How is Meniere's syndrome diagnosed?

Many people don't know much about Meniere's syndrome, which is an inner ear disease. The main symptom of this disease is that patients are prone to sudden dizziness, which often causes tinnitus, nystagmus and other symptoms. The group of people who suffer from it are mostly middle-aged people. If you want to confirm whether you have Meniere's syndrome, you should go to the hospital for examination in time. There are many contents of the examination, such as audiological examination, electronystagmography examination, etc.

How is Meniere's syndrome diagnosed?

1. Audiological examination.

(1) Pure tone audiometry: It can determine whether hearing has decreased, and the degree and nature of the hearing loss. In the early stages, it is mostly low-frequency sensorineural hearing loss, and the hearing curve shows a slightly ascending type. After multiple attacks, high-frequency hearing decreases and the hearing curve may be flat or decreasing. Pure tone audiometry can also dynamically observe continuous changes in a patient's hearing.

(2) Electrocochlear electrogram: This examination can objectively determine whether there is water accumulation in the membranous labyrinth. -SP/AP amplitude ratio>0.37 is diagnostically significant and can indirectly indicate the presence of translabyrinthal hydrops.

(3) Otoacoustic emission (OAE): It can first reflect the cochlear function of patients with early Meniere's syndrome. When no abnormalities are found in the early pure tone audiometry of the disease, TEOAE (transient evoked otoacoustic emission) may be weakened or cannot be induced.

2. Electronystagmogram.

During the climax of the attack, spontaneous nystagmus can be seen. Horizontal spontaneous nystagmus and positional nystagmus with regular rhythm and different intensities, which initially move to the affected side and then turn to the healthy side, can be observed or recorded by electronystagmus. During the recovery period, the nystagmus turns to the healthy side. Spontaneous nystagmus during the intermittent period and the results of various induced tests may be normal.

3. Glycerol test.

It is mainly used to determine whether there is hydrops in the membranous labyrinth. Because glycerol has a high osmotic pressure and its molecular diameter is smaller than the diameter of the pores in the cytoplasmic membrane, it can diffuse into the marginal cells of the inner ear, increasing the intracellular osmotic pressure and allowing the water in the endolymph to enter the blood vessels of the stria vascularis through the cellular pathways, thereby achieving a decompression effect.

Method: Drink with an equal amount of saline or juice at a concentration of 1.2-1.5 g/kg of glycerol on an empty stomach. Perform pure tone audiometry once every hour before and within 3 hours after taking the drug. If the average hearing threshold of the affected ear increases by 15dB or more, or the speech recognition rate increases by 16% or more after taking glycerol, it is positive.

After taking glycerol, some patients may experience adverse reactions such as dizziness, headache, nausea, and vomiting, which will improve after a short rest. This experiment is not only used for diagnosis, but also for selecting surgical procedures based on the experimental results: endolymphatic sac decompression is more effective for patients with positive glycerol test.

4. Vestibular function test.

(1) Hot and cold test: In the early stage, the vestibular function of the affected side may be normal or slightly reduced. After multiple attacks, the healthy side may become dominant. In the late stage, semicircular canal paralysis or loss of function may occur.

(2) Vestibular evoked myogenic potentials (VEMP): abnormalities in amplitude and threshold may occur.

(3) Hennebert's sign: When the stapes footplate adheres to the inflated balloon, increasing or decreasing the air pressure in the external auditory canal may induce vertigo and nystagmus. Henenbert's sign may be positive in patients with Meniere's syndrome.

5. Imaging examination.

Temporal bone CT scan can show vestibular aqueduct stenosis. MRI of the inner ear membranous labyrinth under special contrast can show narrowing of the endolymphatic vessels in some patients.

6. Immunological examination.

Raoch (1995) reported that 47% of patients with Meniere's syndrome had HSP70 antibodies, and 58.8% of those with bilateral disease had HSP70 antibodies. Gottschlich (1995) used protein immunoblotting to detect antibodies to bovine inner ear antigens in the serum of patients with Meniere's disease, showing that 30% of the patients had antibodies to the 68kD antigen.