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Jasińska-Nowacka A, Lachowska M, Wnuk E, Niemczyk K. Hydrops regression after vestibular denervation - longitudinal magnetic resonance study in patients with severe Meniere's disease treated with vestibular neurectomy. Acta Neurol Belg 2024:10.1007/s13760-024-02605-x. [PMID: 39078606 DOI: 10.1007/s13760-024-02605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 07/13/2024] [Indexed: 07/31/2024]
Abstract
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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Affiliation(s)
- Agnieszka Jasińska-Nowacka
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, Warszawa (Warsaw), 02-097, Poland
| | - Magdalena Lachowska
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, Warszawa (Warsaw), 02-097, Poland.
| | - Emilia Wnuk
- Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, ul. Banacha 1a, Warszawa (Warsaw), 02-097, Poland
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Sun Z, Zhang Y, Liu B, Duan J, Liu G, Zhou X. The correlation of hearing prognosis and caloric test results in Meniere's disease: a follow up study. Acta Otolaryngol 2024; 144:100-106. [PMID: 38436675 DOI: 10.1080/00016489.2024.2324136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Hearing loss is important in the diagnosis and treatment of Meniere's disease (MD). However, little is known about the factors associated with hearing changes in MD. AIMS/OBJECTIVES This study aimed to investigate the correlation between hearing prognosis and caloric test (CT) results in MD. MATERIAL AND METHODS Ninety consecutive patients diagnosed with unilateral definite MD underwent pure tone audiometry (PTA) and CT at initial visits, and were re-tested PTA at the 6-month follow-up. RESULTS Fifty-three of ninety MD patients (58.89%) had abnormal CT results. The change of PTA (cPTA = initial PTA-last PTA) was negatively correlated with canal paresis (CP) values (overall association p = 0.032 and non-linear association p = 0.413). Multivariate linear model showed that as the CP value changed from 0 to 1, the cPTA decreased by -13.31 dB (95% CI: -24.03, -2.6) (p = 0.016). Stratified analysis found that the association was present in MD patients of Stage 1 and 2 (p < 0.05) but not in patients of Stage 3 and 4 (p > 0.05). CONCLUSIONS AND SIGNIFICANCE Elevated CP values may be linked to worse hearing outcomes in MD, especially in Stage 1 and 2 patients. Conducting a caloric test at the initial consultation may aid in assessing hearing regression in MD.
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Affiliation(s)
- Zhengtao Sun
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Yi Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Bo Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Jinping Duan
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Gang Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Xinyang Zhou
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Beijing, China
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Mavrommatis MA, Kaul VF, Chow K, Fan CJ, Bellaire CP, Cosetti MK, Wanna GB, Perez E. Temporal changes in endolymphatic hydrops on MRI with or without intervention: A systematic review. Am J Otolaryngol 2023; 44:103764. [PMID: 36587603 DOI: 10.1016/j.amjoto.2022.103764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The pathophysiology of Meniere's Disease (MD) involves endolymphatic hydrops (ELH) of the inner ear. Magnetic Resonance Imaging (MRI) has been shown to detect ELH, but changes in ELH have been poorly described using this modality. Our objective was to review MRI-measured changes in ELH over time and after medical and/or surgical intervention in patients with MD. We secondarily aim to associate changes in ELH with changes in MD symptomatology. DATABASES REVIEWED Medline, Web of Science, and Embase databases. METHODS A systematic review of articles was performed to identify studies utilizing MRI to measure ELH changes over time, and after medical or surgical treatment. Articles on non-human subjects and without direct measurement of ELH were excluded. RESULTS Of 532 studies identified, 12 were included, involving 170 patients (mean age 56.3 years). Ten studies were prospective; two were retrospective. Five studies strictly utilized medical means of intervention, four utilized surgical treatments, one utilized both, and two observed temporal changes without treatment. Across all interventions, 72.1 % of patients exhibited the same or worsening ELH on imaging. In studies reporting vertigo outcomes, 95.9 % of patients exhibited improvement after the treatment period. CONCLUSION Medical and surgical interventions often yield symptomatic relief of vertigo in MD patients despite stable or increasing ELH volume. MRI may have greater clinical utility in diagnosing ELH as opposed to assessing treatment response.
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Affiliation(s)
- Maria A Mavrommatis
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai, New York, NY, USA
| | - Vivian F Kaul
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kevin Chow
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Caleb J Fan
- Michigan Ear Institute, Farmington Hills, MI, USA
| | | | - Maura K Cosetti
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai, New York, NY, USA
| | - George B Wanna
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai, New York, NY, USA
| | - Enrique Perez
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai, New York, NY, USA
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Li J, Wang L, Hu N, Li L, Song G, Xu H, Xu T, Dou W, Li C, Yan W, Sun L, Gong R. Longitudinal variation of endolymphatic hydrops in patients with Ménière's disease. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:44. [PMID: 36819498 PMCID: PMC9929744 DOI: 10.21037/atm-22-6313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
Background The relationships of endolymphatic hydrops (EH) and perilymphatic enhancement (PE) with Ménière's disease (MD) remains unclear. This study aimed to describe the dynamic variation of EH and PE for MD patients over 2 hospitalizations by applying magnetic resonance imaging (MRI) to further clarify the relationships of EH and PE with MD. Methods A total of 77 MD patients who underwent inner ear MRI after intravenous administration of gadolinium and pure-tone average (PTA) testing during a first and second hospitalization were included. The degree of EH and PE were evaluated via MRI, and the duration and frequency of vertigo attacks and PTA were collected and recorded. The PTA, EH, and PE for the 2 hospitalizations were compared, and the relationships of EH and cochlear PE with the MD stage were investigated. Results There was no difference between the 2 hospitalizations for duration of vertigo attacks or frequency of vertigo attacks. However, there were significant differences in PTA (Z=-3.02, P=0.003). Additionally, the cochlear and vestibular EH in the asymptomatic ear at the second hospitalization was significantly worse than that of the first hospitalization (Z=-2.33 and -2.49, P=0.020 and 0.013, respectively), while there were no differences in EH and PE in the affected ear (all P>0.05). Moreover, the degree of cochlear and vestibular EH was correlated with MD stage (both P<0.01). Conclusions Although EH and PE in the affected ear were unchanged over 2 hospitalizations, an underlying EH in the asymptomatic ear and hearing loss in the affected ear for MD patients developed longitudinally with the duration of disease, and EH varied with the natural course of MD whereas PE did not. Therefore, EH instead of PE is necessary but insufficient to cause the clinical symptoms of MD.
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Affiliation(s)
- Jinye Li
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Linsheng Wang
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Na Hu
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Long Li
- Department of Medical Service, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Gesheng Song
- Department of Radiology, Shandong Province Qianfoshan Hospital, Jinan, China
| | - Han Xu
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Ting Xu
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Beijing, China
| | - Chuanting Li
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Wenqing Yan
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Lixin Sun
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China
| | - Ruozhen Gong
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, Jinan, China;,Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, China;,Gong Ruozhen Innovation Studio, Shandong Provincial Hospital, Shandong University, Jinan, China
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Diorflar S, Guigou C, Daguet E, Bensimon JL, Toupet M, Bozorg-Grayeli A. Confrontation of endolymphatic hydrops diagnosis on 3-Tesla MRI to clinical and audiovestibular findings in Meniere's disease. Front Neurol 2023; 14:1105461. [PMID: 36779070 PMCID: PMC9909016 DOI: 10.3389/fneur.2023.1105461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Objective The aim of this study was to compare different MRI diagnostic criteria for endolymphatic hydrops (EH) and to investigate the relation between audiovestibular and MRI findings in Meniere's disease (MD). Materials and methods Prospective cross-sectional cohort study in 2 referral centers included 76 patients with unilateral (n = 62) or bilateral (n = 14) MD. All patients underwent inner ear 3T-MRI 4 h (n = 52) or >24H (n = 24) following audiovestibular tests. T2-CISS and 3D-FLAIR images 4H after gadolinium were obtained. EH diagnosis was based on saccular morphology on coronal views (T2 and 3D-FLAIR), semi quantitative estimation of endolymphatic space enlargement, and saccule utricle ratio inversion (SURI) on 3D-FLAIR axial views. Results SURI was the best criterion related to the disease side (43 SURI+ on symptomatic ears, n = 77, vs. 6 SURI+ on asymptomatic ears, n = 53, p < 0.0001, Chi-2). Same-day MRI revealed relation between EH, hearing loss and caloric weakness which could not be detected on delayed MRI: SURI was associated with a higher pure-tone average (43 ± 4.1 dB in SURI+ ears, n = 42 vs. 23 ± 2.6 SURI-, n = 62, p < 0.0001, unpaired t-test,), and a higher proportion of vestibular caloric weakness (23/46 SURI+ ears vs. 4/62 SURI-, p < 0.001, Chi-2). Among all criteria, SURI combined to caloric weakness was the best predictor of the affected side in a logistic regression model. Conclusion SURI had the strongest relation to the side the disease and audio vestibular findings for unilateral, probable and definite meniere disease. A short delay between MRI and audio vestibular tests improved the coherence between the findings.
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Affiliation(s)
- Sarah Diorflar
- Department of Otolaryngology, Dijon University Hospital, Dijon, France
| | - Caroline Guigou
- Department of Otolaryngology, Dijon University Hospital, Dijon, France,ImVia, Université Bourgogne Franche-Comté, Dijon, France,*Correspondence: Caroline Guigou ✉
| | | | | | - Michel Toupet
- Department of Otolaryngology, Dijon University Hospital, Dijon, France,Centre d'Explorations Fonctionnelles Otoneurologiques, Paris, France
| | - Alexis Bozorg-Grayeli
- Department of Otolaryngology, Dijon University Hospital, Dijon, France,ImVia, Université Bourgogne Franche-Comté, Dijon, France
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Gürkov R, Barath K, de Foer B, Fukushima M, Gluth M, Hornibrook J, Perez-Fernandez N, Pyykkö I, Sone M, Usami SI, Wang W, Zou J, Naganawa S. A plea for systematic literature analysis and conclusive study design, comment on: "Systematic review of magnetic resonance imaging for diagnosis of Meniere disease". J Vestib Res 2023; 33:151-157. [PMID: 31658075 DOI: 10.3233/ves-190662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Robert Gürkov
- Department of Otorhinolaryngology Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
| | - Krisztina Barath
- Radiologie und Neuroradiologie am Glattzentrum, Wallisellen, Switzerland
| | - Bert de Foer
- Department of Radiology, GZA Hospitals Antwerp, Belgium
| | - Munehisa Fukushima
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Michael Gluth
- Section of Otolaryngology- Head & Neck Surgery, The University of Chicago Medicine & Biological Sciences, Chicago, USA
| | - Jermy Hornibrook
- Canterbury District Health Board, Department of Otolaryngology, Christchurch, New Zealand
| | | | | | | | - Shin-Ichi Usami
- Department of Otorhinolaryngology, Shinshu University School of Medicine, China
| | - Wuqing Wang
- Eye Ear Nose and Throat Hospital of Fudan University, China
| | - Jing Zou
- Department of Otolaryngology, Changhai Hospital Second Military Medical University, Shanghai, China
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Gürkov R. Retraction to: A plea for systematic literature analysis and conclusive study design. J Vestib Res 2023; 33:163. [PMID: 31177255 DOI: 10.3233/ves-180662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Robert Gürkov
- Department of Otorhinolaryngology Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
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Lopez-Escamez JA, Attyé A. Magnetic resonance imaging of endolymphatic hydrops: Controversies and common ground, comment on: "A plea for systematic literature analysis and conclusive study design". J Vestib Res 2023; 33:159-162. [PMID: 31177256 DOI: 10.3233/ves-180663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Jose A Lopez-Escamez
- Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (Genyo), Otology & Neurotology Group CTS495, PTS, Granada, Spain
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria, ibs.Granada, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Arnaud Attyé
- Department of Neuroradiology and MRI, Grenoble, France
- IRMaGe Facility, Grenoble Alps University, Grenoble, France
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Fukushima M, Akahani S, Okamoto H, Takeda N, Inohara H. Assessment of inner ear morphology and function in response to local positive pressure for Ménière's disease: a nonrandomized controlled trial. Sci Rep 2022; 12:20782. [PMID: 36456740 PMCID: PMC9715546 DOI: 10.1038/s41598-022-25321-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Ménière's disease (MD) is an inner ear disorder in which the main pathological feature is endolymphatic hydrops (EH). Positive pressure therapy (PPT) using a portable device is now a second-line therapy for intractable MD when initial medical treatment fails. However, it remains unknown whether PPT causes the morphological and functional changes of inner ear in patients with active MD in accordance with reduction of vertigo attacks. In this nonrandomized controlled trial of 52 patients with MD, the volume of EH significantly decreased with reduction of vertigo attacks during 8 months of PPT combined with medications while the volume of that significantly increased with medications alone. There was no difference between Control group (n = 26) and PPT group (n = 26) regarding the vertigo control, however, PPT group achieved a significant functional improvement of vertical semicircular canals. The effect of volume reduction by PPT has been firstly demonstrated and the functional changes of all semicircular canals during PPT have been firstly examined. Morphological and functional changes in the inner ear by administrating local positive pressure are quite different from those caused by medications alone.Clinical trial registration: UMIN-CTR UMIN000041164 (registered on July 20, 2020).
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Affiliation(s)
- Munehisa Fukushima
- grid.414976.90000 0004 0546 3696Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511 Japan ,grid.136593.b0000 0004 0373 3971Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shiro Akahani
- grid.414976.90000 0004 0546 3696Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511 Japan
| | - Hidehiko Okamoto
- grid.411731.10000 0004 0531 3030Department of Physiology, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Noriaki Takeda
- grid.267335.60000 0001 1092 3579Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan
| | - Hidenori Inohara
- grid.136593.b0000 0004 0373 3971Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Is there progression of endolymphatic hydrops in Ménière’s disease? Longitudinal magnetic resonance study. Eur Arch Otorhinolaryngol 2022; 280:2225-2235. [PMID: 36344698 DOI: 10.1007/s00405-022-07721-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Endolymphatic hydrops (EH) is universal in Ménière´s disease (MD). Given its chronic course, with variable interval before complete clinical picture is installed, it seems relevant to understand the progression of vestibular EH and hemato-perilymphatic barrier disruption in patients with MD and monosymptomatic presentations. METHODS 239 consecutive patients were referred to us with suspected hydropic ear disease. 50 individuals accepted to participate in this study-final longitudinal sample included 24 patients (7 D1, 7 D2, 10 D3). Control group included ten patients. At recruitment, a clinical and MRI re-evaluation was done (3T, intravenous technique) (MR2) and 2 years after MRI was repeated (MR3). Previous MRI (MRI1) were retrospectively evaluated. Patients were classified as definite (D1), possible (D2) and atypical (D3-monosymptomatic) MD. Control group included non-typical symptoms (C2/C3) and 6 asymptomatic (C1). Vestibular endolymphatic ratio (vER) and grading, presence/absence of cochlear EH, asymmetry of cochlear perilymphatic enhancement, and rate of progression of vER were assessed by two independent neuroradiologists and compared between patient and control groups (index ear). RESULTS EH was universal and pronounced in D1 and remained stable. vER progression was more variable and higher in some D3 patients (index ear worse) and in D2 (non-index), although this observation was not statistically significant. CONCLUSIONS Considering that many probable and monosymptomatic presentations progress years later into definite MD and given the bilateral tendency of the disease, these findings may indicate that there is an initial accelerated worsening of EH in initial stages of the disease. These data should be confirmed with controlled and larger sample studies.
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Niu Y, Chen W, Lin M, Sha Y. Progression of endolymphatic hydrops and vertigo during treatment in Meniere's disease. Acta Otolaryngol 2022; 142:653-657. [PMID: 36369788 DOI: 10.1080/00016489.2022.2138968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with Meniere's disease (MD) receive treatment to reduce vertigo. PURPOSE To explore the fluctuation of vertigo symptoms and the changes in endolymphatic hydrops (EHs) in MD patients during long-term regular medication. MATERIALS AND METHODS We enrolled MD patients who had received two magnetic resonance imaging with intravenous contrast agents. RESULTS Of the 42 patients in the study, 18(42.9%) had progressive EHs and 3(7.1%) had remission. The change value of the signal intensity ratio (SIR; cochlear perilymph/cerebellum) on the affected side (1.2) was larger than that on the healthy side (0.9), but there was no statistical difference. Among the 30 patients followed up, two patients had complete control of vertigo, two patients had substantial control, and three patients had worse control. The other 23 patients had insignificant control of vertigo symptoms before and after treatment. The correlation between the progression of cochlear and vestibular hydrops and the improvement of vertigo symptoms in MD patients was not significant. CONCLUSIONS AND SIGNIFICANCE In treated patients with MD, EHs may progress or relieve over the long course of the disease. But there was no correlation between the development of EHs and changes in vertigo symptoms.
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Affiliation(s)
- Yue Niu
- Eye, Ear, Nose and Throat (EENT) Hospital, Fudan University, Shanghai, PR China
| | - Wei Chen
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, PR China
| | - Mengyan Lin
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, PR China
| | - Yan Sha
- Eye, Ear, Nose and Throat (EENT) Hospital, Fudan University, Shanghai, PR China
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12
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Niu Y, Chen W, Lin M, Sha Y. Development and Characteristics of Hearing Loss With the Progression of Endolymphatic Hydrops. EAR, NOSE & THROAT JOURNAL 2022:1455613221101088. [PMID: 35856637 DOI: 10.1177/01455613221101088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This study aims to explore how patients' hearing loss developed with the progression of endolymphatic hydrops and the characteristics of hearing loss at different stages. MATERIALS AND METHODS We collected 73 patients with definite or possible unilateral Meniere's disease or sudden hearing loss who underwent magnetic resonance imaging after intravenous contrast agent injection. There were 25 cases of isolated cochlear hydrops, 24 cases of isolated vestibular hydrops, and 24 cases of cochlear and vestibular hydrops. Primary outcome analyses included their evaluation of endolymphatic hydrops and hearing thresholds at low and high frequencies. RESULTS The overall hearing threshold of patients with vestibular and cochlear hydrops was significantly higher than that of patients with isolated cochlear hydrops and patients with isolated vestibular hydrops. There was a significant correlation between low-frequency hearing loss and cochlear hydrops, and the low-frequency hearing threshold was proportional to the grade of cochlear hydrops. At low frequency, the hearing threshold of patients with isolated vestibular hydrops was lower than that of patients with isolated cochlear hydrops and patients with both cochlear and vestibular hydrops. The audiogram configurations of patients with isolated cochlear hydrops consist largely of flat type and up-sloping type. The audiogram configurations of patients with isolated vestibular hydrops and patients with both cochlear and vestibular hydrops are mainly flat type and down-sloping type. CONCLUSIONS Patients present with low-frequency hearing loss in the early stage of endolymphatic hydrops. When the hydrops involves the whole cochlea and vestibule, the patients' hearing is impaired at both low and high frequencies.
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Affiliation(s)
- Yue Niu
- Eye, Ear, Nose and Throat (EENT) Hospital of Fudan University, Shanghai, China
| | - Wei Chen
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Mengyan Lin
- Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yan Sha
- Eye, Ear, Nose and Throat (EENT) Hospital of Fudan University, Shanghai, China
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van der Lubbe MFJA, Vaidyanathan A, de Wit M, van den Burg EL, Postma AA, Bruintjes TD, Bilderbeek-Beckers MAL, Dammeijer PFM, Bossche SV, Van Rompaey V, Lambin P, van Hoof M, van de Berg R. A non-invasive, automated diagnosis of Menière's disease using radiomics and machine learning on conventional magnetic resonance imaging: A multicentric, case-controlled feasibility study. Radiol Med 2021; 127:72-82. [PMID: 34822101 PMCID: PMC8795017 DOI: 10.1007/s11547-021-01425-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/26/2021] [Indexed: 12/02/2022]
Abstract
Purpose This study investigated the feasibility of a new image analysis technique (radiomics) on conventional MRI for the computer-aided diagnosis of Menière’s disease. Materials and methods A retrospective, multicentric diagnostic case–control study was performed. This study included 120 patients with unilateral or bilateral Menière’s disease and 140 controls from four centers in the Netherlands and Belgium. Multiple radiomic features were extracted from conventional MRI scans and used to train a machine learning-based, multi-layer perceptron classification model to distinguish patients with Menière’s disease from controls. The primary outcomes were accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the classification model. Results The classification accuracy of the machine learning model on the test set was 82%, with a sensitivity of 83%, and a specificity of 82%. The positive and negative predictive values were 71%, and 90%, respectively. Conclusion The multi-layer perceptron classification model yielded a precise, high-diagnostic performance in identifying patients with Menière’s disease based on radiomic features extracted from conventional T2-weighted MRI scans. In the future, radiomics might serve as a fast and noninvasive decision support system, next to clinical evaluation in the diagnosis of Menière’s disease. Supplementary Information The online version contains supplementary material available at 10.1007/s11547-021-01425-w.
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Affiliation(s)
- Marly F J A van der Lubbe
- Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Center +, Maastricht, The Netherlands.
| | - Akshayaa Vaidyanathan
- The D-Lab, Department of Precision Medicine, GROW Research Institute for Oncology, Maastricht University, Maastricht, The Netherlands.,Research and Development, Oncoradiomics SA, Liege, Belgium
| | - Marjolein de Wit
- Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Elske L van den Burg
- Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Mental Health and Sciences, Maastricht University, Maastricht, The Netherlands
| | - Tjasse D Bruintjes
- Department of Otorhinolaryngology, Gelre Hospital, Apeldoorn, The Netherlands.,Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Stephanie Vanden Bossche
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium.,Department of Radiology, AZ St-Jan Brugge-Oostende, Bruges, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW Research Institute for Oncology, Maastricht University, Maastricht, The Netherlands
| | - Marc van Hoof
- Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Raymond van de Berg
- Department of Otolaryngology and Head and Neck Surgery, Maastricht University Medical Center +, Maastricht, The Netherlands
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14
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Fukushima M, Suekata Y, Kusumoto T, Akahani S, Okamoto H, Inohara H, Takeda N. Rupture-Like Shrinkage and Regrowth of Endolymphatic Hydrops in Ménière's Disease During Remission. Otol Neurotol 2021; 42:1390-1393. [PMID: 34191784 DOI: 10.1097/mao.0000000000003221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To clarify pathophysiological characteristics of Ménière's disease during the remission phase. PATIENTS Two Ménière's disease patients with different disease durations, whose endolymphatic hydrops was longitudinally observed using 3-T magnetic resonance imaging. INTERVENTIONS Diagnostic. MAIN OUTCOMES AND MEASURES Morphological changes of endolymphatic hydrops visualized using 3-T magnetic resonance imaging. RESULTS Rupture-like shrinkage and regrowth of endolymphatic hydrops during the remission phase was observed in both patients. CONCLUSION The remission phase with hearing improvement could be as important as vertigo attacks in Ménière's disease.
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Affiliation(s)
- Munehisa Fukushima
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo
| | - Yu Suekata
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo
| | - Takuya Kusumoto
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo
| | - Shiro Akahani
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo
| | - Hidehiko Okamoto
- Department of Physiology, School of Medicine, International University of Health and Welfare, Chiba
| | - Hidenori Inohara
- Department of Otolaryngology and Head and Neck Surgery, Osaka University, Graduate School of Medicine, Osaka
| | - Noriaki Takeda
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan
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15
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Magnetic resonance imaging and Ménière's disease-unavoidable alliance. Neuroradiology 2021; 63:1749-1763. [PMID: 34142211 DOI: 10.1007/s00234-021-02744-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 05/31/2021] [Indexed: 12/28/2022]
Abstract
Ménière's disease (MD) is a clinical syndrome characterized by recurrent episodes of spontaneous vertigo, unilateral fluctuating sensorineural hearing loss, tinnitus, and aural fullness. Endolymphatic hydrops is recognized as the pathophysiological substrate of the disease, having been demonstrated in anatomical pathological studies and more recently by magnetic resonance imaging (MRI). The current criteria of the disease, however, remain symptom based and do not include the demonstration of endolymphatic hydrops. The authors review MRI techniques and diagnostic criteria of endolymphatic hydrops and the role of MRI in MD is discussed.
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16
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Fukushima M, Akahani S, Inohara H, Takeda N. Case Report: Positive Pressure Therapy Combined With Endolymphatic sac Surgery in a Patient With Ménière's Disease. Front Surg 2021; 8:606100. [PMID: 33842529 PMCID: PMC8027478 DOI: 10.3389/fsurg.2021.606100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/03/2021] [Indexed: 12/03/2022] Open
Abstract
Positive pressure therapy (PPT) is applied for medically-intractable vertigo in Ménière's disease (MD); however, it remains unknown whether PPT affects in vivo endolymphatic hydrops (EH). In this case report, we describe a 5-year course of MD in a patient in which EH was repeatedly observed. As the patient experienced recurrent vertigo attacks after endolymphatic sac surgery, he began to use the PPT device additionally and vertiginous episodes decreased in accordance with a decrease in the EH volume. The mechanism of PPT is suggested that the pressure increase in the middle ear inhibits EH development. PPT, if added after surgery, might be more effective to reduce EH volume compared with surgery alone. A larger study group size is required to test these preliminary data concerning EH changes.
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Affiliation(s)
- Munehisa Fukushima
- Department of Otolaryngology-Head and Neck Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Shiro Akahani
- Department of Otolaryngology-Head and Neck Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Hidenori Inohara
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Noriaki Takeda
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan
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17
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Fukushima M, Ueno Y, Kitayama I, Akahani S, Inohara H, Takeda N. Assessment of the Progression of Vertical Semicircular Canal Dysfunction and Increased Vestibular Endolymphatic Hydrops in Patients With Early-Stage Ménière Disease. JAMA Otolaryngol Head Neck Surg 2021; 146:789-800. [PMID: 32644132 DOI: 10.1001/jamaoto.2020.1496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Importance Vertical semicircular canals and endolymphatic hydrops play important roles in the pathophysiological mechanisms of Ménière disease. However, their characteristics and associations with disease progression during medical treatment have not been determined. Objective To examine the function of both the horizontal and vertical semicircular canals in patients with Ménière disease and to evaluate the change in endolymphatic hydrops volume during medical treatment, including treatment with diuretic therapy, over a 2-year period. Design, Setting, and Participants This prospective longitudinal observational cohort study included 55 patients with definite unilateral Ménière disease and was performed in a tertiary care hospital in Japan. Participants were enrolled between April 1, 2017, and January 31, 2018, and those with vestibular migraine were excluded. All participants received education regarding diet and lifestyle modifications and treatment with betahistine mesylate (36 mg daily) and/or an osmotic diuretic (42-63 mg daily). Patients were followed up for vertigo and hearing evaluations at least once per month for more than 12 months and were instructed to record episodes of vertigo in a self-check diary. Audiometry was performed monthly, video head impulse testing and caloric testing were performed every 4 months, and magnetic resonance imaging was conducted annually. Data were analyzed from May 15, 2017, to January 31, 2020. Main Outcomes and Measures Neurootological testing to evaluate vestibuloocular reflex gain over time, magnetic resonance imaging to evaluate the change in endolymphatic hydrops volume over time, and monthly vertigo and hearing evaluations for more than 12 months. Results Among 55 participants with definite Ménière disease, 32 patients (58.2%) were female, and the mean (SD) age was 59.0 (15.1) years. The median disease duration was 2 years (interquartile range, 0-4 years), with 43 patients (78.2%) having an early stage (ie, disease duration ≤4 years) of Ménière disease. Over the 2-year study period, the vestibuloocular reflex gain decreased from 0.76 to 0.56 in the superior semicircular canals, for a difference of 0.20 (95% CI, 0.14-0.26) and from 0.68 to 0.50 in the posterior semicircular canals, for a difference of 0.18 (95% CI, 0.14-0.22). The maximum slow-phase velocity and vestibuloocular reflex gain in the horizontal semicircular canals were maintained. The volume ratio of vestibular endolymphatic hydrops increased from 19.7% to 23.3%, for a difference of 3.6% (95% CI, 1.4%-5.8%). The frequency of vertiginous episodes decreased, and the hearing level over the study period worsened from 40.9 dB to 44.5 dB, for a difference of 3.5 dB (95% CI, 0.7-6.4 dB). Conclusions and Relevance In this study, during a 2-year period of medical treatment among patients with Ménière disease, vestibuloocular reflex gain decreased in the vertical semicircular canals but was maintained in the horizontal semicircular canals; the endolymphatic hydrops volume ratio increased, and the frequency of vertiginous episodes decreased. These findings describe the pathological progression of chronic Ménière disease and expand the understanding of its pathophysiological characteristics during the early stage of disease.
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Affiliation(s)
- Munehisa Fukushima
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan.,Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuya Ueno
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Itsuki Kitayama
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Shiro Akahani
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Hidenori Inohara
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Noriaki Takeda
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan
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18
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Naganawa S, Nakamichi R, Ichikawa K, Kawamura M, Kawai H, Yoshida T, Sone M. MR Imaging of Endolymphatic Hydrops: Utility of iHYDROPS-Mi2 Combined with Deep Learning Reconstruction Denoising. Magn Reson Med Sci 2020; 20:272-279. [PMID: 32830173 PMCID: PMC8424026 DOI: 10.2463/mrms.mp.2020-0082] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: MRI of endolymphatic hydrops (EH) 4 h after intravenous administration of a single dose of gadolinium-based contrast agent is used for clinical examination in some institutions; however, further improvement in image quality would be valuable for wider clinical utility. Denoising using deep learning reconstruction (Advanced Intelligent Clear-IQ Engine [AiCE]) has been reported for CT and MR. The purpose of this study was to compare the contrast-to-noise ratio of endolymph to perilymph (CNREP) between the improved hybrid of reversed image of the positive endolymph signal and the native image of the perilymph signal multiplied with the heavily T2-weighted MR cisternography (iHYDROPS-Mi2) images, which used AiCE for the three source images (i.e. positive endolymph image [PEI], positive perilymph image [PPI], MR cisternography [MRC]) to those that did not use AiCE. We also examined if there was a difference between iHYDROPS-Mi2 images with and without AiCE for degree of visual grading of EH and in endolymphatic area [EL] ratios. Methods: Nine patients with suspicion of EH were imaged on a 3T MR scanner. iHYDROPS images were generated by subtraction of PEI images from PPI images. iHYDROPS-Mi2 images were then generated by multiplying MRC with iHYDROPS images. The CNREP and EL ratio were measured on the iHYDROPS-Mi2 images. Degree of radiologist visual grading for EH was evaluated. Results: Mean CNREP ± standard deviation was 1681.8 ± 845.2 without AiCE and 7738.6 ± 5149.2 with AiCE (P = 0.00002). There was no significant difference in EL ratio for images with and without AiCE. Radiologist grading for EH agreed completely between the 2 image types in both the cochlea and vestibule. Conclusion: The CNREP of iHYDROPS-Mi2 images with AiCE had more than a fourfold increase compared with that without AiCE. Use of AiCE did not adversely affect radiologist grading of EH.
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Affiliation(s)
- Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Rei Nakamichi
- Department of Radiology, Nagoya University Graduate School of Medicine
| | | | - Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Hisashi Kawai
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine
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19
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Hahn HJ, Kwak SG, Kim DK, Kim JY. A Nationwide, Population-based Cohort Study on Potential Autoimmune Association of Ménière Disease to Atopy and Vitiligo. Sci Rep 2019; 9:4406. [PMID: 30867466 PMCID: PMC6416401 DOI: 10.1038/s41598-019-40658-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/21/2019] [Indexed: 12/16/2022] Open
Abstract
Ménière disease (MD), an idiopathic disorder of sensorineural hearing loss and vertigo, shares many similarities with two common skin conditions, atopic dermatitis (AD) and vitiligo. Recent studies have suggested that MD may be related to or triggered by autoimmune conditions, notably Hashimoto thyroiditis and alopecia areata. These evidences led to the authors contemplating the possibility of immunological bridge between MD and the two skin conditions. The authors have tested this hypothesis with population-based cohort from the National Health Insurance Service Database of Korea. A cohort of 1.1 million patients was extracted from the database. Using χ2 tests, prevalence of the two skin disorders in relation to MD status was analysed. In MD patients, the odds ratios for having concurrent AD and vitiligo were 0.717 (95% CI, 0.535–0.962, p = 0.026) and 2.149 (95% CI, 1.396–3.308, p = 0.001), respectively. Females and older patients were more than twice likely to be affected by the two skin conditions. The relationship between vitiligo and MD was significant in younger subgroup only. Socio-economic subgroup analysis revealed the observed patterns are primarily a middle-upper class phenomenon. Uncertainty regarding temporal sequence of onset, and lack of detail on disease severity and subtype kept the study from more refined conclusion. In concluding, AD and vitiligo might be linked to MD through Treg-driven action of cellular immunity, but further big data-based investigations must follow.
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Affiliation(s)
- Hyung Jin Hahn
- Department of Dermatology, College of Medicine, Konyang University, Daejeon, Republic of Korea.,Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Sang Gyu Kwak
- School of Medicine, Department of Medical Statistics, Catholic University of Daegu, Gyeongsan, South Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea. .,Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea.
| | - Jong-Yeup Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea. .,Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, Republic of Korea. .,Myunggok Medical Research Institute, College of Medicine, Konyang University, Daejeon, Republic of Korea.
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20
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Fukushima M, Oya R, Nozaki K, Eguchi H, Akahani S, Inohara H, Takeda N. Vertical head impulse and caloric are complementary but react opposite to Meniere's disease hydrops. Laryngoscope 2018; 129:1660-1666. [PMID: 30515842 DOI: 10.1002/lary.27580] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS Meniere's disease (MD) patients can show normal head impulses despite poor caloric test results. This study aimed to investigate the discrepancy in the vestibulo-ocular reflex (VOR) in MD patients and whether endolymphatic hydrops (EH) influence the VOR. STUDY DESIGN Prospective, cross-sectional observational study. METHODS Ninety MD patients were enrolled. Neuro-otological testing, including a video head impulse test (vHIT) of all semicircular canals (SCs), and gadolinium-enhanced inner ear magnetic resonance imaging were performed. The vestibular EH volume was quantitatively evaluated by processing magnetic resonance images. RESULTS Abnormal vHIT results in MD patients were found most frequently in the posterior (44.4%) SCs, followed by the horizontal (13.3%) and anterior (10%) SCs. Canal paresis (CP) was assessed using the vHIT and the caloric test, and results were not significant when vHIT responses were assessed as CP only using the horizontal SC. The difference in the vestibular EH between the presence and absence of CP was not significant if assessed using the vHIT (P = .5591), but it was statistically different if assessed using the caloric test (P = .0467). CONCLUSIONS The contradictory reaction of VOR in MD patients may result from the high specificity but low sensitivity of CP in the horizontal vHIT. EH volume in the vestibule affects the caloric response but does not affect the vHIT response. LEVEL OF EVIDENCE 2b Laryngoscope, 129:1660-1666, 2019.
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Affiliation(s)
- Munehisa Fukushima
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan.,Department of Otolaryngology and Head and Neck Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Ryohei Oya
- Department of Otolaryngology and Head and Neck Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Kengo Nozaki
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Hirotaka Eguchi
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Shiro Akahani
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Hidenori Inohara
- Department of Otolaryngology and Head and Neck Surgery, Osaka University, Graduate School of Medicine, Osaka, Japan
| | - Noriaki Takeda
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan
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