Changes in endolymphatic hydrops after vestibular neurectomy observed in magnetic resonance imaging – A pilot study

Jasińska, Agnieszka; Lachowska, Magdalena; Wnuk, Emilia; Niemczyk, Kazimierz

doi:10.1016/j.anl.2021.12.001

Cited by 4 publications

(3 citation statements)

References 33 publications

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“…In the literature, increased perilymphatic enhancement of the inner ear structures as a sign of blood-perilymph barrier impairment was described as the next probable biomarker of MD [6,8,21,22,[37][38][39]. Our study observed it in 59-63% of definite MD patients, in the group of ears with other symptoms in 13%, and only 2.7% in asymptomatic ears.…”

Section: Discussionsupporting

confidence: 58%

“…Additionally, it was discovered that the presence of EH may precede symptoms in MD patients [8,41], can progress with the disease duration, and is correlated with clinical symptoms [10,[42][43][44][45][46][47][48]. Therefore, it can serve as a method of early detection and support the diagnosis in clinically atypical cases, help to choose proper treatment, and potentially monitor therapeutic effects [39,47,49,50].…”

Section: Discussionmentioning

confidence: 99%

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Reliability of Endolymphatic Hydrops Qualitative Assessment in Magnetic Resonance Imaging

Wnuk

Lachowska

Jasińska

et al. 2022

JCM

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The study aimed to compare the consistency of MRI interpretation of endolymphatic hydrops qualitative assessment of inner ear structures performed by independent observers. MRI with a delayed post-contrast 3D-FLAIR sequence was performed to visualize EH in patients suspected of having or diagnosed with MD. The scans were analyzed independently by three observers. In total, 220 ears were evaluated and, of these, 75 had definite MD, five probable MD, 67 with other Menieriform symptoms, and 73 were asymptomatic. Significant differences in cochlear endolymphatic hydrops (CoEH) grading between all observers were observed. On the Barath scale of vestibular endolymphatic hydrops (VEH), differences were found between the radiologists and otorhinolaryngologist in grading. No differences were noted in VEH on the Bernaerts scale and increased perilymphatic enhancement. Our study showed that evaluation of vestibular endolymphatic hydrops is repeatable between observers and easy to learn. It proved that Bernaerts’ modification increased the sensitivity of EH diagnosis. Both parameters, CoEH and VEH, may serve as a differentiation method of EH from normal ears. The distinction between normal and hydropic ears is much easier to perform than EH grading. Therefore, it may be used to diagnose MD rather than EH staging.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Reliability of Endolymphatic Hydrops Qualitative Assessment in Magnetic Resonance Imaging

Wnuk

Lachowska

Jasińska

et al. 2022

JCM

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“…Vestibular neurectomy is known to be an effective treatment of disabling vertigo episodes in patients with severe MD with no clinical improvement despite conservative and intratympanic therapy. Several studies have reported vertigo control in 88–100% of patients [ 22 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. In 1980, Garcia-Ibanez et al [ 26 ] analyzed clinical outcomes in 373 patients three to seven years after middle fossa vestibular neurectomy.…”

Section: Discussionmentioning

confidence: 99%

Functional Level and Dynamic Posturography Results Two Years after Vestibular Neurectomy in Patients with Severe Meniere’s Disease

Jasińska-Nowacka,

Lachowska,

Niemczyk

2024

JCM

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Objectives: The aim of this study was to evaluate the functional outcomes and balance compensation in patients with severe Meniere’s disease after vestibular neurectomy. Methods: Pre- and postoperative results were analyzed in twenty patients with unilateral Meniere’s disease before and two years after vestibular neurectomy. Clinical evaluation was performed using a subjective grading scale proposed by the American Academy of Otolaryngology-Head and Neck Surgery and the Dizziness Handicap Inventory. Sensory organization test results were analyzed to assess the balance system before and after the surgery. Results: All patients reported a complete resolution of vertigo attacks after the vestibular neurectomy; 95% of patients reported functional level improvement according to a scale proposed by the American Academy of Otolaryngology-Head and Neck Surgery, and the average score decreased from 4.5 to 1.6. Clinical improvement, evaluated with the Dizziness Handicap Inventory, was present in all patients, with the average result decreasing from 81.7 to 16.4. Analyzing both grading systems, differences between pre- and postoperative results were statistically significant. No statistically significant differences were found between the sensory organization test results before and after vestibular neurectomy. Significant correlations were found between a patient’s age and postoperative results of the Dizziness Handicap Inventory and posturography. Conclusions: Vestibular neurectomy is an effective vertigo treatment in patients with severe Meniere’s disease with no clinical improvement despite conservative treatment. It results in subjective physical, functional, and emotional improvement, enabling patients to return to daily activities and work. An appropriate qualification of patients and comprehensive preoperative evaluation are essential to obtaining satisfactory clinical outcomes.

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Hydrops regression after vestibular denervation - longitudinal magnetic resonance study in patients with severe Meniere’s disease treated with vestibular neurectomy

Jasińska-Nowacka,

Lachowska,

Wnuk

et al. 2024

Acta Neurol Belg

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Objectives The aim was to evaluate endolymphatic hydrops in patients with severe Ménière’s disease (MD) before and after vestibular neurectomy to verify if vestibular denervation results in hydrops regression. Methods Magnetic resonance imaging was performed after intravenous gadolinium injection in twenty patients with unilateral definite MD before and after the vestibular neurectomy. Clinical symptoms and audiovestibular tests were evaluated. Follow-up intervals ranged from 18 to 35 months after the surgery. Results Endolymphatic hydrops were visualized in all patients in the preoperative scans. After the vestibular neurectomy, all patients presented a complete resolution of vertigo episodes. Regression of the endolymphatic hydrops was observed in 35% and 15% of cases analyzing cochlea and vestibule, respectively. In 71.43% of patients with utricular herniation into the lateral semicircular canal, withdrawal of the hernia was visualized. Asymmetrical contrast enhancement in the cochlea regressed in 17.64% of cases. Analyzing all the parameters collectively, in 60% of patients, partial regression of at least one of the radiological signs was confirmed in the follow-up examination. No progression of the endolymphatic hydrops was visualized after the surgery in either the cochlea or the vestibule. Conclusions Vestibular neurectomy is an effective treatment, eliminating vertigo attacks and improving the quality of life in patients with MD. Magnetic resonance imaging of the inner ear allows visualization of changes in endolymphatic hydrops degree after treatment. Regression of the endolymphatic hydrops after vestibular neurectomy suggests that vestibular denervation may effectively halt the progression of the endolymphatic space dilatation and result in hydrops regression.

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Changes in endolymphatic hydrops after vestibular neurectomy observed in magnetic resonance imaging – A pilot study

Cited by 4 publications

References 33 publications

Reliability of Endolymphatic Hydrops Qualitative Assessment in Magnetic Resonance Imaging

Reliability of Endolymphatic Hydrops Qualitative Assessment in Magnetic Resonance Imaging

Functional Level and Dynamic Posturography Results Two Years after Vestibular Neurectomy in Patients with Severe Meniere’s Disease

Hydrops regression after vestibular denervation - longitudinal magnetic resonance study in patients with severe Meniere’s disease treated with vestibular neurectomy

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