An alternative diagnostic test for active Ménière's disease and cochlear hydrops using high-pass noise masked responses: the complex amplitude ratio.

We [Don et al.: Otol Neurotol 2005;26:711-722] previously demonstrated that patients diagnosed with an active case of Ménière's disease could be distinguished from non-Ménière's normal-hearing subjects by a special auditory brainstem response method involving clicks and ipsilateral high-pass masking pink noise. Specifically, auditory brainstem responses to clicks presented alone and clicks with masking noise high-pass filtered at 8, 4, 2, 1 and 0.5 kHz were recorded. It was shown that the level of masking noise sufficient to progressively mask the response to clicks in non-Ménière's normal-hearing subjects was insufficient to appropriately mask the responses in Ménière's disease subjects, resulting in an obvious undermasked component. A relative latency measure of wave V or the undermasked component in the response to clicks with 0.5 kHz high-pass masking noise and wave V in the response to clicks presented alone clearly distinguished these two groups on an individual level, thus making it a valuable clinical tool. However, determining the peak latency of wave V or the undermasked component can be difficult in some cases. In anticipation of this difficulty, we investigated and present in this paper several amplitude measures that may help in the evaluation of these cases. One amplitude measure, the 'complex amplitude ratio', appears to be a good alternative when the latency measure of the undermasked component is difficult to determine.