Meniere's Disease Patients with Distinct Sac Pathoanatomic Findings React Differently to Endolymphatic Duct Blockage

Wang, Qin; Hu, Junjiao; Li, Wei; Huang, Li; Pan, Xin-Bin; Zhou, Zhou; Yang, Tao; Tu, Rong; Huang, Chao; Peng, Anquan; Zhang, Zhiwen

doi:10.1002/lary.30520

Cited by 3 publications

(1 citation statement)

References 39 publications

(71 reference statements)

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“…This is consistent with data at our own institution showing superior control with wider decompression [21][22][23]. Differences in response may relate to underlying differences in ELS anatomy, with 'normoplastic' sacs responding more favorably to surgery than 'atrophic' sacs [50]. Another series of 73 patients underwent resection of the lateral wall of the ELS with excellent long-term control of vertigo in 90% of patients [51].…”

Section: Present Day Surgery On the Endolymphatic Sacsupporting

confidence: 85%

Recent surgical advances and continued controversies in medically refractory Meniere's disease

Lucas

Hong

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of reviewMeniere's disease is caused by hydropic changes in the endolymphatic system, and manifests as a collection of vertigo, hearing loss, tinnitus, and aural fullness. Although high-quality clinical practice guidelines exist for the diagnosis and initial management of Meniere's disease, there is no strong consensus for treatment of medically refractory Meniere's disease. This review summarizes treatment options and highlights controversies surrounding surgical treatment of Meniere's disease. Recent findingsIntratympanic steroid and intratympanic gentamicin injections continue to be widely used as in-office therapies in medically refractory Meniere's disease. Despite historical controversy surrounding the use of endolymphatic sac (ELS) surgery, the use of ELS decompression has been widely adopted by the international neurotologic community due to high vertigo control rate, coupled with low risk of audiovestibular loss. Wider decompression of the sac and surgical manipulation of the endolymphatic duct may impact outcome and are the subject of discussion. An emerging surgical technique called Triple Semicircular Canal Occlusion (TSCO) holds promise as a partially ablative procedure with high vertigo control rate in Meniere's disease. Cochlear implants may be placed in active Meniere's disease patients, or during an ablative surgery such as labyrinthectomy.

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Section: Present Day Surgery On the Endolymphatic Sacsupporting

confidence: 85%

Recent surgical advances and continued controversies in medically refractory Meniere's disease

Lucas

Hong

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

View full text Add to dashboard Cite

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Comparison of vestibular aqueduct visualization on computed tomography and magnetic resonance imaging in patients with Ménière’s disease

Xia,

Lei,

Liu

et al. 2024

BMC Med Imaging

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Background The vestibular aqueduct (VA) serves an essential role in homeostasis of the inner ear and pathogenesis of Ménière’s disease (MD). The bony VA can be clearly depicted by high-resolution computed tomography (HRCT), whereas the optimal sequences and parameters for magnetic resonance imaging (MRI) are not yet established. We investigated VA characteristics and potential factors influencing MRI-VA visibility in unilateral MD patients. Methods One hundred patients with unilateral MD underwent MRI with three-dimensional sampling perfection with application optimized contrasts using different flip angle evolutions (3D-SPACE) sequence and HRCT evaluation. The imaging variables included MRI-VA and CT-VA visibility, CT-VA morphology and CT-peri-VA pneumatization. Results The most frequent type of MRI-VA and CT-VA visualization was invisible VA and continuous VA, respectively. The MRI-VA visibility was significantly lower than CT-VA visibility. MRI-VA visibility had a weak positive correlation with ipsilateral CT-VA visualization. For the affected side, the MRI-VA visualization was negatively correlated with the incidence of obliterated-shaped CT-VA and positively with that of tubular-shaped CT-VA. MRI-VA visualization was not affected by CT-peri-VA pneumatization. Conclusion In patients with MD, the VA visualization on 3D-SPACE MRI is poorer than that observed on CT and may be affected by its osseous configuration. These findings may provide a basis for further characterization of VA demonstrated by MRI and its clinical significance.

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Comparison of radiological abnormalities between the jugular bulb and the vestibular aqueduct in patients with Ménière’s disease

et al. 2023

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ObjectiveAnatomical variations of the inner ear may contribute to the development of Ménière’s disease (MD), which is a complex inner ear disorder histopathologically characterized by idiopathic endolymphatic hydrops (ELH). Abnormalities of the vestibular aqueduct (VA) and the jugular bulb (JB) have been suggested as predisposing factors. Yet, few studies have investigated the correlation between JB abnormalities and VA variations as well as its clinical relevance in these patients. In this retrospective study, we investigated the differences in the incidence of radiological abnormalities of the VA and JB in patients with definite MD.MethodsAnatomical variations of JB and VA were evaluated based on high-resolution CT (HRCT) in a series of 103 patients with MD (93 unilateral cases and 10 bilateral cases). JB-related indices included JB anteroposterior and mediolateral diameter, JB height, JB type regarding to Manjila classification system, and incidences of JB diverticulum (JBD), JB related inner ear dehiscence (JBID), and inner ear adjacent JB (IAJB). VA-related indices included CT-VA visibility, CT-VA morphology (funnel, tubular, filiform, hollow, and obliterated-shaped type), and peri-VA pneumatization. Radiological indices were compared between MD ears and control ears.ResultsRadiological JB abnormalities were comparable between MD ears and control ears. As for VA-related indices, the CT-VA visibility was lower in MD ears than in control ears (p = 0.004). The distribution of CT-VA morphology was significantly different between MD and control ears (p = 0.013), with a higher proportion of obliterated-shaped type in MD ears (22.1%) than in control ears (6.6%).ConclusionCompared with JB abnormalities, the anatomical variations of VA are more likely to be an anatomically predisposing factor for MD.

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Meniere's Disease Patients with Distinct Sac Pathoanatomic Findings React Differently to Endolymphatic Duct Blockage

Cited by 3 publications

References 39 publications

Recent surgical advances and continued controversies in medically refractory Meniere's disease

Recent surgical advances and continued controversies in medically refractory Meniere's disease

Comparison of vestibular aqueduct visualization on computed tomography and magnetic resonance imaging in patients with Ménière’s disease

Comparison of radiological abnormalities between the jugular bulb and the vestibular aqueduct in patients with Ménière’s disease

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