Intraoperative Electrocochleography in Patients With Meniere's Disease Undergoing Endolymphatic Sac Decompression and Shunt Surgery

Hypothesis: Objective physiologic changes measured using electrocochleography at the round window (ECOG(RW)) are observable during endolymphatic sac decompression and shunt surgery (ELS). Background: Limited effective treatment options are available to patients with Meniere's disease (MD) who have failed conservative management, experience persistent vertigo symptoms, and have substantial residual hearing. ELS is a feasible therapeutic option for these patients. However, the efficacy of this procedure has been questioned, and objective measures assessing inner ear physiologic alterations are lacking. Methods: ECOG(RW) was measured in patients with MD undergoing ELS. Stimuli consisted of tone bursts (250, 500, 1000, 2000, 4000 Hz) and 100 ps broadband clicks at various intensities (60-90dB nHL). Cochlear microphonic (CM), summation potential (SP), compound action potential (AP), SP:AP ratio, and CM harmonic distortions were measured. Results: ECOG(RW) was completed in 18 patients. The mean SP magnitude at 500 Hz changed significantly from -7.1 mu V before to -5.1 mu V after ELS (p < 0.05). However, the mean SP:AP ratio in those tested (n=13) did not significantly change after ELS. CM harmonic magnitudes remained unchanged from pre- to post-ELS (n=12) across all frequencies. Conclusion: ECOG(RW) allows detection of acute electrophysiological changes in the cochlea. However, our results indicate only small objective changes in the low-frequency SP magnitude (500 Hz) immediately after ELS, but not in other frequencies or measures tested (CM, SP:AP, CM harmonic distortions). These results suggest minimal electrophysiological changes occur in the cochlea as a result of ELS.