Clinical utility of electrocochleography in the diagnosis and management of Ménière's disease: AOS and ANS membership survey data.

OBJECTIVE Evaluate the clinical use of electrocochleography (ECoG) for diagnosis/treatment of Ménière's disease among members of the American Otological Society (AOS) and American Neurotology Society (ANS). SUBJECTS Clinically active members of the AOS/ANS. MAIN OUTCOME MEASURE Survey responses. RESULTS A total of 143 responses were received from 344 possible respondents (41.6%). In suspected cases of Ménière's disease, 45.5% of respondents did not use ECoG at all, 17.5 % used ECoG routinely, and 37.1% used it only in questionable cases. Electrocochleography users differed widely in electrode approach and stimulus modality used, with extratympanic approach and click stimuli used most frequently. Most respondents (73.2%) thought that ECoG is a test of indeterminate value. Only 3.6% required an abnormal ECoG to diagnose endolymphatic hydrops. An abnormal test was a requirement to proceed with ablative therapy for just 8.6% of respondents. Still, 77.9% think that ECoG findings do fluctuate with activity of the disorder, but only 18.0% agree that when the ECoG reverts to normal, one can predict remission of symptoms. Almost half of respondents (46.7%) reported that they have now stopped ordering ECoG due to variability in results and lack of correlation with their patients' symptoms. CONCLUSION Among AOS/ANS members, there is low clinical use of ECoG in diagnosis/management of Ménière's disease. For approximately half of respondents, ECoG has no role in their clinical practice. Electrocochleography was used routinely by only 1 in 6 respondents. Those who used ECoG differed widely in electrode placement and type of stimuli paradigm used.