What is the typical audiologic pattern during a Menière disease attack?

• A. High-frequency stable SNHL with constant vertigo
• B. Conductive hearing loss with diplacusis
• C. Low-frequency fluctuating SNHL with episodic vertigo and tinnitus; electrocochleography hydropic pattern.
• D. Normal hearing with vertigo only

Answer: (C)

The key idea is that during a Menière disease attack the cochlear pattern is a fluctuating, low-frequency sensorineural hearing loss accompanied by episodic vertigo and tinnitus. This low-frequency loss happens because endolymphatic hydrops—distension of the inner ear’s fluid spaces—affects the apical cochlear regions responsible for low-pitched sounds, and the symptoms tend to wax and wane with each attack.

Audiometry during an attack often shows a temporary drop in hearing at low frequencies, while higher frequencies are relatively preserved early on. Tinnitus and a sense of fullness in the ear commonly accompany these episodes.

Electrocochography tends to reveal a hydropic pattern, reflecting the endolymphatic chaos. This means an abnormal SP/AP response where the summating potential is amplified relative to the action potential, signaling the altered bioelectrical environment of the cochlea during hydrops.

So, the combination of fluctuating low-frequency sensorineural hearing loss with vertigo and tinnitus, along with a hydropic ECochG pattern, is the hallmark of an attack in Menière disease.