Endolymphatic hydrops in patients with vestibular migraine and auditory symptoms

Abstract

Vertigo patients exhibiting features of vestibular migraine (VM) and Menière's disease (MD) present a difficult diagnostic challenge to the clinician, and the two entities are likely to overlap. The aim of the present study was to investigate the occurrence of endolymphatic hydrops in patients with VM and auditory symptoms. This was an observatory diagnostic study. At an academic interdisciplinary dizziness centre, nineteen consecutive patients with definite or probable VM and auditory symptoms were examined by locally enhanced inner ear MR imaging. MR images were evaluated for the presence of endolymphatic hydrops. Of the 19 included patients, four patients (21 %) demonstrated evidence of cochlear and vestibular endolymphatic hydrops on locally enhanced inner ear MR imaging (three with "definite VM", one with "probable VM"). Locally enhanced inner ear MR imaging may be useful in the diagnostic evaluation of patients with VM and auditory symptoms, as some of these patients have signs of endolymphatic hydrops. Whether these patients suffer from MD only and are misdiagnosed as VM or suffer from both, VM and MD or whether endolymphatic hydrops is a consequence of inner ear damage due to VM are clinically relevant questions that can be evaluated by application of this technique.

Headache and Sadness: Two Independent Symptoms or Different Spectros of the Same Disease

“…In both groups of patients, HE in the vestibule was more common than in the cochlea, which strengthens the findings of the present study by Nakada et al In their study, Gurkov et al [7] aimed to investigate the presence of HE in patients with definite or probable MV, with hearing-related symptoms, to elucidate more clearly the relationship between MV and DM, due to the overlap of these entities. The population studied was 19 patients with definite or probable MV diagnosis, according to Neuhauser et al criteria, with auditory symptoms (hearing loss, tinnitus or aural fullness).…”

“…According to the analysis of the existing literature, the scarcity of data can be observed to arrive at an accurate diagnosis of MV. Often, the diagnosis can be confused with another etiology because the current criteria do not overcome the overlap with other entities and their clinical variability [7].…”

“…Non-drug therapy that demonstrates efficacy in individual cases, such as diet, management of triggers (triggers), stress management, etiology clarification and vestibular rehabilitation [1] are also indicated. According to Gurkov et al [7], the diagnosis of MV is difficult for three reasons: first, the attacks are associated in only 65% with typical symptoms of migraine; Second, vertigo attacks and headaches may appear simultaneously or independently; third, there is evidently an overlap between MV and DM.…”

“…Gurkov et al [7] says that Neuhauser et al [13] diagnostic criteria present a broad base as a starting point to help clinicians guide themselves. Neuhauser & Lempert [1] report that the pathophysiology of MV is still unclear, none of the possible pathophysiological mechanisms for MV have been investigated experimentally.…”

Vestibular migraine: diagnosis challenges and need for targeted treatment

“…Nineteen patients with definite or probable VM and auditory symptoms were examined by locally enhanced inner ear MR imaging. Of the 19 included patients, four patients (21 %) demonstrated evidence of cochlear and vestibular endolymphatic hydrops 44 .…”