Dynamics in Endolymphatic Hydrops & Symptoms in Meniere's Disease After Endolymphatic Duct Blockage, Preliminary Results

Abstract

Objective: The purpose of the present study was to evaluate the dynamics of endolymphatic hydrops (EH) and symptoms in a group of patients who underwent endolymphatic duct blockage (EDB) for treatment of intractable Meniere's Disease (MD), and to explore a metric for verifying the effectiveness of EDB procedure.Methods: A total of 22 patients with intractable MD patients who underwent EDB participated in the present study. EH was visualized using locally enhanced inner ear magnetic resonance imaging (MRI) prior to and following surgery. The vestibular hydrops ratio (VHR) in the second MRI examination was compared with the pre-surgery recordings.Results: Following EDB, 6 patients exhibited complete or partial reversal of EH, complete control of vertigo spells and reported improvement in hearing; 13 patients showed no changes in EH or hearing, but 5 of these patients exhibited complete control of vertigo attacks, and the other 8 patients exhibited improved control of vertigo attacks. The final 3 patients showed an increase in EH, but symptomatic worsening in 2 patients, and symptomatic improvement in 1 patient. There was a significant difference in the average VHR prior to and following EDB. Postoperative VHR was positively correlated with the frequency of vertigo spells in the latest 6 months of follow-up and improvement of postoperative average hearing threshold.Conclusion: The decreased EH accompanying the reduction in vertigo attacks and hearing preservation may provide a metric for verifying the effectiveness of EDB treatment in patients with MD.

Correlation of clinical parameters with endolymphatic hydrops on MRI in Meniere's disease

“…Several recent studies analyzed MRI findings of EH and clinical data ( 19 , 20 , 28 – 31 ). Two Korean studies calculated the mean hydrops ratios in study populations of 29 and 16 patients with unilateral definite MD ( 19 , 20 ).…”

“…In another study, in a population of 78 patients with unilateral definite MD, there were 57 cases of cochlear EH and 60 of vestibular EH, and these were related to the results of audiometry and caloric tests ( 30 ). In a study in which MRI was performed before the endolymphatic duct blockage procedure for unilateral definite MD, all affected ears had cochlear and vestibular EH ( 31 ).…”

Up-Regulated Expression of Interferon-Gamma, Interleukin-6 and Tumor Necrosis Factor-Alpha in the Endolymphatic Sac of Meniere's Disease Suggesting the Local Inflammatory Response Underlies the Mechanism of This Disease

“…The EDB procedures used for treatment of MD, as described previously ( 27 ), were performed in 25 patients with intractable MD with MRI based visualization of unilateral EH between January 2019 and June 2020. After blockage of the distal intraosseous portion of the ES by applying the ligating clip, the proximal extraosseous ES was opened with an L-shaped incision, and the lumen of the ES was carefully identified ( Figure 2A ).…”

A comparison of endolymphatic duct blockage, endolymphatic sac drainage and endolymphatic sac decompression surgery in reversing endolymphatic hydrops in Meniere's disease

“…MRI was performed as previously described [ 11 , 12 ]. In brief, when a single-dose (0.2 ml/kg) gadolinium-based contrast agent (Magnevist®, Bayer AG) was administrated intravenously 4 h before the MRI scan (IV-Gd) and a eightfold-diluted Gd was injected intratympanically in both ears 24 h prior to the MRI scan (IT-Gd), the MRI scan was performed with a three-dimensional real inversion recovery (3D-real IR) sequence on a 3 T MR unit (Magnetom Verio; Siemens AG) using a 12-channel head coil, as previously described [ 11 , 12 ]. For the second and third Gd-MRI, the intratympanic administration of contrast agent might be used in the ear undergoing surgery alone when patients were reluctant to receive intratympanic injections in their healthy ear.…”

“…Briefly, a simple mastoidectomy was performed to expose the endolymphatic sac in the area between the sigmoid sinus and the inferior margin of the posterior semicircular canal, including the rugose portion. The surgical procedure used for endolymphatic duct blackage was performed as previously described [ 7 , 12 , 13 ]. Briefly, following decompression of the sac, the retrolabyrinthine bone medial to the sac was dissected to create a region for the insertion of the tips of the forceps.…”