Normative data for TM electrocochleography measures.

OBJECTIVE: Establish normative data for tympanic electrocochleography (TM ECochG) parameters in normal hearing adults without Ménière's disease's (MD) symptoms. Describe TM ECochG variables that help to distinguish normal from MD ears. MATERIAL AND METHODS: We enrolled 100 subjects (N = 200 ears), 59 females, aged between 19 and 71 years from 09/2010 to 04/2014. Inclusion criteria: normal otomicroscopy, hearing thresholds ≤25 dB nHL from 250 to 4000 Hz, normal tympanogram, no symptoms of MD according to the AAO-HNS 1995 criteria and Gibson's score <7. We excluded subjects with dizziness, aural fullness or other symptoms of endolymphatic hydrops. The following parameters were analyzed: SP/AP amplitude ratio, SP/AP area ratio and the difference between AP latency with rarefaction and condensation stimuli. RESULTS: There was no significant difference between right and left ears (Intraclass correlation coefficient < 0.6). SP/AP amplitude ratio varied between 0.084 and 0.356 and SP/AP area ratio between 0.837 and 1.671 (percentiles 5 and 95). The AP latency difference to rarefaction and condensation clicks was between 0.0 and 0.333 ms. CONCLUSION: Normative data for TM ECochG parameters were established in 100 normal hearing subjects without MD. These data can be used to distinguish normal from pathological findings and in follow-up of MD patients.

Summating potential-action potential waveform amplitude and width in the diagnosis of Menière's disease.

OBJECTIVES: It has been suggested that analyzing the width and amplitude of the summating potential-action potential (SP-AP) waveforms can increase the sensitivity of electrocochleography. The objective of this study was to evaluate the ratio of SP to AP amplitude (SP/AP) and SP-AP waveform width, as well as the AP latency difference to condensation and rarefaction clicks, for the diagnosis of Menière's disease. STUDY DESIGN: This was a prospective, controlled study. METHODS: We used transtympanic electrocochleography to evaluate 21 patients with definite Menière's disease and 19 normal-hearing patients with other cochleovestibular disorders, comparing SP/AP, AP latency difference, and SP-AP waveform widths as well as calculating the diagnostic sensitivity of these parameters. RESULTS: Mean SP-AP waveform width was 1.89 ms in the study group and 1.58 ms in the control group. Mean SP/AP was 0.37 in the study group and 0.22 in the control group. The mean product of SP-AP waveform width and SP/AP was 75.26 ms% in the study group and 34.60 ms% in the control group. Mean AP latency difference was 0.13 ms in the study group and 0.07 ms in the control group. For the parameters evaluated, the differences between the groups were statistically significant. In the study group, the sensitivities for the width of the SP-AP waveform, the SP/AP, and the AP latency difference were 33.3%, 52.4%, and 23.8%, respectively. CONCLUSIONS: The use of the parameters evaluated did not increase the sensitivity of the electrocochleography, whether used in isolation or in conjunction with the SP/AP. Determining SP/AP presented the greatest sensitivity.

Are Auditory Steady-State Responses Useful to Evaluate Severe-to-Profound Hearing Loss in Children?

OBJECTIVE: To evaluate Auditory Steady-State Responses (ASSR) at high intensities in pediatric cochlear implant candidates and to compare the results to behavioral tests responses. METHODS: This prospective study evaluated 42 children with suspected severe-to-profound hearing loss, aged from 3 to 72 months. All had absent ABR and OAE responses. ASSR were evoked using binaural single frequency stimuli at 110 dB HL with a 10 dB down-seeking procedure. ASSR and behavioral test results were compared. RESULTS: Forty-two subjects completed both ASSR and behavioral evaluation. Eleven children (26.2%) had bilateral responses. Four (9.5%) showed unilateral responses in at least two frequencies, all confirmed by behavioral results. Overall 61 ASSR responses were obtained, most (37.7%) in 500 Hz. Mean thresholds were between 101.3 and 104.2 dB HL. Among 27 subjects with absent ASSR, fifteen had no behavioral responses. Seven subjects showed behavioral responses with absent ASSR responses. No spurious ASSR responses were observed at 100 or 110 dB HL. CONCLUSION: ASSR is a valuable tool to detect residual hearing. No false-positive ASSR results were observed among 42 children, but in seven cases with absent ASSR, the test underestimated residual hearing as compared to the behavioral responses.