Diagnosis and management of cochlear hydrops.

In an early case of cochlear hydrops, the symptoms of a mild pressure sensation or fullness in the involved ear may be mistaken for a blocked eustachian tube. More severe cases demonstrate a true sensori-neutral hearing loss that fluctuates. Tinnitis is usually present during the attack and will often subside when the hearing returns to normal. The neurotologic evaluation is negative and attempts to establish an etiology are seldom fruitful. The treatment is usually medical, and empirically, these individuals are treated with diuretics, low salt diet, and vasodilators. It is felt by most investigators that cochlear hydrops is an early form of Ménière's disease, and over a long period of time these individuals may develop vertigo as a complaint. The purpose of this paper is to discuss this interesting form of Ménière's disease in detail concerning etiology, physiology, diagnosis, and treatment. A small series of patients who have undergone the subarachnoid endolymphatic sac procedure will be reported according to the guidelines set forth by the Committee on Hearing and Equilibrium of the American Academy of Ophthalmology and Otolaryngology. Based on the result in these patients, it would appear that this procedure should be considered in those individuals who are refractory to medical management. There is convincing evidence that the shunt does stabilize the hearing in many instances.