Intratympanic gadolinium magnetic resonance imaging supports the role of endolymphatic hydrops in the pathogenesis of immune-mediated inner-ear disease

Lobo, David; Tuñón, María J.; Villarreal, I.; Brea, Beatriz; García-Berrocal, José Ramón

doi:10.1017/s0022215118000749

Cited by 24 publications

(13 citation statements)

References 24 publications

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“…CMV infection, especially in congenital contexts, has been identified as among the most prevalent of the infective etiopathologies of SNHL, with deleterious consequences almost invariably for hearing and often too the vestibular system [64–66]. Moreover, CMV has been suggested to lead to hydropic ear disease, and so too has EH been linked to immune-mediated inner-ear disease [67, 68]. So CMV is probably influential for a variety of pathophysiological processes of the vestibular and cochlear labyrinths that are themselves associated strongly with MD, and thus too in MD CMV-infection may be a factor in facilitating dysregulation of the inner-ear labyrinths, a hypothesis suggested by Arenberg and colleagues [48].…”

Section: Discussionmentioning

confidence: 99%

Are viral-infections associated with Ménière’s Disease? A systematic review and meta-analysis of molecular-markers of viral-infection in case-controlled observational studies of MD

et al. 2019

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Despite considerable research, it remains controversial as to whether viral-infections are associated with Meniere’s Disease (MD), a clinically heterogeneous set of chronic inner-ear disorders strongly associated with endolymphatic hydrops. Here, we investigated whether viral-infections are associated with MD through a systematic review and meta-analysis of observational clinical studies using molecular-diagnostics. Eligible for inclusion were case-controlled studies which ascertained molecular-determinants of past or present viral-infection through either viral nucleic acids or host serological marker in MD cases and non-MD controls. Across online databases and grey literature, we identified 210 potentially relevant articles in the English language, from which a total of 14 articles fully satisfied our eligibility criteria such that meta-groups of 611 MD-cases and 373 controls resulted. The aggregate quality of the modest-sized (14 studies) body of evidence was limited and varied considerably with regards to participant selection, matching, and ascertainment(s) and determinant(s) of viral-infection. Most data identified concerned the human cytomegalovirus (CMV), and meta-analysis of eligible studies revealed that evidence of CMV-infection was associated approximately three-fold with MD compared to controls, however the timing of the infections was indeterminate as the pooled analyses combined antiviral serological markers with viral nucleic acid markers. No association was found for any of HSV-1, -2, VZV, or EBV. Associative analyses of any viral species not aforementioned were precluded by limited data, and thus potential associations between other viral species and MD, especially other than Herpesviridae, are yet to be characterised. Overall, we have found a small association between CMV-infection and MD, however it is to be determined for what sub-groups of MD this finding may be relevant, and ideally the reported association remains would be reproduced by a greater volume of higher quality evidence.

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Section: Discussionmentioning

confidence: 99%

Are viral-infections associated with Ménière’s Disease? A systematic review and meta-analysis of molecular-markers of viral-infection in case-controlled observational studies of MD

et al. 2019

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“…MRI is typically obtained to rule out retrocochlear pathology 3 . Although there is no correlation between cochlear enhancement on MRI and proven AIED, MRI with intratympanic gadolinium may have utility in diagnosing AIED through detection of inner ear gadolinium 22,23 . If MRI is negative, work‐up should be continued with laboratory evaluation to confirm the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…This system contains 28 "yes or no" questions across 5 sections: study quality (10), external validity (3), study bias (7), confounding and selection bias (6), and power of the study (1). Down and Black score ranges were then given corresponding quality levels: excellent (26)(27)(28), good (20)(21)(22)(23)(24)(25), fair (15)(16)(17)(18)(19), and poor (<15). The quality of each study included in this review was assessed using this checklist and is reported in Table 2.…”

Section: Bias Assessmentmentioning

confidence: 99%

Autoimmune inner ear disease: A systematic review of management

Breslin

Varadarajan

Sobel

et al. 2020

Laryngoscope Investig Oto

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Objectives: The study systematically reviewed the existing literature on the management of autoimmune inner ear disease (AIED). Study Design: Systematic review. Methods: We performed a literature search of Embase, NCBI, Cochrane, and Web of Science databases from April 1990 to April 2020. Inclusion criteria included studies that were retrospective or prospective in nature evaluating the treatment of AIED with audiometric data measuring hearing outcomes during treatment. Hearing improvement was the primary study outcome and improvement in vestibular symptoms was the secondary study outcome. Results: Sixteen of 412 candidate articles were included in our study. Systemic steroid treatment is most commonly described. Alternative treatment modalities included intratympanic steroid treatment, methotrexate, cyclophosphamide, azathioprine, infliximab, etanercept, adalimumab, golimumab, methylprednisolone, rituximab, and anakinra. Conclusion: Systemic corticosteroids are the first line treatment of AIED. Intratympanic steroids are a potential adjuvant or alternative treatment for patients who cannot tolerate or become refractory to steroid treatment. Steroid nonresponders may benefit from biologic therapy. Alternative treatment modalities including nonsteroidal immunosuppressants and biologics have been studied in small cohorts of patients with varying results. Prospective studies investigating the efficacy of biologic and nonsteroidal therapy are warranted.

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“…Today, the relationship between ELH and MD symptoms (for review cp [3]), as well as the specificity of ELH for MD, has come under scrutiny. The underlying reason is that different ELH patterns can be found not only in MD [4,5], but also so far in 3.3-28% of healthy ears [6,7], various inner ear [8][9][10] and central [11][12][13][14] pathologies, as well as in anatomic or vascular abnormalities affecting endolymph resorption [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

VOLT: a novel open-source pipeline for automatic segmentation of endolymphatic space in inner ear MRI

et al. 2020

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Background Objective and volumetric quantification is a necessary step in the assessment and comparison of endolymphatic hydrops (ELH) results. Here, we introduce a novel tool for automatic volumetric segmentation of the endolymphatic space (ELS) for ELH detection in delayed intravenous gadolinium-enhanced magnetic resonance imaging of inner ear (iMRI) data. Methods The core component is a novel algorithm based on Volumetric Local Thresholding (VOLT). The study included three different data sets: a real-world data set (D1) to develop the novel ELH detection algorithm and two validating data sets, one artificial (D2) and one entirely unseen prospective real-world data set (D3). D1 included 210 inner ears of 105 patients (50 male; mean age 50.4 ± 17.1 years), and D3 included 20 inner ears of 10 patients (5 male; mean age 46.8 ± 14.4 years) with episodic vertigo attacks of different etiology. D1 and D3 did not differ significantly concerning age, gender, the grade of ELH, or data quality. As an artificial data set, D2 provided a known ground truth and consisted of an 8-bit cuboid volume using the same voxel-size and grid as real-world data with different sized cylindrical and cuboid-shaped cutouts (signal) whose grayscale values matched the real-world data set D1 (mean 68.7 ± 7.8; range 48.9-92.8). The evaluation included segmentation accuracy using the Sørensen-Dice overlap coefficient and segmentation precision by comparing the volume of the ELS. Results VOLT resulted in a high level of performance and accuracy in comparison with the respective gold standard. In the case of the artificial data set, VOLT outperformed the gold standard in higher noise levels. Data processing steps are fully automated and run without further user input in less than 60 s. ELS volume measured by automatic segmentation correlated significantly with the clinical grading of the ELS (p < 0.01). Conclusion VOLT enables an open-source reproducible, reliable, and automatic volumetric quantification of the inner ears' fluid space using MR volumetric assessment of endolymphatic hydrops. This tool constitutes an important step towards comparable and systematic big data analyses of the ELS in patients with the frequent syndrome of episodic vertigo attacks. A generic version of our three-dimensional thresholding algorithm has been made available to the scientific community via GitHub as an ImageJ-plugin.

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Intratympanic gadolinium magnetic resonance imaging supports the role of endolymphatic hydrops in the pathogenesis of immune-mediated inner-ear disease

Cited by 24 publications

References 24 publications

Are viral-infections associated with Ménière’s Disease? A systematic review and meta-analysis of molecular-markers of viral-infection in case-controlled observational studies of MD

Are viral-infections associated with Ménière’s Disease? A systematic review and meta-analysis of molecular-markers of viral-infection in case-controlled observational studies of MD

Autoimmune inner ear disease: A systematic review of management

VOLT: a novel open-source pipeline for automatic segmentation of endolymphatic space in inner ear MRI

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