Pauliana Lamounier

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.69668

#### **Abstract**

Ménière's disease (MD) is a progressive inner ear disorder that affects at least 0.2% of the population in EUA. The symptoms triad of fluctuating hearing loss, tinnitus, and vertigo was described by Prosper Ménière for more than a century and its pathophysiology is still unknown. MD has a fluctuating course and in many cases, difficult clinical management. Progressive hearing loss and intense dizzying seizures becomes more frequent as the disease progresses. All of this increases the challenges of accurate identification and has probably led to the trial of several tests for identifying MD. The tests are useful tools to assist the otolaryngologist both in diagnosis and prognosis of MD. These tests includes audiometry, otoacustic emission (OAE), electrocochleography (EcochG), vestibular evoked myogenic potentials (VEMP), cochlear hydrops analysis masking procedure (CHAMP) and video head impulse test (vHIT).

**Keywords:** Meniere's disease, endolymphatic hydrops, electrocochleography, VEMP, CHAMP, vHIT

## **1. Introduction**

Ménière's disease (MD) is a progressive inner ear disorder that affects at least 0.2% of the population in EUA [1]. The symptoms triad of fluctuating hearing loss, tinnitus, and vertigo was described by Prosper Ménière for more than a century and its pathophysiology is still unknown.

For a long time, it was believed that endolymphatic hydrops would be the histopathological substrate of the disease. The cause of hydrops is still unknown and most of the theories are based on altered endolymph production or reabsorption. The hydrops occurs more often in the cochlea and saccule, followed by the utricle and semicircular channels [2]. Recent studies have indicated that hydrops is a finding of the MD, together with the symptoms, since it

alone does not explain all the clinical features, including the progression of hearing loss and the frequency of vertigo attacks [3].

According to the criteria of the Bárány Society, MD is classified as definite or probable. In definite MD, the patient should have had two or more spontaneous episodes of vertigo, each lasting from 20 min to 12 h, documented mild to moderate sensorineural hearing loss, aural symptoms (hearing, tinnitus, and fullness) in the affected ear, and exclusion of other vestibular disorders that explain the symptoms. In probable MD, the patient should have had two or more episodes of vertigo or loss of balance, each lasting from 20 min to 24 h, floating aural symptoms (hearing, tinnitus, or fullness) in that ear, and exclusion of other vestibular disorders that explain the symptoms [4].

MD has a fluctuating course and in many cases difficult in clinical management. Progressive hearing loss becomes more frequent and intense dizzying seizures as the disease progresses. All of this increases the challenges of accurate identification, and has probably led to the trial of several tests for identifying MD. The tests are useful tools to assist the otolaryngologist both in diagnosis and prognosis of MD. Identify the site of hydrops, even in cases of severe hearing loss and possible involvement of the asymptomatic ear are useful information on disease management.

These tests includes tonal and speech audiometry /impedance, otoacustic emissions (OAE), electrocochleography (EcochG), vestibular evoked myogenic potentials (VEMP), cochlear hydrops analysis masking procedure (CHAMP) and video head impulse test (vHIT).
