Diagnostic Tests For Meniere's Disease Symptoms

Here is an actual "question and answer" about testing done for Meniere's Disease type symptoms. The classic symptoms are listed below.  Hi Kathy, this was your original request. I hope you get some sort of helpful information out of it. I believe you did four
tests: ECoG, Audiogram, Tympanogram, and ENG. Your test results were documented as follows:

ECoG showed an AP ratio of 0.51 on the right indicating Meniere's Disease.

Audiogram was normal.

Speech thresholds are 5 dB bilaterally, 88 % discrim right, 96 % left, normal tympanogram.

She had an ENG and had a caloric weakness of 71 % to the right and direction preponderance of 43 % to the right.

She had some abnormal tracking. ABR was normal.

She had SPAP ratio of 0.51 for the right ear and 0.22 for the left ear on her ECoG which means that Meniere's Disease is a possibility.

Her difference was 0.03 which is normal on her ABR.

Speech thresholds are 5 dB bilaterally, 88 % discrimination right, 96 % left, Her ENG showed a caloric weakness of 0.71 to the right direction, preponderance was 43 % to the right.

I don't understand this can you help me to understand. Thank-you Kathy
 

My response:
Kathy, this has been a very long exercise in research! Thank you for asking to me to do it. I visited many Internet sites and eventually settled on two of them. But I also researched many textbooks.

The very best one was written by Patty Haybach, RN, M.S.

http://www.vestibular.org/
http://www.bme.jhu.edu/labs/chb/disorders/menieres.html
 

The ear is an organ of the body. Its purpose is to take the "message" of sound from a person's environment and allow the person to hear. A normal body has two ears. (We will discuss one.) It has 3 distinct sections or parts: the outer ear, the middle ear, and the inner ear.  The outer ear catches the sound and carries it into the middle ear to the tympanic membrane (eardrum).  This membrane is like a "curtain" or filter and separates the outer ear from the middle ear. The sound waves make the eardrum vibrate. This "translates" the sounds into vibrations. The middle ear has three bones that stretch from the tympanic membrane (curtain) to the start of the inner ear (oval window).  These bones are all connected from the tympanic membrane to the oval window. Their function is to transmit the vibrations into the cochlea and the fluid found in the inner ear (endolymph).  The inner ear is has several parts. Some of its more prominent parts are the cochlea, semicircular canals, and vestibulo-cochlear nerve and its branches. (vestibular/balance and acoustic/hearing nerves).

Deep in the cochlea are special hearing receivers. These receivers are stimulated by this vibrating fluid, and their message of sound is transmitted to the hearing/balance nerves, as electrical impulses. These impulses are then relayed to the brain (brain stem) for interpretation.  Two main functions of the inner ear have to do with hearing
("acoustic" or "auditory") and balance ("vestibular"). The nerves then communicate with the brain (cerebellum). The appropriate part of the brain will then interpret the message and give commands back to the ear. These commands will relate to hearing and balance.  "Classic" Meniere's symptoms include: hearing fluctuation, ear pressure, tinnitus (a variety of sounds or ear noises), vertigo, and/or dizziness.

So the testing is done to check for abnormal responses related to balance and hearing.ECoG: a hearing test.  Elecrocochleography is a complex hearing test designed to record the electrical activity of the cochlea, a part of the inner ear. It is done with a special computer. Sound is put into the ear, where it is transformed into vibrations in the middle ear. (Your ear does this naturally and automatically all the time.) And then these vibrations are turned into electrical impulses in the inner ear. This test records and measures this electrical activity. These results are then compared to established
patterns typical of normal hearing and of Meniere's. Hydrops (Ménières) is suggested when the ratio is greater than 35%.  Balance is not involved with this part.

"SP" & "AP" measure certain parts of these impulses. The ratios refer to established "Meniere's" patterns. Hydrops (Ménières) is suggested when the ratio is greater than 35%. The SP:AP ratios give definite numbers which also help in the diagnosis.

Your result:

"She had SP / AP ratio of 0.51 for the right ear and 0.22 for the left ear on her ECoG which means that Menieres disease is a possibility. ECoG showed an AP ratio of 0.51 on the right indicating Meniere's Disease".


Audiogram is a test that also measures hearing.

When trying to make a diagnosis of Ménières, it is very helpful to have precise documentation of fluctuating hearing loss.

Audiometry is the computer technique that records the faintest levels of sounds that the person can hear. It is a graph or chart of hearing. It is a relatively simple way to determine levels of hearing sounds. Audiometry is particularly helpful in making the diagnosis of Ménières syndrome. There may be a low frequency or mixed low and high frequency. A documented fluctuating hearing loss, especially in the low frequencies, is
very helpful.

Speech thresholds refers to the level at which you can hear sounds.

"Discrim" refers to discrimination and that means how well you recognize a spoken word.

Your result: "Audiogram was normal."

Speech thresholds are 5 dB bilaterally, 88 % discrimination right, 96 % left,

Tympanogram

The tympanic membrane is the eardrum. It separates the outer ear from the middle ear. This test checks for the "health" or "permeability" of this membrane. It needs to be pliable and responsive to sounds being transformed into vibrations. The tympanic membrane should appear smooth and symmetrical to function properly.

A tympanogram is a graph or recording showing the "permeability" or health of this membrane to sounds or air. A negative or abnormal graph could be the result of blockages or interruptions ("impediments"). This test shows how well the membrane is
functioning. It does this by observing its response to waves of pressure. It also measures the pressure of the middle ear.  Remember this is where the sound is transformed into vibrations.

Tympanometry can identify abnormal results. This MIGHT mean any number of things: fluid in the middle ear, perforated ear drum, impacted ear wax scarring of the tympanic membrane, lack of contact between the conduction bones of the middle ear, or a
tumor in the middle ear.

Your result: "normal tympanogram."

Electronystagmography "ENG": is the record or a graph showing eye movements. Electronystagmography records and interprets or assesses movements in certain eye muscles.

This test has to do with hearing and balance.

A test called "Caloric (pertaining to heat) Stimulation" is performed to evaluate function of the hearing nerve, which provides hearing and helps with balance. The actual test wants to create a specific response.

This test is done by putting warm air or water into the ear canal and recording the eye movements through special electrodes. The test can include either air or water. And the temperature usually includes both warm and cold water. If the vestibular (balance) part is normal, the irrigation results WILL produce equal values of jerky movements. If it is diseased, the results will be fewer or reduced jerky movements. This test may be recommended when the person is experiencing dizziness or vertigo, when there is impaired hearing, with suspected toxicity from certain antibiotics, with some anemia, when psychological causes of vertigo are suspected.

This test should cause nystagmus: jerky movements.

Your results: "She had an ENG and had a caloric weakness of 71 % to the right and direction preponderance of 43 % to the right." My thoughts: The normal reaction should be strong, jerky movements. So a weakness of 71% would mean that instead of the strong jerky movements, your response was measured as a weakness.

Visual tracking: (visual dysmetria testing) this tests the ability of the eye to focus on a particular object or a moving target.

Your results: "She had some abnormal tracking."


ABR: auditory brain stem. This is another computerized hearing test, but it is following the electrical paths to and into the brain. This test measures the sound waves (messages) which have been transformed into vibrations. These vibrations are then transformed into electrical impulses in the cochlea. Then they end up in the brain stem. Here the impulse is interpreted and the appropriate command is returned to the person. This test checks the route the message travels.

Your result:

"ABR (Auditory Brainstem Response) was normal. Her difference was 0.03 which is normal on her ABR." "BSER" seemed to be the same but had different abbreviations.

For Meniere's Disease to be considered, your overall responses would lead results that show a weakness or lack in each test.

This information is not to be used as a diagnostic tool but just to help understand the tests. Please consult your doctor if you have questions about your own symptoms.

This information was intended to help you understand your body and its functions. If you have a medical problem, please seek appropriate advice.

You can also go to our Meniere's Disease diagnosis page for more information on diagnosing Meniere's Disease.