménière disease.
  • Transtympanic electrocochleography (ECoG) is used to detect distortion of nerve-containing membranes of the inner ear (presumably due to pressure fluctuations of the perilymph pressure) and may show evidence of cochlear involvement.
    • ECoG is used to measure the ratio of summating potential (probably arising from movement of the basilar membrane) and action potential on the nerve in response to auditory stimuli. Hydrops is suggested when the ratio is greater than 35%.
    • ECoG is most accurate when Ménière disease is active.
  • Electronystagmography (ENG) and videonystagmography (VNG) is performed to test vestibular function of the inner ear, particularly that of the semicircular canals.
    • Typically, endolymphatic hydrops causes reduced vestibular response in the affected ear, but increased vestibular response may develop secondary to an irritative lesion.
    • ENG is used to determine responsiveness of the inner ear to movement and caloric stimulation. It tests central and peripheral function and can help localize lesion sites.
    • Perform ENG when the patient has an empty stomach and when therapy with meclizine, antihistamines, and sedatives has been discontinued for 2 weeks, as these drugs may alter the test results.
    • ENG may cause dizziness and nausea.
  • Direction of spontaneous nystagmus during or after an episode of Ménière syndrome is not a reliable indicator of the lesion site. An irritative phase may occur during the attack (fast phases directed toward involved ear), followed by a paretic phase (fast phases directed toward the opposite ear).
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Contributor Information and Disclosures
Author

John C Li, MD  Private Practice in Otology and Neurotology; Medical Director, Balance Center

John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Tinnitus Association, Florida Medical Association, and North American Skull Base Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael E Hoffer, MD  Director, Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center of San Diego

Michael E Hoffer, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: American biloogical group Royalty Other

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Gerard J Gianoli, MD  Clinical Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Tulane University School of Medicine; Vice President, The Ear and Balance Institute; Chief Executive Officer, Ponchartrain Surgery Center

Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, and Triological Society

Disclosure: Vesticon, Inc. None Board membership

Christopher L Slack, MD  Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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  2. Pullens B, van Benthem PP. Intratympanic gentamicin for Ménière's disease or syndrome. Cochrane Database Syst Rev. Mar 16 2011;3:CD008234. [Medline].

  3. Monsell EM. New and revised reporting guidelines from the Committee on Hearing and Equilibrium. American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg. Sep 1995;113(3):176-8. [Medline].

  4. Bretlau P, Thomsen J, Tos M, et al. Placebo effect in surgery for Menière's disease: nine-year follow-up. Am J Otol. Jul 1989;10(4):259-61. [Medline].

  5. Densert B, Sass K. Control of symptoms in patients with Meniere's disease using middle ear pressure applications: two years follow-up. Acta Otolaryngol. Jul 2001;121(5):616-21. [Medline].

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  7. Gottshall KR, Hoffer ME, Moore RJ, et al. The role of vestibular rehabilitation in the treatment of Meniere's disease. Otolaryngol Head Neck Surg. Sep 2005;133(3):326-8. [Medline].

  8. Kato BM, LaRouere MJ, Bojrab DI, et al. Evaluating quality of life after endolymphatic sac surgery: The Ménière's Disease Outcomes Questionnaire. Otol Neurotol. May 2004;25(3):339-44. [Medline].

  9. Kitahara T, Kondoh K, Morihana T, et al. Surgical management of special cases of intractable Meniere's disease: unilateral cases with intact canals and bilateral cases. Ann Otol Rhinol Laryngol. May 2004;113(5):399-403. [Medline].

  10. Monsell EM, Wiet RJ. Endolymphatic sac surgery: methods of study and results. Am J Otol. Sep 1988;9(5):396-402. [Medline].

  11. Odkvist LM, Arlinger S, Billermark E, et al. Effects of middle ear pressure changes on clinical symptoms in patients with Ménière's disease--a clinical multicentre placebo-controlled study. Acta Otolaryngol Suppl. 2000;543:99-101. [Medline].

  12. Pyykkö I, Ishizaki H, Kaasinen S, et al. Intratympanic gentamicin in bilateral Menière's disease. Otolaryngol Head Neck Surg. Feb 1994;110(2):162-7. [Medline].

  13. Shea JJ Jr. Classification of Menière's disease. Am J Otol. May 1993;14(3):224-9. [Medline].

  14. Shea JJ Jr, Ge X. Streptomycin perfusion of the labyrinth through the round window plus intravenous streptomycin. Otolaryngol Clin North Am. Apr 1994;27(2):317-24. [Medline].

  15. Silverstein H, Lewis WB, Jackson LE, et al. Changing trends in the surgical treatment of Ménière's disease: results of a 10-year survey. Ear Nose Throat J. Mar 2003;82(3):185-7, 191-4. [Medline].

  16. Silverstein H, Smouha E, Jones R. Natural history vs. surgery for Menière's disease. Otolaryngol Head Neck Surg. Jan 1989;100(1):6-16. [Medline].

 
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Tinnitus model. Two phenomena in the auditory cortex are associated with peripheral deafferentation: 1) hyperactivity in the lesion projection zone and 2) increased cortical representation of the lesion-edge frequencies (here, C6) in the lesion projection zone. These two phenomena are presumed to be the neurophysiological correlates of tinnitus. The red letters correspond to octave intervals of a fundamental frequency.
 
 
 
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