Electrocochleography (ECochG)
DESCRIPTION
Electrocochleography (ECochG) is used to evaluate hearing impairment. To perform the test, first the tympanic membrane of the affected ear is anesthetized. Then a fine needle connected to a recording wire is passed through the membrane to the medial wall of the inner ear. The needle records the electrical activity of the cochlea hair cells as tonal clicks are administered through headphones. The test allows measurement of the electrical potentials generated in the inner ear as a result of this sound stimulation.
POLICY
Electrocochleography for the evaluation of endolymphatic hydrops or Ménière's disease is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Electrocochleography for the evaluation of other conditions/diseases is considered investigational.
MEDICAL APPROPRIATENESS
Electrocochleography is considered medically appropriate in the evaluation of endolymphatic hydrops or Ménière's disease if ALL of the following criteria are met:
The individual meets ANY ONE of the following:
Child
Adult
The individual has ALL the following triad of symptoms:
Hearing loss
Vertigo
Tinnitus
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Age listings are intended as a guideline for individuals who have no other developmental or physical impairment. The use of electrocochleography is not preferred in infants.
Well-designed studies were not found in the published literature that validates the application of electrocochleography for the evaluation of other conditions/diseases.
SOURCES
Adams, M. E., Heidenreich, K. D., & Kileny, P. R. (2010). Audiovestibular testing in patients with Meniere’s disease. Otolaryngologic Clinics of North America, 43 (5), 996-1009.
American Academy of Otolaryngology - Head and Neck Surgery. (2010, December). Insight into diagnosis and treatment. Retrieved June 7, 2011 from http://www.entnet.org/HealthInformation/menieresDisease.cfm.
American Academy of Pediatrics Joint Committee on Infant Hearing. (2007). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Pediatrics, 120 (4), 898-921.
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2005). Evaluation of hearing impairment (9.01.02). Retrieved June 7. 2011 from BlueWeb. (6 articles and/or guidelines reviewed)
Lopes, K. C., Munhoz, M. S., Santos, M. A., Moraes, M. F., & Chaves, A. G. (2011). Graphic angle measure as an electrocochleography evaluation parameter. Brazilian Journal of Otorhinolaryngology, 77 (2), 214-220.
Nguyen, L. T., Harris, J. P., & Nguyen, Q. T. (2010). Clinical utility of electrocochleography in the diagnosis and management of Meniere’s disease: AOS and ANS membership survey data. Otology & Neurotology, 31 (3), 455-459.
Semaan, M. T., & Megerian, C. A. (2011). Meniere’s disease: A challenging and relentless disorder. Otolaryngologic Clinics of North America, 44 (2), 383-403.
U. S. Food and Drug Administration. (2006, December). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K063402. Retrieved June 7, 2011 from http://www.accessdata.fda.gov/cdrh_docs/pdf6/K063402.pdf.
ORIGINAL EFFECTIVE DATE: 10/12/1998
MOST RECENT REVIEW DATE: 7/14/2011
ID_BA
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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