Longitudinal up‐regulation of endolymphatic hydrops in patients with Meniere's disease during medical treatment

Abstract

Objective/HypothesisMeniere's disease (MD) is a common inner ear disease characterized by repeated episodic vertigo, fluctuating sensorineural hearing loss, and tinnitus. Its pathology is defined as endolymphatic hydrops (EH) in the inner ear and EH has been hypothesized to correlate with the clinical symptoms of MD. We presented the dynamics of in vivo EH in MD patients during medical treatments.Study DesignProspective, single‐arm repeated measuresMethodsEleven MD patients were enrolled. All subjects prospectively underwent gadolinium‐enhanced inner ear magnetic resonance (MR) imaging and neuro‐otological testing before and after medical treatment. The volume of EH was quantitatively evaluated by processing MR images. All MD patients were administered continuous medication and followed up for more than 12 months.ResultsThe frequency of vertigo episodes decreased in all patients and vestibular function decreased to 13–91% of the pre‐treatment level. The volume ratio of post‐treatment EH‐to‐pre‐treatment EH ranged from 1.01–3.22. The total volume of pre‐treatment EH was significantly correlated with cochlear symptom disease duration and the affected ear's hearing level.ConclusionEH in MD patients developed longitudinally with deterioration of inner ear function during medical treatment. The natural course of MD may progress with development of EH at least for a certain period.Level of Evidence2b.

Vertical head impulse and caloric are complementary but react opposite to Meniere's disease hydrops

“…It is assumed that MD patients have posterior SC dysfunction more frequently than 44.4%. CP% and max‐SPEV are conventional caloric parameters to estimate vestibular function in MD patients, and they have been widely used . However, the caloric test is not sufficient to assess vestibular function of MD patients, because the SC dysfunction of MD patients is most frequently located in the posterior SC.…”

“…MR imaging was performed as previously described . Briefly, a standard dose (0.2 mL/kg) of intravenous gadoteridol (ProHance; Eisai Co., Ltd., Tokyo, Japan) was administered, and 4 hours later, MRI was performed using a 3 T MRI unit (Magnetom Verio; Siemens, Erlangen, Germany) equipped with a receive‐only, 32‐channel phased‐array coil.…”

“…The HYDROPS‐Mi2 image (Fig. , right) was obtained by multiplying the MRC and HYDROPS images using a Digital Imaging and Communications in Medicine viewer OsiriX (version 9.0; Pixmeo SARL, Berne, Switzerland) . Experienced otologists, who were blinded to the clinical progress of patients, manually placed regions of interest (ROI) contouring of the vestibule on the MRC, and then they were copied to the HYDROPS‐Mi2 image.…”

“…Experienced otologists, who were blinded to the clinical progress of patients, manually placed regions of interest (ROI) contouring of the vestibule on the MRC, and then they were copied to the HYDROPS‐Mi2 image. Using the OsiriX histogram function, we measured the total number of all pixels in the ROI and the number of pixels with negative signal intensity values, which represents vestibular EH, in the ROI . The volume ratio of vestibular EH (v‐EH%) was calculated based on the ratio defined as the number of negative pixels for EH in the ROI divided by the total number of pixels in the ROI.…”

“…In this study, we prospectively investigated vHIT findings of all SCs and caloric responses in MD patients. We also measured the volume ratio of the vestibular part of EH by processing MRI semiquantitatively and analyzed whether vestibular EH affects VOR responses delivered by two different tests.…”