Electrocochleography with postural changes in perilymphatic fistula and Menière's disease: case reports.

Perilymphatic fistula can be difficult to diagnose differentially prior to exploratory surgery. In this study, we investigated a new test technique in four case studies of subjects with perilymphatic fistula and compared our findings to results obtained in 20 normally hearing subjects with no history of vertigo and 10 subjects with Meniere's disease. Recordings from an eardrum electrode were obtained with the subject in an upright position, after the subject had been lying in a horizontal position for 30 minutes with the test ear up and after 15 minutes with the test ear down. Stimuli consisted of high level clicks and tonebursts. Neither the summating potential (SP) and action potential (AP) amplitudes nor the SP/AP amplitude ratio were significantly affected by postural change in either the normal or Meniere's disease group. The perilymphatic fistula subjects, in general, showed greater changes in the SP/AP, particularly for the 6000 Hz tonebursts, than did the other two groups. More data will be needed to determine if these findings are consistent in a large population of perilymphatic fistula patients.