Question
I have been doing ABR testing in our clinic for about 6 years. During this time, I have only done 2 or 3 ECOGS (with help). I have never had formal training in ECOG, but have now been asked by our ENT to do one on a patient suspected of having Meniere's. We have resident ENTs that cycle in and out of here every quarter, so the requests for ECOGS are really a result of the interests of the particular resident at the time. Consequently, we get very few requests. My question is, how aggressive should our clinic be in getting ECOG training? Should we let ECOG fall by the wayside? Most of the ENTs request ENGs that our facility contracts out. Can ENG provide ENTs with appropriate information regarding Meniere's. Is ECOG necessary?
Answer
While I believe strongly in ECochG as a valuable component to the AEP test battery, the approach is still somewhat controversial. My opinion is that this controversy stems from inexperience on the part of the examiner and the difficulty in performing the exam itself. Once you become adept at making and using TM electrodes, the test is relatively as easy to do as an ABR. Here's a question back at the asker: how many patients does your clinic see that are suspected of having Meniere's disease/endolymphatic hydrops? Probably a lot more than are thought to have acoustic tumors. So if you do AEPs, why not do more. And, in our experience, ECochG is a far better tool for diagnosing hydrops than either ABR or ENG. Plus it has a CPT code and reimbursement rate is good.
My advice (admittedly biased) - learn how to do ECochG. How - workshops are far and few between. You might want to consider bringing someone in as a consultant, which may be cheaper in the long run. In addition, learning how to perform an exam in your own setting will overcome the obstacles associated with learning how to do it at a workshop, then trying to duplicate the setup back home.
John A. Ferraro, PhD, is currently the Chairman and Professor of the Hearing and Speech Department at the University of Kansas Medical Center. He has also served as the Co-Director of the University of Kansas Intercampus Program in Communicative Disorders since 1983. Dr. Ferraro has authored over 70 publications, including the 1997 textbook Laboratory Exercises in Auditory Evoked Potentials.