Visualization of endolymphatic hydrops and correlation with audio-vestibular functional testing in patients with definite Meniere's disease
Introduction
In 1861, Prosper Meniere described the classic triadic symptomatology of disabling attacks of vertigo, fluctuating hearing loss and tinnitus, which he attributed to a labyrinthine disorder. Its cause has been believed to be related to endolymphatic hydrops, resulting from a malfunction of the endolymph volume regulation mechanisms [1]. According to the 1995 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria for the diagnosis of Meniere's disease in [2], histopathologic confirmation of endolymphatic hydrops is necessary for a “certain” diagnosis of Meniere's disease; there are no useful objective examinations or methods for diagnosis of “definite” or “probable” Meniere's disease. These diagnoses are usually based on patients’ subjective symptoms, such as episodes of vertigo and hearing loss, or physical examination. There is a need for more objective confirmatory tests to diagnosis patients with possible Meniere's disease.
Recent advances in magnetic resonance imaging (MRI) techniques, with increasing magnetic field strength and technical developments of various imaging sequences, have enabled visualization of the delicate anatomy of the inner ear structures. Nakashima et al. [6] and Naganawa et al. [3] have reported that endolymphatic spaces can be visualized using the 3D-FLAIR sequence following intratympanic injection of gadolinium-diethylene-triamnie petaaetic acidbis (Gd-DTPA); enlarged endolymphatic spaces were identified in patients with heterogeneous and mixed Meniere's disease.
Hearing loss in pure tone audiometry (PTA) is a distinguishing test for Meniere's disease, which demonstrates a fluctuating pattern of hearing loss. The electrocochleography (EcoG) is known to be a test with a high sensitivity for denfinite Meniere's disease, especially in cochlear Meniere's disease. To evaluate vestibular lesions, Vestibular Evoked Myogenic Potential (VEMP) testing can be used. This is an inhibitory sacculocollic reflex recorded in the ipsilateral sternocleidomastoid muscle in response to acoustic stimulation of the saccule. Abnormal EcoG and VEMP testing may reflect cochlear and saccular hydrops, respectively, and may be a clinically valuable metric of disease severity or progression in patients with Meniere's disease [4], [5].
The purpose of the current study was to correlate positive and negative results in patients with known Meniere's disease using 3 Tesla (3 T)-MRI following intratympanic Gd-DTPA administration to evaluate for hydrops as well as various auditory vestibular tests (PTA, EcoG and VEMP) and to evaluate the reliability of visualized abnormalities (hydrops) using the auditory vestibular testing.
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Subject selection and controls
Twenty-six patients with definite Meniere's disease, according to the diagnostic criteria proposed by the AAO-HNS, were evaluated by MR imaging and three auditory vestibular functional tests (PTA, EcoG, and VEMP). After reviewing histories and symptoms, such as vertigo, tinnitus, sensation of ear fullness, and fluctuating hearing loss (PTA), we selected the definite Meniere's disease group from patients treated for Meniere's disease in our hospital from 2006 to 2008. Of these, the study group
Visualization of endolymphatic hydrops
A total of 21/26 (81%) of the definite Meniere's disease patients had perilymphatic spaces enhanced and endolymphatic spaces demonstrating a signal void in the affected cochleas by MRI. Dilated endolymphatic spaces of the cochlea were seen wholly or partially in 21 patients (Fig. 1). A total of 18/26 (69%) patients had visualized endolymphatic hydrops of vestibular spaces (especially saccular lesions) on 3D-FLAIR imaging. 3 patients and 11 patients among these had severe dilated vestibular
Discussion
Meniere's disease was first described by Prosper Ménière in 1861. In 1938, post-mortem histological examination revealed endolymphatic hydrops in patients with Meniere's disease; this has been considered a major cause of Meniere's disease in recent years [10]. A large number of factors has been proposed as leading to the development of endolymphatic hydrops. The list includes excessive endolymph production, decreased endolymph absorption by the endolymphatic sac, ionic imbalance, genetic
Conclusion
Cochlea hydrops and vestibular (saccular) hydrops are readily visualized using these techniques. Hydrops, as visualized on MRI, may be a reliable means to diagnosis Meniere's disease; this is supported by appropriate correlations with auditory vestibular functional testing. We are sure that this method will reveal the pathophysiology of Meniere's disease as well as help to diagnosis the disease.
Conflict of interest
The authors have no funding, financial relationships, or conflicts of interest to disclose.
References (25)
- et al.
Meniere's disease
Lancet
(2008) - et al.
Magnetic resonance imaging of guinea pig cochlea after vasopressin-induced or surgically induced endolymphatic hydrops
Otolaryngol Head Neck Surg
(2010) - et al.
Detection and quantification of endolymphatic hydrops in the guinea pig cochlea by magnetic resonance microscopy
Hear Res.
(1995) - et al.
Electrocochleography in patients with Meniere's disease
Am J Otolaryngol
(2005) Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc.
Otolaryngol Head Neck Surg
(1995)- et al.
Imaging of endolymphatic and perilymphatic fluid at 3 T after intratympanic administration of gadolinium-diethylene-triamine pentaacetic acid
Am J Neuroradiol
(2008) - et al.
Vestibular evoked myogenic potential (VEMP) in patients with Meniere's disease with drop attacks
Laryngoscope
(2006) - et al.
Significance of some otologic function tests in dignosis of Meniere's disease
Lin Chuang Er Bi Yan Hou Ke Za Zhi
(2006) - et al.
Visualization of endolymphatic hydrops in patients with Meniere's disease
Laryngoscope
(2007) - et al.
Progression of endolymphatic hydrops in Ménière's disease as evaluated by magnetic resonance imaging
Otol Neurotol
(2011)
In vivo visualization of endolyphatic hydrops in patients with Meniere's disease:correlation with audiovestibular function
Eur Arch Otorhinolaryngol
Diagnostic significance of transtympanic electrocochleography in Meniere's disease
Ann Otol Rhinol Laryngol
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