Pressure test for the diagnosis of Menière's disease

Analysis of wideband tympanometry in Ménière's disease

Introduction

Endolymphatic hydrops is the pathophysiological substrate of Ménière’s disease. The changes in the inner ear, transmitted to the middle ear through changes in the ossicular chain mobility, can be quantified by wideband tympanometry, through the measurement of the acoustic absorbance at multiple frequencies, represented by the sound energy absorbed by the middle ear, even at its early stages. Studying the behavior of the middle ear through the absorbance in patients with endolymphatic hydrops under ambient pressure and under peak pressure can be useful for detecting Ménière's disease.

Objective

To characterize acoustic absorbance behavior in subjects with symptomatic and asymptomatic Ménière's disease compared to controls, in order to verify the ability of wideband tympanometry to detect Ménière's disease.

Methods

We carried out a cross-sectional study with a diagnostic approach comparing the findings of wideband tympanometry at ambient pressure and peak pressure between the ears of the control group (n = 30), the asymptomatic group (n = 21) and the symptomatic group (n = 9).

Results

Different peak pressure values were found between the ears of the control group (0 daPa), the asymptomatic group (−11 daPa) and the symptomatic group (−192 daPa), with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction. Different absorbance values were found between the ears of the symptomatic group and the asymptomatic group compared to the control group for low frequencies at ambient pressure and peak pressure, with p < 0.05 by the Kruskal-Wallis test, Mann Whitney test and Bonferroni correction.

Conclusions

The Wideband Tympanometry test was capable of identifying the presence of Ménière´s disease, and to differentiate between asymptomatic and symptomatic patients, when comparing them with healthy individuals.

Multifrequency admittancemetry in Ménière's Disease: a preliminary study for a new diagnostic test

OBJECTIVE

To assess the qualitative and quantitative aspects of multifrequency tympanograms in patients with Ménière's disease.

STUDY DESIGN

Prospective study of adults.

SETTING

University medical center.

PATIENTS

Forty patients with Ménière's disease outside of episodes and 24 normal-hearing subjects with no otologic history.

INTERVENTIONS

Resonance frequency sweep and tympanograms of admittance, conductance, and susceptance at 2 kHz and at resonance frequency were performed in each ear.

MAIN OUTCOME MEASURES

A qualitative assessment was performed to find reproducible and comparable tympanograms (Student's t test) as a prerequisite for quantitative assessment. Four measurement criteria were compared between the groups to establish a diagnostic test (chi Pearson test). A p value less than 0.05 was considered statistically significant.

RESULTS

Resonance frequency was decreased in Ménière's disease. Only conductance tympanograms at 2 kHz had a constant pattern. Width of conductance tympanograms at 2 kHz was increased in symptomatic Ménière's disease compared with normal ears. Using conductance width at 2 kHz as a diagnostic test with a threshold of 235 daPa, we found a statistically significant difference between symptomatic ears of patients with Ménière's disease and ears of normal subjects (p < 10). More than 95% of normal subjects' ears had a negative test; 56.5% of affected ears of patients with Ménière's disease and 45.8% of nonaffected ears of patients with Ménière's disease had a positive test.

CONCLUSION

Width of conductance at 2 kHz seems to be a sensitive, simple diagnostic test in Ménière's disease. It would also be of great interest in studying Ménière's disease bilaterality.

Alternobaric and hyperbaric oxygen therapy in the immediate and long-term treatment of Menière's disease

Forty-five patients suffering from Menière's disease were submitted to pressure chamber therapy: 20 with constant pressure (2.2 ATA, hyperbaric treatment) and 25 with continuous variations in pressure levels (from 1.7 to 2.2 ATA, alternobaric treatment). Oxygenation therapy consisted of one session per day lasting 90 minutes for 15 days during the acute attacks followed by five consecutive sessions per month during a follow-up of two years. For a control group we used 18 patients treated with 10 per cent intravenous glycerol during the acute episode and 8 mg tid of betahistine thereafter. We compared hearing loss, vertigo and tinnitus in the three groups 15 days after starting treatment and at the end of the follow-up, according to the criteria suggested by the 1995 Committee on Hearing and Equilibrium. We found no statistically significant differences in recovery from the cochlear-vestibular symptoms in the three groups at the end of the first 15 days of therapy, whereas hyperbaric and, in particular, alternobaric treatment permitted a significant control of the principal attacks of vertigo during the follow-up period. Hearing loss also showed a more significant and more persistent improvement in the patients treated with alternobaric oxygenation compared to the patients in the other two groups.

Effect of atmospheric pressure on hearing in patients with Menière's disease

Hearing in patients with Menière's disease improved when they were treated in an underpressure chamber. In this study 46 patients with neurotological diseases, including 32 cases of Menière's disease, were tested in an overpressure chamber. As a result, hearing in 32% of the patients with Menière's disease improved, although this was lower than the 50% rate of improvement in Menière's disease patients tested in an underpressure chamber.