Meniere's Disease - Vertigo - Tinnitus - Dizziness - Endolymphatic Hydrops - Inner Ear Pressure - Labyrinthitis
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Diagnostic Tests For Meniere's Disease
How Meniere's Disease is Diagnosed
Because the exact cause of Meniere's Disease is still unknown, it is really important to get a correct diagnosis. To arrive at a firm and supportive diagnosis and in order to rule out other problems, a very detailed history and physical examination will be required. Several tests using technology will also be ordered. Most than likely you will be sent to one or more specialists: an otolaryngologist (ear nose and throat) or a neurologist (brain). The eyes, ears, and brain are in close proximity.
The fluid-filled semicircular canals of the inner ear, plus the 8th cranial nerve, control balance and our sense of position. Meniere's Disease involves a swelling of the part of that canal that controls the filtration and excretion of the fluid in the inner ear.
Each individual's case must be checked against the possible cause of middle ear infections, otitis media, syphilis, or head injury. Other risk factors include recent a viral illness, respiratory infection, stress, fatigue, use of prescription or nonprescription drugs including aspirin, and a history of allergies, smoking, and alcohol use.
Please remember that the body wants to be in harmony: with all systems working together to create balance.
The diagnostic tests will include MRI, EEG, Audiometry Tests (Hearing) including Electronystagmography, Transtympanic electrocochleography (ECOG)
Detailed History
In your details, you will need to describe what happens when you have an attack. It really helps to have this written down. Better still, give the doctor a copy of your description.
He will need a history of the frequency, duration, severity, and character of your attacks, the duration of hearing loss and whether it has been changing.
You will be asked if you have any history of: diabetes, high blood pressure, high blood cholesterol, thyroid, neurological or emotional disorders, tinnitus or fullness in either or both ears, syphilis, mumps, or other serious infections in the past, inflammations of the eye, auto-immune disorders or allergy, or ear surgery in the past.
A physical examination of the ears and other structures of the head and neck will be done, but these findings are usually normal, except during an attack.
Several other tests will be done. They include:
Magnetic Resonance Imaging "MRI"
This will be one of the first as it simply rules out any abnormal physical conditions in your head.
It provides detailed pictures of brain and nerve tissues from multiple planes without obstruction by overlying bone.
What will this test tell you? MRI is the procedure of choice for most brain disorders because it can clearly show various types of nerve tissue. It provides clear pictures. It is noninvasive and can evaluate blood flow and the flow of cerebrospinal fluid (CSF). An MRI can distinguish tumors or other lesions from normal tissues. MRI is sometimes used to avoid the dangers of repeated exposure to radiation
How the test is performed The MRI scanner is in an area that has been shielded from outside magnetic fields. You lie on a narrow table that can slide inside a large tunnel-like tube within the scanner. The scanner creates a magnetic field around you, then directs radio waves at the tissues in question. Several sets of images are usually required, each taking from 2 to 15 minutes. The complete scan takes about 1 hour; some scans take more than 90 minutes. This test will not cause any discomfort.
Electroencephalogram "EEG"
What will this test tell you? It helps to diagnose the presence and type of seizure disorders, confusion, head injuries, brain tumors, infections, degenerative diseases, and metabolic disturbances that all could affect the brain. Incidentally the procedure cannot be used to "read the mind," measure intelligence, or diagnose mental illness.
How the test is performed. It will be done by an specially-trained technician in a room designed for this purpose only. It may be in an office or in a hospital setting. You will be asked to lie on your back on the table or to sit in a reclining chair. Many flat metal discs (electrodes) will be placed in different positions on your scalp. (They are held in place with a sticky paste.) These electrodes are connected by wires to an amplifier and a recording machine. The recording machine converts the electrical signals into a series of wavy lines. (Like an ECG.) These are then shown on a monitor and can be printed out. Because any movement can alter the results, you will need to lie very still with your eyes closed. You may be asked to do certain things during the recording, such as breathe deeply and rapidly for several minutes or look at a very bright flickering light. (It will be OK to move during these requests.) This test is without discomfort.
Hearing Tests: Audiometry/Audiology
What will this test tell you?
These measure hearing ability. There are several different ones. Each is done for a specific purpose.
An audiometric examination typically indicates a sensory type of hearing loss in the affected ear. With Meniere's Disease the ability to distinguish "sit" and "fit" is often diminished in the affected ear. (Speech discrimination)
Audiometry is particularly helpful in making the diagnosis of Ménières syndrome. This can determine and measure low frequency or mixed low and high frequency, "Pike's Peak" pattern. When trying to make a diagnosis of Ménières, iIt is very helpful to have precise documentation of fluctuating hearing loss.
How the test is performed
Audiography provides a more precise measurement of hearing. Air conduction is tested by having you wear earphones attached to the audiometer. Pure tones of controlled intensity are delivered, usually to one ear at a time. You are asked to indicate (by raising a hand, pressing a button, or other means) when they hear a sound, and the minimum intensity (volume) required to hear each tone is graphed. An attachment is placed against the bone behind each ear to test bone conduction.
Transtympanic electrocochleography (ECOG)
This can show evidence for cochlear involvement. It may indicate increased inner ear fluid pressure in some cases of Meniere's disease.
Electronystagmography "ENG"
This test may be performed to evaluate balance function.
Caloric Stimulation
Why is the test done Caloric stimulation is performed to evaluate the acoustic nerve, which provides hearing and helps with balance. 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.
How the test is performed
Each ear is tested separately. One teaspoon of cold water is gently instilled in the ear canal with a bulb syringe. This should cause nystagmus (quick movement of both eyes away from the direction of ice water and then slowly back). If it does not cause nystagmus, 2 teaspoons of cold water are instilled in the ear canal. If nystagmus still fails to occur, 4 and then 8 teaspoons of cold water are used.
At times, hot water may be used in addition to cold water. The nystagmus should occur in the opposite direction (toward the hot water then slowly away). Use of both cold water and hot water makes the test more accurate.
Diagnostic Tests For Meniere's Disease Symptoms
By Karin Henderson (menieres-disease.ca)
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, tinnitis(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.
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