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Ueno Y, Imai T, Higashi-Shingai K, Ohta Y, Sato T, Kamakura T, Ozono Y, Inohara H. Stratification of patients with Menière's disease based on eye movement videos recorded from the beginning of vertigo attacks and contrast-enhanced MRI findings. Front Neurol 2024; 14:1348177. [PMID: 38274876 PMCID: PMC10809283 DOI: 10.3389/fneur.2023.1348177] [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: 12/02/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Purpose Diagnosis of Menière's disease (MD) relies on subjective factors and the patients diagnosed with MD may have heterogeneous pathophysiologies. This study aims to stratify MD patients using two objective data, nystagmus videos and contrast-enhanced magnetic resonance imaging (CE-MRI). Methods This is a retrospective cross-sectional study. According to the Japan Society for Equilibrium Research criteria (c-JSER), adults diagnosed with definite MD and who obtained videos recorded by portable nystagmus recorder immediately following vertigo attacks and underwent CE-MRI of the inner ear were included (ss = 91). Patients who obtained no nystagmus videos, who had undergone sac surgery, and those with long examination intervals were excluded (n = 40). Results The gender of the subjects was 22 males and 29 females. The age range was 20-82 y, with a median of 54 y. Endolymphatic hydrops (EH) were observed on CE-MRI in 84% (43 patients). Thirty-one patients had unilateral EH. All of them demonstrated EH on the side of the presence of cochlear symptoms. The number of patients who had both nystagmus and EH was 38. Five patients only showed EH and 5 patients only exhibited nystagmus, while 3 patients did not have either. Of the 43 nystagmus records, 32 showed irritative nystagmus immediately after the vertigo episode. The direction of nystagmus later reversed in 44% of cases over 24 h. Conclusion Patients were stratified into subgroups based on the presence or absence of EH and nystagmus. The side with cochlear symptoms was consistent with EH. The c-JSER allows for the diagnosis of early-stage MD patients, and it can be used to treat early MD and preserve hearing; however, this approach may also include patients with different pathologies.
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Affiliation(s)
- Yuya Ueno
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takao Imai
- Department of Otorhinolaryngology and Head and Neck Surgery, Bellland General Hospital, Osaka, Japan
| | - Kayoko Higashi-Shingai
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yumi Ohta
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Sato
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takefumi Kamakura
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiyuki Ozono
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Xiao H, Chen Y, Huang Q, Huang M, Zheng Y, Fang Z, Chen G. Differentiating Meniere's Disease and Vestibular Migraine: Insights from Gadolinium-Enhanced Magnetic Resonance Imaging and Clinical Features. Laryngoscope 2024; 134:426-432. [PMID: 37357969 DOI: 10.1002/lary.30858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/19/2023] [Accepted: 06/14/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To explore the predictive factors between Meniere's disease (MD) and vestibular migraine (VM) by Gadolinium-enhanced Magnetic resonance imaging (MRI) of the inner ear and Clinical Features. METHODS Eighty-seven patients (50 MD and 37 VM) underwent intratympanic injection of gadolinium and MRI was performed 24 h later. All patients underwent pure tone audiometry and caloric tests. RESULTS In the MD group, 46 (92%) of 50 patients developed endolymphatic hydrops, although only 2 (5.4%) in the vestibular migraine (VM) group had positive results groups (p < 0.001). The incidence of migraine was 14% in the MD group and 67.7% in the VM group (p < 0.001). Multivariate logistic regression of the two groups of patients indicated that the greater the sum of the maximum slow phase velocity (SPV) of the ipsilateral ear, the higher the risk of VM occurrence (p = 0.009). The incidence of carsickness was positively correlated with the incidence of VM (p < 0.001) and asymmetric hearing loss (AHL) was negatively correlated with the diagnosis of VM (p = 0.045). CONCLUSION Gadolinium-enhanced MRI of the inner ear is helpful for the differential diagnosis of VM and MD. Carsickness, decreased AHL, and increased Sum of the maximum SPV in the ipsilateral side (SSPVI) may act as diagnostic predictors of VM. LEVEL OF EVIDENCE 3 Laryngoscope, 134:426-432, 2024.
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Affiliation(s)
- Heng Xiao
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yibin Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Qinrong Huang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Min Huang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yingying Zheng
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zheming Fang
- Departments of Imaging, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guohao Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Institute of Otorhinolaryngology, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Li J, Li L, Jin X, Hu N, Kong X, Wang L, Li X, Dou W, Sun L, Li C, Gong R. MRI can help differentiate Ménière's disease from other menieriform diseases. Sci Rep 2023; 13:21527. [PMID: 38057393 PMCID: PMC10700494 DOI: 10.1038/s41598-023-49066-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
It is difficult to distinguish other pathologies mimicking Ménière's disease (MD) clinically. This study aims to investigate the differences of imaging findings and features between MD and other menieriform diseases via intravenous gadolinium-enhanced magnetic resonance imaging (MRI). 426 patients with menieriform symptoms, including MD, vestibular migraine (VM), and vestibular schwannoma (VS), underwent 3D-FLAIR and 3D-T2WI MRI 6 h after the intravenous gadolinium injection. MR images were analyzed for inner ear morphology, perilymphatic enhancement (PE), EH and other abnormalities. EH was observed at a higher rate in MD patients (85.71%) than patients with other menieriform diseases (VM group = 14.75%, VS group = 37.50%). The prevalence of unilateral EH as well as both cochlear and vestibular EH showed significant differences between MD and VM groups. The prevalence of cochlear EH (I and II) and vestibular EH (II and III) was different between MD and VM groups. The prevalence of PE was higher in MD than VM group. The degrees of cochlear and vestibular hydrops were higher in the definite than probable MD group (P < 0.05). Using these imaging features, MRI can be used to help differentiate MD from other menieriform diseases.
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Affiliation(s)
- Jinye Li
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China
| | - Long Li
- Hospital office, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China
| | - Xianwen Jin
- Department of Radiology, Shandong Maternal and Child Health Care Hospital, Jinan, People's Republic of China
| | - Na Hu
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China
| | - Xiao Kong
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China
| | - Linsheng Wang
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China
| | - Xiaoqin Li
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China
| | - Weiqiang Dou
- GE Healthcare, MR Research China, Beijing, 100000, People's Republic of China
| | - Lixin Sun
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China.
| | - Chuanting Li
- Department of Radiology, Shandong Provincial Hospital, Shandong University, 324 Jing Wu Wei-Qi Road, Jinan, China.
| | - Ruozhen Gong
- Department of Radiology, Shandong Provincial ENT Hospital, Shandong University, 4 Duan Xing-Xi Road, Jinan, China
- Gong Ruozhen Innovation Studio, Shandong Provincial Hospital, Shandong University, 324 Jing Wu Wei-Qi Road, Jinan, China
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Connor S, Grzeda MT, Jamshidi B, Ourselin S, Hajnal JV, Pai I. Delayed post gadolinium MRI descriptors for Meniere's disease: a systematic review and meta-analysis. Eur Radiol 2023; 33:7113-7135. [PMID: 37171493 PMCID: PMC10511628 DOI: 10.1007/s00330-023-09651-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/12/2023] [Accepted: 02/22/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Delayed post-gadolinium magnetic resonance imaging (MRI) detects changes of endolymphatic hydrops (EH) within the inner ear in Meniere's disease (MD). A systematic review with meta-analysis was conducted to summarise the diagnostic performance of MRI descriptors across the range of MD clinical classifications. MATERIALS AND METHODS Case-controlled studies documenting the diagnostic performance of MRI descriptors in distinguishing MD ears from asymptomatic ears or ears with other audio-vestibular conditions were identified (MEDLINE, EMBASE, Web of Science, Scopus databases: updated 17/2/2022). Methodological quality was evaluated with Quality Assessment of Diagnostic Accuracy Studies version 2. Results were pooled using a bivariate random-effects model for evaluation of sensitivity, specificity and diagnostic odds ratio (DOR). Meta-regression evaluated sources of heterogeneity, and subgroup analysis for individual clinical classifications was performed. RESULTS The meta-analysis included 66 unique studies and 3073 ears with MD (mean age 40.2-67.2 years), evaluating 11 MRI descriptors. The combination of increased perilymphatic enhancement (PLE) and EH (3 studies, 122 MD ears) achieved the highest sensitivity (87% (95% CI: 79.92%)) whilst maintaining high specificity (91% (95% CI: 85.95%)). The diagnostic performance of "high grade cochlear EH" and "any EH" descriptors did not significantly differ between monosymptomatic cochlear MD and the latest reference standard for definite MD (p = 0.3; p = 0.09). Potential sources of bias were case-controlled design, unblinded observers and variable reference standard, whilst differing MRI techniques introduced heterogeneity. CONCLUSIONS The combination of increased PLE and EH optimised sensitivity and specificity for MD, whilst some MRI descriptors also performed well in diagnosing monosymptomatic cochlear MD. KEY POINTS • A meta-analysis of delayed post-gadolinium magnetic resonance imaging (MRI) for the diagnosis of Meniere's disease is reported for the first time and comprised 66 studies (3073 ears). • Increased enhancement of the perilymphatic space of the inner ear is shown to be a key MRI feature for the diagnosis of Meniere's disease. • MRI diagnosis of Meniere's disease can be usefully applied across a range of clinical classifications including patients with cochlear symptoms alone.
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Affiliation(s)
- Steve Connor
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK.
- Department of Neuroradiology, King's College Hospital, London, SE5 9RS, UK.
- Department of Radiology, Guy's Hospital and St Thomas' Hospital, London, SE1 9RT, UK.
| | - Mariusz T Grzeda
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College, London, SE1 7EH, UK
| | - Babak Jamshidi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- King's Technology Evaluation Centre, School of Biomedical Engineering and Imaging Sciences, King's College, London, SE1 7EH, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Joseph V Hajnal
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Irumee Pai
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, SE1 7EH, UK
- Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' Hospital, London, SE1 9RT, UK
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5
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Inui T, Kimura F, Moriyama K, Kuriyama T, Shirai T, Ayani Y, Inaka Y, Yuki M, Haginomori SI, Kawata R. Evaluation of Vestibular Functions in a Case of Vestibular Migraine With Successful Treatment With Erenumab. EAR, NOSE & THROAT JOURNAL 2023:1455613231202200. [PMID: 37743840 DOI: 10.1177/01455613231202200] [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: 09/26/2023] Open
Abstract
This is the first report of vestibular examinations before and after the successful treatment of vestibular migraine (VM), a common cause of recurrent vertigo, with calcitonin gene-related peptide (CGRP) receptor inhibitor. We evaluated a 42-year-old female with VM and concomitant probable Meniere's disease, whose headache and dizziness have improved promptly with the administration of erenumab, a CGRP receptor inhibitor. The sensorineural hearing loss in pure-tone audiometry, dysfunctions shown in vestibular examinations (cervical and ocular vestibular evoked myogenic potentials), and mild endolymphatic hydrops shown in gadolinium-enhanced inner ear magnetic resonance imaging, all in the right ear, revealed no change compared with those observed before treatment. This case suggests that VM may be treated by blocking CGRP in the trigeminal ganglion, which suppresses the effects on the vestibular nucleus; herein, no effects were observed in the inner ear despite the clear amelioration of dizziness.
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Affiliation(s)
- Takaki Inui
- Department of Otorhinolaryngology - Head & Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Fumiharu Kimura
- Department of Neurology, Osaka Medical and Pharmaceutical University Mishima-minami Hospital, Takatsuki, Osaka, Japan
| | - Kou Moriyama
- Department of Otorhinolaryngology - Head & Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Tatsuro Kuriyama
- Department of Otorhinolaryngology - Head & Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takeo Shirai
- Department of Otorhinolaryngology - Head & Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yusuke Ayani
- Department of Otorhinolaryngology - Head & Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Yuko Inaka
- Department of Otorhinolaryngology - Head & Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masako Yuki
- Department of Radiology, Hokusetsu General Hospital, Takatsuki, Japan
| | - Shin-Ichi Haginomori
- Department of Otorhinolaryngology - Head & Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Ryo Kawata
- Department of Otorhinolaryngology - Head & Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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6
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Chen JY, Guo ZQ, Wang J, Liu D, Tian E, Guo JQ, Kong WJ, Zhang SL. Vestibular migraine or Meniere's disease: a diagnostic dilemma. J Neurol 2023; 270:1955-1968. [PMID: 36562849 PMCID: PMC10025214 DOI: 10.1007/s00415-022-11532-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Meniere's disease (MD) represents one of the vertigo disorders characterized by triad symptoms (recurrent vertigo, fluctuating hearing loss, tinnitus or ear fullness). The diagnosis of MD relies on the accurate and detailed taking of medical history, and the differentiation between MD and vestibular migraine (VM) is of critical importance from the perspective of the treatment efficacy. VM is a highly prevalent vertigo condition and its typical symptoms (headache, vestibular symptoms, cochlear symptoms) mimic those of MD. Furthermore, the misdiagnosis in MD and VM could lead to VM patients mistakenly receiving the traumatic treatment protocol designed for MD, and sustaining unnecessary damage to the inner ear. Fortunately, thanks to the advances in examination technologies, the barriers to their differentiation are being gradually removed. These advances enhance the diagnostic accuracy of vertigo diseases, especially VM and MD. This review focused on the differentiation of VM and MD, with an attempt to synthesize existing data on the relevant battery of differentiation diagnosis (covering core symptoms, auxiliary tests [audiometry, vestibular tests, endolymphatic hydrops tests]) and longitudinal follow-up. Since the two illnesses are overlapped in all aspects, no single test is sufficiently specific on its own, however, patterns containing all or at least some features boost specificity.
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Affiliation(s)
- Jing-Yu Chen
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhao-Qi Guo
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Wang
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Liu
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - E Tian
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jia-Qi Guo
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei-Jia Kong
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China.
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
| | - Su-Lin Zhang
- Department of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan City, 430022, Hubei Province, People's Republic of China.
- Institute of Otorhinolaryngology, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
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Dieterich M, Hergenroeder T, Boegle R, Gerb J, Kierig E, Stöcklein S, Kirsch V. Endolymphatic space is age-dependent. J Neurol 2023; 270:71-81. [PMID: 36197569 PMCID: PMC9813103 DOI: 10.1007/s00415-022-11400-8] [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: 04/25/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 01/09/2023]
Abstract
Knowledge of the physiological endolymphatic space (ELS) is necessary to estimate endolymphatic hydrops (ELH) in patients with vestibulocochlear syndromes. Therefore, the current study investigated age-dependent changes in the ELS of participants with normal vestibulocochlear testing. Sixty-four ears of 32 participants with normal vestibulocochlear testing aged between 21 and 75 years (45.8 ± 17.2 years, 20 females, 30 right-handed, two left-handed) were examined by intravenous delayed gadolinium-enhanced magnetic resonance imaging of the inner ear (iMRI). Clinical diagnostics included neuro-otological assessment, video-oculography during caloric stimulation, and head-impulse test. iMRI data analysis provided semi-quantitative visual grading and automatic algorithmic quantitative segmentation of ELS volume (3D, mm3) using a deep learning-based segmentation of the inner ear's total fluid space (TFS) and volumetric local thresholding, as described earlier. As a result, following a 4-point ordinal scale, a mild ELH (grade 1) was found in 21/64 (32.8%) ears uni- or bilaterally in either cochlear, vestibulum, or both. Age and ELS were found to be positively correlated for the inner ear (r(64) = 0.33, p < 0.01), and vestibulum (r(64) = 0.25, p < 0.05). For the cochlea, the values correlated positively without reaching significance (r(64) = 0.21). In conclusion, age-dependent increases of the ELS should be considered when evaluating potential ELH in single subjects and statistical group comparisons.
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Affiliation(s)
- Marianne Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Tatjana Hergenroeder
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Rainer Boegle
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany
| | - Johannes Gerb
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Emilie Kierig
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Sophia Stöcklein
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Valerie Kirsch
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany. .,German Center for Vertigo and Balance Disorders-IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany. .,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany.
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8
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Vestibular paroxysmia entails vestibular nerve function, microstructure and endolymphatic space changes linked to root-entry zone neurovascular compression. J Neurol 2023; 270:82-100. [PMID: 36255522 DOI: 10.1007/s00415-022-11399-y] [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: 11/24/2021] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/07/2023]
Abstract
Combining magnetic resonance imaging (MRI) sequences that permit the determination of vestibular nerve angulation (NA = change of nerve caliber or direction), structural nerve integrity via diffusion tensor imaging (DTI), and exclusion of endolymphatic hydrops (ELH) via delayed gadolinium-enhanced MRI of the inner ear (iMRI) could increase the diagnostic accuracy in patients with vestibular paroxysmia (VP). Thirty-six participants were examined, 18 with VP (52.6 ± 18.1 years) and 18 age-matched with normal vestibulocochlear testing (NP 50.3 ± 16.5 years). This study investigated whether (i) NA, (ii) DTI changes, or (iii) ELH occur in VP, and (iv) to what extent said parameters relate. Methods included vestibulocochlear testing and MRI data analyses for neurovascular compression (NVC) and NA verification, DTI and ELS quantification. As a result, (i) NA increased NVC specificity. (ii) DTI structural integrity was reduced on the side affected by VP (p < 0.05). (iii) 61.1% VP showed mild ELH and higher asymmetry indices than NP (p > 0.05). (iv) "Disease duration" and "total number of attacks" correlated with the decreased structural integrity of the affected nerve in DTI (p < 0.001). NVC distance within the nerve's root-entry zone correlated with nerve function (Roh = 0.72, p < 0.001), nerve integrity loss (Roh = - 0.638, p < 0.001), and ELS volume (Roh = - 0.604, p < 0.001) in VP. In conclusion, this study is the first to link eighth cranial nerve function, microstructure, and ELS changes in VP to clinical features and increased vulnerability of NVC in the root-entry zone. Combined MRI with NVC or NA verification, DTI and ELS quantification increased the diagnostic accuracy at group-level but did not suffice to diagnose VP on a single-subject level due to individual variability and lack of diagnostic specificity.
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9
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Tabet P, Elblidi A, Saliba I. Vestibular Migraine versus Méniere's Disease: Diagnostic Utility of Electrocochleography. Audiol Res 2022; 13:12-22. [PMID: 36648923 PMCID: PMC9844276 DOI: 10.3390/audiolres13010002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Objectives: The diagnostic criteria for vestibular migraine (VM) and Méniere’s disease (MD) present an important overlap, which leads to a difficult diagnosis in patients presenting with headache, vertigo, hearing loss, ear fullness, and tinnitus. The objective of our study is to determine whether the area-under-the-curve ratio of the summating potentials (SP) and action potentials (AP) curves on electrocochleography (ECoG) helps differentiate VM from MD with or without the use of the well-established clinical criteria. Method: A retrospective review of patients filling either VM or MD criteria was undertaken between September 2015 and December 2018. All patients underwent ECoG before the introduction of anti-migraine therapy. The prediction of symptom improvement between the clinical criteria and ECoG results was compared by using the Vertigo Symptom Scale. Results: In total, 119 patients were included. An overlap of 36% exists between patients filling VM and MD criteria. Clinical criteria alone did not demonstrate a significant prediction of symptom response to anti-migraine therapy (VM 83%, MD 51%; p = 0.10). However, ECoG results alone did demonstrate adequate prediction (VM 94%, MD 32%; p < 0.001). A negative ECoG result combined with the clinical criteria of VM (100% symptom improvement) was shown to be more predictive of treatment response when compared to clinical criteria alone (83% symptom improvement) (p = 0.017). Finally, when used in patients filling both the VM and MD criteria (VMMD), ECoG was able to predict symptom improvement, thus better differentiating both diseases (normal ECoG: 95%, abnormal ECoG 29%; p < 0.001). Conclusion: Combining VM criteria with normal ECoG using the AUC ratio seems superior in predicting adequate symptom improvement than VM criteria alone.
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Affiliation(s)
- Paul Tabet
- Division of Otolaryngology Head & Neck Surgery, University of Montreal Hospital Center (CHUM), Montreal, QC H2X 3E4, Canada
| | - Ahlem Elblidi
- Division of Otolaryngology Head & Neck Surgery, University of Montreal Hospital Center (CHUM), Montreal, QC H2X 3E4, Canada
| | - Issam Saliba
- Division of Otolaryngology Head & Neck Surgery, University of Montreal Hospital Center (CHUM), Montreal, QC H2X 3E4, Canada
- University of Montreal Hospital Centre Research Centre (CRCHUM), Montreal, QC H2X 3E4, Canada
- Correspondence:
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10
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Liu D, Wang J, Tian E, Guo ZQ, Chen JY, Kong WJ, Zhang SL. Diagnostic Value of the Vestibular Autorotation Test in Menière's Disease, Vestibular Migraine and Menière's Disease with Migraine. Brain Sci 2022; 12:1432. [PMID: 36358359 PMCID: PMC9688433 DOI: 10.3390/brainsci12111432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Vestibular migraine (VM) and Menière's disease (MD) share multiple features in terms of clinical presentations and auditory-vestibular functions, and, therefore, more accurate diagnostic tools to distinguish between the two disorders are needed. (2) Methods: The study was of retrospective design and examined the data of 69 MD patients, 79 VM patients and 72 MD with migraine patients. Five vestibular autorotation test (VAT) parameters, i.e., horizontal gain/phase, vertical gain/phase and asymmetry were subjected to logistic regression. The receiver operating characteristic (ROC) curves were generated to determine the accuracy of the different parameters in the differential diagnosis of MD and VM. (3) Results: Our results showed that the horizontal gain of VAT significantly outperformed other parameters in distinguishing MD and VM. In addition, the sensitivity, specificity and accuracy of the horizontal gain were 95.7%, 50.6% and 71.6%, respectively, for the differentiation between VM and MD. In most MD patients, the horizontal gain decreased in the range of 3-4 Hz, while in most VM patients, horizontal gain increased in the range between 2-3 Hz. More MD with migraine patients had an increased horizontal gain when the frequency was less than 5.0 Hz and had a decreased horizontal gain when the frequency was greater than 5.0 Hz. (4) Conclusion: Our study suggested the VAT, especially the horizontal gain, as an indicator, may serve as a sensitive and objective indicator that helps distinguish between MD and VM. Moreover, VAT, due to its non-invasive and all-frequency nature, might be an important part of a test battery.
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Affiliation(s)
- Dan Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jun Wang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Zhao-qi Guo
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jing-yu Chen
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wei-jia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Key Laboratory of Neurological Disorders of Education Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Su-lin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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11
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Development and Validation of the Predictive Model for the Differentiation between Vestibular Migraine and Meniere's Disease. J Clin Med 2022; 11:jcm11164745. [PMID: 36012984 PMCID: PMC9410183 DOI: 10.3390/jcm11164745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Vestibular migraine (VM) and Meniere’s disease (MD) share multiple features in terms of clinical presentations and auditory-vestibular dysfunctions, e.g., vertigo, hearing loss, and headache. Therefore, differentiation between VM and MD is of great significance. (2) Methods: We retrospectively analyzed the medical records of 110 patients with VM and 110 patients with MD. We at first established a regression equation by using logistic regression analysis. Furthermore, sensitivity, specificity, accuracy, positive predicted value (PV), and negative PV of screened parameters were assessed and intuitively displayed by receiver operating characteristic curve (ROC curve). Then, two visualization tools, i.e., nomograph and applet, were established for convenience of clinicians. Furthermore, other patients with VM or MD were recruited to validate the power of the equation by ROC curve and the Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva (GiViTI) calibration belt. (3) Results: The clinical manifestations and auditory-vestibular functions could help differentiate VM from MD, including attack frequency (X5), phonophobia (X13), electrocochleogram (ECochG) (X18), head-shaking test (HST) (X23), ocular vestibular evoked myogenic potential (o-VEMP) (X27), and horizontal gain of vestibular autorotation test (VAT) (X30). On the basis of statistically significant parameters screened by Chi-square test and multivariable double logistic regression analysis, we established a regression equation: P = 1/[1 + e−(−2.269× X5 − 2.395× X13 + 2.141× X18 + 3.949 × X23 + 2.798× X27 − 4.275× X30(1) − 5.811× X30(2) + 0.873)] (P, predictive value; e, natural logarithm). Nomographs and applets were used to visualize our result. After validation, the prediction model showed good discriminative power and calibrating power. (4) Conclusions: Our study suggested that a diagnostic algorithm based on available clinical features and an auditory-vestibular function regression equation is clinically effective and feasible as a differentiating tool and could improve the differential diagnosis between VM and MD.
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12
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Seo T, Okano Y, Aomi M, Yamada Z, Kasugai S, Nakamura M, Miyamoto Y, Koizuka I. Endolymphatic hydrops presumption tests for patients with vestibular migraine. Acta Otolaryngol 2022; 142:406-409. [PMID: 35642536 DOI: 10.1080/00016489.2022.2080251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The aetiology of vestibular migraine (VM) has not yet been defined; endolymphatic hydrops (EH) has been suggested as a candidate. OBJECTIVES This study aimed to clarify the relationship between VM and EH using neuro-otological tests, including the EH presumption test. MATERIALS AND METHODS Fourteen patients with VM underwent caloric testing, video head impulse test (vHIT), cervical and ocular vestibular evoked myogenic potential (cVEMP and oVEMP), and EH presumption tests such as the Futaki's test and furosemide loading VEMP. RESULTS Caloric testing was abnormal in two of the 14 cases (14.3%), and vHIT was abnormal in one of 12 cases (8.3%). Abnormal asymmetry ratios (ARs) of cVEMP and oVEMP were observed in two of 14 cases (14.3%) and six of 13 cases (46.2%), respectively. Futaki's test results were positive in five of 14 cases (35.7%). Furosemide loading VEMP was positive in seven of 14 cases (50.0%). Nine patients (64.3%) were positive for at least one EH presumption test. CONCLUSIONS AND SIGNIFICANCE EH is not a rare finding in VM; however, the ratio is less than that in Meniere's disease.
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Affiliation(s)
- Toru Seo
- Department of Otolaryngology, St. Marianna University Yokohama Seibu Hospital, Yokohama, Japan
| | - Yohei Okano
- Department of Otolaryngology, St. Marianna University Yokohama Seibu Hospital, Yokohama, Japan
| | - Mizuho Aomi
- Department of Otolaryngology, St. Marianna University Yokohama Seibu Hospital, Yokohama, Japan
| | - Zenyu Yamada
- Department of Otolaryngology, St. Marianna University Yokohama Seibu Hospital, Yokohama, Japan
| | - Shigeru Kasugai
- Department of Otolaryngology, St Marianna University School of Medicine, Yokohama, Japan
| | - Manabu Nakamura
- Department of Otolaryngology, St. Marianna University Yokohama Seibu Hospital, Yokohama, Japan
| | - Yasuhiro Miyamoto
- Department of Otolaryngology, St Marianna University School of Medicine, Yokohama, Japan
| | - Izumi Koizuka
- Department of Otolaryngology, St Marianna University School of Medicine, Yokohama, Japan
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13
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Leng Y, Lei P, Chen C, Liu Y, Xia K, Liu B. Non-contrast MRI of Inner Ear Detected Differences of Endolymphatic Drainage System Between Vestibular Migraine and Unilateral Ménière's Disease. Front Neurol 2022; 13:814518. [PMID: 35572933 PMCID: PMC9099065 DOI: 10.3389/fneur.2022.814518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/30/2022] [Indexed: 12/12/2022] Open
Abstract
Objective We aimed to evaluate the diagnostic performance of some anatomical variables with regard to endolymphatic sac (ES) and duct (ED), measured by non-contrast three-dimensional sampling perfection with application-optimized contrasts using different flip angle evolutions (3D-SPACE) magnetic resonance imaging (MRI), in differentiating vestibular migraine (VM) from unilateral Ménière's disease (MD). Methods In this study, 81 patients with VM, 97 patients with unilateral MD, and 50 control subjects were enrolled. The MRI-visualized parameters, such as the distance between the vertical part of the posterior semicircular canal and the posterior fossa (MRI-PP distance) and visibility of vestibular aqueduct (MRI-VA), were measured bilaterally. The diagnostic value of the MRI-PP distance and MRI-VA visibility for differentiating VM from unilateral MD was examined. Results (1) Compared with the VM patients, patients with unilateral MD exhibited shorter MRI-PP distance and poorer MRI-VA visibility. No differences in the MRI-PP distance and MRI-VA visibility were detected between patients with VM and control subjects. (2) No significant interaural difference in the MRI-PP distance and MRI-VA visibility was observed in patients with VM and those with unilateral MD, respectively. (3) Area under the curve (AUC) showed a low diagnostic value for the MRI-PP distance and MRI-VA visibility, respectively, in differentiating between the VM and unilateral MD. Conclusions Based on non-enhanced MRI-visualized measurement, anatomical variables with regard to the endolymphatic drainage system differed significantly between the patients with VM and those with unilateral MD. Further investigations are needed to improve the diagnostic value of these indices in differentiating VM from unilateral MD.
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Affiliation(s)
- Yangming Leng
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Lei
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Ping Lei
| | - Cen Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingzhao Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaijun Xia
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Bo Liu
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14
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Boegle R, Gerb J, Kierig E, Becker-Bense S, Ertl-Wagner B, Dieterich M, Kirsch V. Intravenous Delayed Gadolinium-Enhanced MR Imaging of the Endolymphatic Space: A Methodological Comparative Study. Front Neurol 2021; 12:647296. [PMID: 33967941 PMCID: PMC8100585 DOI: 10.3389/fneur.2021.647296] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
In-vivo non-invasive verification of endolymphatic hydrops (ELH) by means of intravenous delayed gadolinium (Gd) enhanced magnetic resonance imaging of the inner ear (iMRI) is rapidly developing into a standard clinical tool to investigate peripheral vestibulo-cochlear syndromes. In this context, methodological comparative studies providing standardization and comparability between labs seem even more important, but so far very few are available. One hundred eight participants [75 patients with Meniere's disease (MD; 55.2 ± 14.9 years) and 33 vestibular healthy controls (HC; 46.4 ± 15.6 years)] were examined. The aim was to understand (i) how variations in acquisition protocols influence endolymphatic space (ELS) MR-signals; (ii) how ELS quantification methods correlate to each other or clinical data; and finally, (iii) how ELS extent influences MR-signals. Diagnostics included neuro-otological assessment, video-oculography during caloric stimulation, head-impulse test, audiometry, and iMRI. Data analysis provided semi-quantitative (SQ) visual grading and automatic algorithmic quantitative segmentation of ELS area [2D, mm2] and volume [3D, mm3] using deep learning-based segmentation and volumetric local thresholding. Within the range of 0.1-0.2 mmol/kg Gd dosage and a 4 h ± 30 min time delay, SQ grading and 2D- or 3D-quantifications were independent of signal intensity (SI) and signal-to-noise ratio (SNR; FWE corrected, p < 0.05). The ELS quantification methods used were highly reproducible across raters or thresholds and correlated strongly (0.3-0.8). However, 3D-quantifications showed the least variability. Asymmetry indices and normalized ELH proved the most useful for predicting quantitative clinical data. ELH size influenced SI (cochlear basal turn p < 0.001), but not SNR. SI could not predict the presence of ELH. In conclusion, (1) Gd dosage of 0.1-0.2 mmol/kg after 4 h ± 30 min time delay suffices for ELS quantification. (2) A consensus is needed on a clinical SQ grading classification including a standardized level of evaluation reconstructed to anatomical fixpoints. (3) 3D-quantification methods of the ELS are best suited for correlations with clinical variables and should include both ears and ELS values reported relative or normalized to size. (4) The presence of ELH increases signal intensity in the basal cochlear turn weakly, but cannot predict the presence of ELH.
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Affiliation(s)
- Rainer Boegle
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB (Integriertes Forschungs- und Behandlungszentrum), University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany
| | - Johannes Gerb
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB (Integriertes Forschungs- und Behandlungszentrum), University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Emilie Kierig
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB (Integriertes Forschungs- und Behandlungszentrum), University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Sandra Becker-Bense
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB (Integriertes Forschungs- und Behandlungszentrum), University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB (Integriertes Forschungs- und Behandlungszentrum), University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Valerie Kirsch
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB (Integriertes Forschungs- und Behandlungszentrum), University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany
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15
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Redon S, Elzière M, Donnet A. The neurologist and the hydrops. J Vestib Res 2021; 31:303-309. [PMID: 33843710 DOI: 10.3233/ves-200790] [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]
Abstract
The presence of endolymphatic hydrops has been studied in many neurological disorders. The pathophysiological mechanisms may involve CSF pressure variations, transmitted to the innear ear. This hydrops could play a role in vestibular or cochlear symptoms. For the ENT specialist, the etiological diagnosis of endolymphatic hydrops is a challenge, and neurological etiologies must be known. The treatment of these neurological causes could be effective on cochleo-vestibular symptoms. The knowledge of endolymphatic hydrops could also be a target for noninvasive tests, able to estimate CSF pressure variations. For the neurologist, this could represent a useful tool for the diagnosis and follow-up, in some of these neurological disorders, related to a CSF pressure imbalance. The purpose of this paper is to summarize literature data on endolymphatic hydrops in neurological disorders. We define some neurological conditions, for which there is a particular interest in noninvasive investigations of endolymphatic hydrops.
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Affiliation(s)
- Sylvain Redon
- Department of Evaluation and Treatment of Pain, FHU INOVPAIN, CHU Timone, AP-HM, Marseille, France
| | - Maya Elzière
- Vertigo center, European Hospital, Marseille, France
| | - Anne Donnet
- Department of Evaluation and Treatment of Pain, FHU INOVPAIN, CHU Timone, AP-HM, Marseille, France.,INSERM U-1107, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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16
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Perez-Carpena P, Lopez-Escamez JA. Do we need to reconsider the classification of vestibular migraine? Expert Rev Neurother 2021; 21:503-516. [PMID: 33755502 DOI: 10.1080/14737175.2021.1908129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: Vestibular migraine (VM) is a complex disease characterized by recurrent episodes of migraine associated with vertigo attacks that are observed in 1-3% of the general population. Given its high prevalence and the impact on the health system, it is important to characterize these patients, in order to offer an accurate diagnosis and a proper treatment. As the diagnosis of VM is based on clinical features, the study of potential biomarkers has gained more interest in the last years, to improve the precision in the diagnosis of this disease. The aim of this review is to summarize the main tests available for the diagnosis of VM, including the accuracy of biomarkers for the diagnosis of VM.Areas covered: This review summarizes the main information on VM, including all diagnosis records published in the field in the last 10 years, and focusing on candidate biomarkers for the diagnosis of VM patients.Expert opinion: There is a limited knowledge in the pathophysiology of VM. The search of biomarkers for diagnosis of VM is needed to improve the precision in the diagnosis promoting clinical and translational research. The potential reclassification of VM will depend upon the discovery and validation of these biomarkers.
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Affiliation(s)
- Patricia Perez-Carpena
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO-Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta De Andalucía, Granada, PTS, Spain.,Department of Otolaryngology, Instituto De Investigación Biosanitaria ibs.GRANADA, Hospital Universitario Virgen De Las Nieves, Granada, Spain
| | - Jose A Lopez-Escamez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO-Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta De Andalucía, Granada, PTS, Spain.,Department of Otolaryngology, Instituto De Investigación Biosanitaria ibs.GRANADA, Hospital Universitario Virgen De Las Nieves, Granada, Spain.,Department of Surgery, Division of Otolaryngology, Universidad De Granada, Granada, Spain
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17
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Recurrent vestibulopathy: are cVEMP, oVEMP and inner ear MRI useful to distinguish patients with Menière's disease and vestibular migraine? Eur Arch Otorhinolaryngol 2021; 279:713-721. [PMID: 33651151 DOI: 10.1007/s00405-021-06716-6] [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: 01/12/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to assess the rate of endolymphatic hydrops (EH) on MRI and the rate of otolithic dysfunction with cVEMP and oVEMP, in patients with recurrent vertigo such as Menière's disease (MD), vestibular migraine (VM) and vestibular Menière's disease (vMD). METHODS In this retrospective study, we performed 3D-FLAIR sequences with delayed acquisition in 20 MD, 20 VM and 20 vMD patients. Each subject was then assessed for the presence of EH on MRI. All patients underwent pure-tone audiometry, cVEMP and oVEMP. RESULTS In MD patients, EH was observed in 18 (90%) out of 20 patients while EH was observed in only 1 MV (5%) and 1 vMD (5%) patients. We found significant differences between groups for the presence of EH on MRI (p = 0.001). MD patients had significant higher PTA level (p < 0.001) and oVEMP impairment than MV and vMD (p = 0.08 and p = 0.06, respectively). However, no significant differences were observed for cVEMP impairment, either asymmetric ratio (p = 0.36) and 1000/500 ratio (p = 0.20). CONCLUSIONS Concerning cVEMP, we observed no significant differences between VM, vMD and MD. However, we observed higher oVEMP impairment, PTA level and EH on MRI in MD patients. We believe that MRI could be used to differentiate MD from VM patients with cochlear symptoms. However, in cases of migraine associated with recurrent vertigo and without cochlear symptoms, we believe that MRI is not a useful tool to differentiate between VM and vMD.
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18
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Morita Y, Takahashi K, Ohshima S, Yagi C, Kitazawa M, Yamagishi T, Izumi S, Horii A. Is Vestibular Meniere's Disease Associated With Endolymphatic Hydrops? Front Surg 2020; 7:601692. [PMID: 33392247 PMCID: PMC7775543 DOI: 10.3389/fsurg.2020.601692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/02/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Vestibular Meniere's disease (American Academy of Ophthalmology and Otolaryngology, 1972) also known as possible Meniere's disease (American Academy of Otolaryngology Head and Neck Surgery, 1995) or vestibular type of atypical Meniere's disease (V-AMD) (Japan Society for Equilibrium Research, 2017) is characterized by an episodic vertigo without hearing loss. Though named as Meniere's disease (MD), this entity may not be caused solely by endolymphatic hydrops (EH). Objective: To estimate the role of EH in vestibular Meniere's disease in comparison with definite Meniere's disease. Methods: Thirty patients with unilateral definite MD and 16 patients with vestibular Meniere's disease were included. Those who met the criteria for definite or probable vestibular migraine were excluded. All patients underwent vestibular assessments including inner ear MRI 4 h after intravenous gadolinium injection, bithermal caloric testing, directional preponderance of vestibulo-ocular reflex in rotatory chair test, cervical- and ocular-vestibular evoked myogenic potential, stepping test, dizziness handicap inventory (DHI), and hospital anxiety and depression scale (HADS). All above tests and frequency/duration of vertigo spells were compared between vestibular Meniere's disease and MD. Results: Even in unilateral MD, cochlear and vestibular endolymphatic hydrops (c-, v-EH) were demonstrated not only in the affected side but also in the healthy side in more than half of patients. Positive rate of v-EH in vestibular Meniere's disease (68.8%) was as high as that of MD (80%). In vestibular Meniere's disease, the number of bilateral EH was higher in the vestibule (56.3%) than that in the cochlea (25.0%). There were no differences in vestibular tests and DHI between vestibular Meniere's disease and MD; however, the frequency of vertigo spells was lower in vestibular Meniere's disease (p = 0.001). The total HADS score in the MD group was significantly higher than that in the vestibular Meniere's disease group. Conclusions: MD is a systemic disease with bilateral involvement of inner ears. V-EH is a major pathophysiology of vestibular Meniere's disease, which would precede c-EH in the development of vestibular Meniere's disease, a milder subtype of MD. MRI is useful for differentiating MD from other vertigo attacks caused by different pathologies in bringing EH into evidence.
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Affiliation(s)
- Yuka Morita
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Kuniyuki Takahashi
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Shinsuke Ohshima
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Chihiro Yagi
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Meiko Kitazawa
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Tatsuya Yamagishi
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Shuji Izumi
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Arata Horii
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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19
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van der Lubbe MFJA, Vaidyanathan A, Van Rompaey V, Postma AA, Bruintjes TD, Kimenai DM, Lambin P, van Hoof M, van de Berg R. The "hype" of hydrops in classifying vestibular disorders: a narrative review. J Neurol 2020; 267:197-211. [PMID: 33201310 PMCID: PMC7718205 DOI: 10.1007/s00415-020-10278-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/03/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
Background Classifying and diagnosing peripheral vestibular disorders based on their symptoms is challenging due to possible symptom overlap or atypical clinical presentation. To improve the diagnostic trajectory, gadolinium-based contrast-enhanced magnetic resonance imaging of the inner ear is nowadays frequently used for the in vivo confirmation of endolymphatic hydrops in humans. However, hydrops is visualized in both healthy subjects and patients with vestibular disorders, which might make the clinical value of hydrops detection on MRI questionable. Objective To investigate the diagnostic value of clinical and radiological features, including the in vivo visualization of endolymphatic hydrops, for the classification and diagnosis of vestibular disorders. Methods A literature search was performed in February and March 2019 to estimate the prevalence of various features in healthy subjects and in common vestibular disorders to make a graphical comparison between healthy and abnormal. Results Of the features studied, hydrops was found to be a highly prevalent feature in Menière’s disease (99.4%). Though, hydrops has also a relatively high prevalence in patients with vestibular schwannoma (48.2%) and in healthy temporal bones (12.5%) as well. In patients diagnosed with (definite or probable) Menière’s disease, hydrops is less frequently diagnosed by magnetic resonance imaging compared to the histological confirmation (82.3% versus 99.4%). The mean prevalence of radiologically diagnosed hydrops was 31% in healthy subjects, 28.1% in patients with vestibular migraine, and 25.9% in patients with vestibular schwannoma. An interesting finding was an absolute difference in hydrops prevalence between the two diagnostic techniques (histology and radiology) of 25.2% in patients with Menière’s disease and 29% in patients with vestibular schwannoma. Conclusions Although the visualization of hydrops has a high diagnostic value in patients with definite Menière’s disease, it is important to appreciate the relatively high prevalence of hydrops in healthy populations and other vestibular disorders. Endolymphatic hydrops is not a pathognomic phenomenon, and detecting hydrops should not directly indicate a diagnosis of Menière’s disease. Both symptom-driven and hydrops-based classification systems have disadvantages. Therefore, it might be worth to explore features “beyond” hydrops. New analysis techniques, such as Radiomics, might play an essential role in (re)classifying vestibular disorders in the future. Electronic supplementary material The online version of this article (10.1007/s00415-020-10278-8) contains supplementary material, which is available to authorized users.
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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
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - 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
| | - Dorien M Kimenai
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - 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
- School for Mental Health and Sciences, Maastricht University, Maastricht, The Netherlands
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20
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Management of Ménière's Disease: How Does the Coexistence of Vestibular Migraine Affect Outcomes? Otol Neurotol 2020; 40:666-673. [PMID: 31083096 DOI: 10.1097/mao.0000000000002176] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report the incidence of vestibular migraine (VM) in patients with Ménière's disease (MD) and investigate whether management outcomes of MD differ by the association of VM. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care academic center. PATIENTS MD patients (n = 251) with/without VM who were managed for 5 years in a dizziness clinic. MAIN OUTCOME MEASURES Influence of VM on management outcomes and hearing at the latest follow-up in stepwise management options. RESULTS Incidence of VM was 35% in MD patients. VM was more common in women than men (40 vs. 22%) and in probable MD than definite MD (43 vs. 29%). Bilateral MD was more frequent with coexistence of VM than without VM in definite MD (14 vs. 0%) as well as probable MD (24 vs. 7%). At the latest follow-up, preventive medications were effective in controlling vertigo in most (80%) patients (74%/90% in definite/probable MD). Additional intratympanic steroids were required in 16% (20%/10% in definite/probable MD) and intratympanic gentamicin or surgeries in 9 (6%) patients with intractable MD. The percentage of intractable MD did not differ with coexistence of VM, though definite MD showed a significantly higher percentage of intractable MD than probable MD (6 vs. 0%, respectively, p = 0.002). Worsening hearing was more frequent in definite MD than probable MD (19 vs. 4%), and association of VM did not influence the incidence of worsening hearing. CONCLUSIONS Coexistence of VM was about 30 to 40% in definite and probable MD, especially frequent in bilateral MD (77%) and women with probable MD (50%), requiring identification of coexisting VM while managing MD patients. Management outcomes and worsening hearing in MD patients are not dependent on the coexistence of VM, when both are managed.
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21
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van Steekelenburg JM, van Weijnen A, de Pont LMH, Vijlbrief OD, Bommeljé CC, Koopman JP, Verbist BM, Blom HM, Hammer S. Value of Endolymphatic Hydrops and Perilymph Signal Intensity in Suspected Ménière Disease. AJNR Am J Neuroradiol 2020; 41:529-534. [PMID: 32029469 DOI: 10.3174/ajnr.a6410] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Ménière disease is characterized by endolymphatic hydrops, whereas perilymphatic enhancement on MR imaging has been suggested to be of additional value in diagnosing Ménière disease. This study evaluates the presence of endolymphatic hydrops and perilymphatic enhancement in patients with Ménière disease and with other vertigo-associated inner ear pathology. MATERIALS AND METHODS A 3D-FLAIR sequence 4 hours after intravenous gadolinium injection was performed to visualize the endolymph and perilymph in 220 patients suspected of having Ménière disease. Patients' ears were retrospectively categorized as having Ménière disease (probable or definite) or other vertigo-associated inner ear pathology not attributable to Ménière disease. Endolymphatic hydrops was evaluated using a visual classification system, and perilymphatic enhancement was scored both visually and quantitatively. RESULTS Endolymphatic hydrops was present in 137 (91.9%) of the definite Ménière disease ears and in 9 (7.0%) of the ears with other vertigo-associated inner ear pathology (P < .001). The combination of endolymphatic hydrops and visually increased perilymphatic enhancement was present in 122 (81.9%) definite Ménière disease ears compared with 4 (3.1%) ears with other vertigo-associated inner ear pathology (P < .001). This combination increases the positive predictive value from 0.94 for endolymphatic hydrops and 0.91 for perilymphatic enhancement to 0.97. The addition of measured perilymphatic enhancement leads to a moderate decrease in sensitivity from 0.92 for endolymphatic hydrops to 0.86. CONCLUSIONS The combination of perilymphatic enhancement and endolymphatic hydrops in patients suspected of having Ménière disease increases the positive predictive value in the diagnosis of definite Ménière disease.
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Affiliation(s)
| | - A van Weijnen
- Otorhinolaryngology (A.v.W., C.C.B., J.P.K., H.M.B.), Haga Teaching Hospital, The Hague, the Netherlands
| | - L M H de Pont
- From the Departments of Radiology (J.M.v.S., L.M.H.d.P., S.H.)
| | - O D Vijlbrief
- Department of Radiology (O.D.V.), Ziekenhuis Groep Twente, Almelo, the Netherlands
| | - C C Bommeljé
- Otorhinolaryngology (A.v.W., C.C.B., J.P.K., H.M.B.), Haga Teaching Hospital, The Hague, the Netherlands
| | - J P Koopman
- Otorhinolaryngology (A.v.W., C.C.B., J.P.K., H.M.B.), Haga Teaching Hospital, The Hague, the Netherlands
| | - B M Verbist
- Department of Radiology (B.M.V.), Leiden University Medical Centre, Leiden, the Netherlands
| | - H M Blom
- Otorhinolaryngology (A.v.W., C.C.B., J.P.K., H.M.B.), Haga Teaching Hospital, The Hague, the Netherlands
| | - S Hammer
- From the Departments of Radiology (J.M.v.S., L.M.H.d.P., S.H.)
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22
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Pyykkö I, Manchaiah V, Färkkilä M, Kentala E, Zou J. Association between Ménière’s disease and vestibular migraine. Auris Nasus Larynx 2019; 46:724-733. [DOI: 10.1016/j.anl.2019.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/16/2019] [Accepted: 02/03/2019] [Indexed: 12/17/2022]
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23
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Relationship Between the Extent of Endolymphatic Hydrops and the Severity and Fluctuation of Audiovestibular Symptoms in Patients With Menière's Disease and MRI Evidence of Hydrops. Otol Neurotol 2019; 39:e123-e130. [PMID: 29315188 DOI: 10.1097/mao.0000000000001681] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize the short-, middle-, and long-term occurrence of vertigo attacks in a large population of Menière's disease (MD) and to investigate the relationship between the extent of endolymphatic hydrops (ELH) and the severity of audiovestibular symptoms. STUDY DESIGN Prospective observational study. METHODS One hundred ninety-two patients with clinically definite MD participated in this study. The degree of ELH was visualized by locally enhanced inner ear magnetic resonance imaging. The occurrence and intensity of vertigo attacks, hearing loss, tinnitus, and aural fullness were documented in patient diaries. RESULTS There was no significant correlation between the extent of cochlear or vestibular hydrops and the number of definite vertigo days, neither with regard to a short-term nor with regard to a middle-term time period. There was also no correlation between the extent of ELH and the intensity or activity of the coexisting aural symptoms hearing loss, tinnitus, and aural fullness. The duration of the disease significantly correlated with the extent of both cochlear and vestibular hydrops, but not with the number of definite vertigo days. CONCLUSION The ELH was progressive in the long-term course of the disease in this large population of definite MD patients, but short-term and middle-term fluctuations of the symptom severity did not involve measurable variations of the ELH. Furthermore, the symptom severity did not decrease with increasing disease duration.
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24
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Kirsch V, Nejatbakhshesfahani F, Ahmadi SA, Dieterich M, Ertl-Wagner B. A probabilistic atlas of the human inner ear's bony labyrinth enables reliable atlas-based segmentation of the total fluid space. J Neurol 2019; 266:52-61. [PMID: 31422454 DOI: 10.1007/s00415-019-09488-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 12/20/2022]
Abstract
Intravenous contrast agent-enhanced magnetic resonance imaging of the endolymphatic space (ELS) of the inner ear permits direct, in-vivo, non-invasive visualization of labyrinthine structures and thus verification of endolymphatic hydrops (ELH). However, current volumetric assessment approaches lack normalization. The aim of this study was to develop a probabilistic atlas of the inner ear's bony labyrinth as a first step towards an automated and reproducible volume-based quantification of the ELS. The study included three different datasets: a source dataset (D1) to build the probabilistic atlas and two testing sets (D2, D3). D1 included 24 right-handed patients (12 females; mean age 51.5 ± 3.9 years) and D2 5 patients (3 female; mean age 48.8 ± 5.01 years) with vestibular migraine without ELH or any measurable vestibular deficits. D3 consisted of five patients (one female; mean age 46 ± 5.2 years) suffering from unilateral Menière's disease and ELH. Data processing comprised three steps: preprocessing using an affine and deformable fusion registration pipeline, computation of an atlas for the left and right inner ear using a label-assisted approach, and validation of the atlas based on localizing and segmenting previously unseen ears. The three-dimensional probabilistic atlas of the inner ear's bony labyrinth consisted of the internal acoustic meatus and inner ears (including cochlea, otoliths, and semicircular canals) for both sides separately. The analyses showed a high level of agreement between the atlas-based segmentation and the manual gold standard with an overlap of 89% for the right ear and 86% for the left ear (measured by dice scores). This probabilistic in vivo atlas of the human inner ear's bony labyrinth and thus of the inner ear's total fluid space for both ears represents a necessary step towards a normalized, easily reproducible and reliable volumetric quantification of the perilymphatic and endolymphatic space in view of MR volumetric assessment of ELH. The proposed atlas lays the groundwork for state-of-the-art approaches (e.g., deep learning) and will be provided to the scientific community.
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Affiliation(s)
- Valerie Kirsch
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany. .,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany. .,German Center for Vertigo and Balance Disorders- IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.
| | - F Nejatbakhshesfahani
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - S-A Ahmadi
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders- IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - M Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders- IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - B Ertl-Wagner
- German Center for Vertigo and Balance Disorders- IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.,Department of Radiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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25
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Gerb J, Ertl-Wagner B, Dieterich M, Kirsch V. P30 Automatic volumetric segmentation of the endolymphatic space calibrated to radiological grading of the endolymphatic hydrops. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Kierig E, Kirsch V, Becker-Bense S, Gerb J, Ertl-Wagner B, Dieterich M. P01 Endolymphatic hydrops: A common finding in vestibular migraine. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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27
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Abstract
More than 150 years after its initial description by Prosper Menière, the disease named after him is still at the center of scientific debates. Two recent developments have specifically created a breeding ground for controversy: (1) Since its first description 10 years ago, magnetic resonance imaging diagnosis of endolymphatic hydrops in living patients has seen an increasing and worldwide application. (2) The Bárány Society Classification Committee published diagnostic criteria for Menière's disease in 2015 and proposed a concept of the disease that has elicited widespread criticism. In order to promote the understanding of the underlying controversies and arguments, this article gives an overview of and discusses relevant classification proposals for Menière's disease, including the new classification system of hydropic ear disease.
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Affiliation(s)
- R Gürkov
- ENT Department, University of Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - J Hornibrook
- Department of Otolaryngology, Christchurch Hospital, University of Canterbury and University of Otago, Christchurch, New Zealand
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28
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Guo P, Sun W, Shi S, Zhang F, Wang J, Wang W. Quantitative evaluation of endolymphatic hydrops with MRI through intravenous gadolinium administration and VEMP in unilateral definite Meniere's disease. Eur Arch Otorhinolaryngol 2019; 276:993-1000. [PMID: 30694377 DOI: 10.1007/s00405-018-05267-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/21/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To help clinicians to further understand the significance of vestibular-evoked myogenic potential (VEMP) examinations to diagnose MD and the quantitative relationship between VEMP and MRI in assessing the location and degree of endolymphatic hydrops (EH) in definite Meniere's disease (MD) patients. METHODS Fifty-six patients with unilateral definite MD participated in this study, which used MRIs through intravenous gadolinium administration (IV-Gd), audiometry, caloric tests and VEMP tests. The VEMP results of 26 healthy volunteers were used as a normal reference value. RESULTS The participants were found through MRI to have differing degrees of vestibular and cochlear EH. Quantitative comparison of MRI and VEMP results found that the response rates of oVEMP decreased with cochlear EH increasing; the asymmetry ratio (AR) of oVEMP can be used to find whether cochlear EH or not, and the P1-N1 amplitude was lower in the extreme cochlear EH group (P < 0.01). The AR of cVEMP was larger in severe vestibular EH group than that of the mild or no vestibular EH group (P < 0.01). The correlation between the degree of cochlear EH and the mean PTA threshold was statistically significant (P < 0.05). The duration of MD correlated positively with vestibular EH (P < 0.05). The abnormal rate of caloric tests was higher in severe vestibular EH group than that of the mild or no vestibular EH group (P < 0.05). CONCLUSIONS The advantages of MRIs by IV-Gd administration were obvious in assessing the location and degree of EH. oVEMP and PTA can be indirectly used to evaluate the extent of cochlear EH, cVEMP and caloric tests can be used to assess the extent of vestibular EH on the condition of absent MRIs.
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Affiliation(s)
- Ping Guo
- NHC Key Laboratory of Hearing Medicine, Department of Otolaryngology, Eye Ear Nose & Throat Hospital Shanghai, Fudan University, 83 Fenyang Rd, Shanghai, 200031, People's Republic of China
| | - Wenfang Sun
- Department of Otolaryngology, Chongqing General Hospital, Chongqing, 400000, People's Republic of China
| | - Suming Shi
- NHC Key Laboratory of Hearing Medicine, Department of Otolaryngology, Eye Ear Nose & Throat Hospital Shanghai, Fudan University, 83 Fenyang Rd, Shanghai, 200031, People's Republic of China
| | - Fang Zhang
- Department of Radiology, Eye Ear Nose & Throat Hospital Shanghai, Shanghai, People's Republic of China
| | - Jiali Wang
- NHC Key Laboratory of Hearing Medicine, Department of Otolaryngology, Eye Ear Nose & Throat Hospital Shanghai, Fudan University, 83 Fenyang Rd, Shanghai, 200031, People's Republic of China
| | - Wuqing Wang
- NHC Key Laboratory of Hearing Medicine, Department of Otolaryngology, Eye Ear Nose & Throat Hospital Shanghai, Fudan University, 83 Fenyang Rd, Shanghai, 200031, People's Republic of China.
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29
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In vivo Assessment of an Endolymphatic Hydrops Gradient Along the Cochlea in Patients With Menière's Disease by Magnetic Resonance Imaging—A Pilot Study. Otol Neurotol 2018; 39:e1091-e1099. [DOI: 10.1097/mao.0000000000002016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Pyykkö I, Manchaiah V, Zou J, Levo H, Kentala E. Impact of Tumarkin attacks on complaints and work ability in Ménière’s disease. J Vestib Res 2018; 28:319-330. [DOI: 10.3233/ves-180634] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ilmari Pyykkö
- Department of Otolaryngology, Hearing and Balance Research Unit, University of Tampere, Tampere, Finland
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX, USA
- Audiology India, Mysore, Karnataka, India
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
| | - Jing Zou
- Department of Otolaryngology, Hearing and Balance Research Unit, University of Tampere, Tampere, Finland
- Department of Otolaryngology-Head and Neck Surgery, Center for Otolaryngology-Head and Neck Surgery of Chinese PLA, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hilla Levo
- Department of Otolaryngology, University of Helsinki, Helsinki, Finland
| | - Erna Kentala
- Department of Otolaryngology, University of Helsinki, Helsinki, Finland
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31
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P122. Multimodal probabilistic atlas of the human inner ear enables an automated and reliable segmentation of the endolymphatic space. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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32
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Kirsch V, Becker-Bense S, Berman A, Gerb J, Ertl-Wagner B, Dieterich M. P120. MRI of the inner ear enables differentiation of central and peripheral vestibular pathologies in a postoperative ELST patient. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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33
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Kirsch V, Becker-Bense S, Berman A, Kierig E, Ertl-Wagner B, Dieterich M. P119. Activity-dependent plasticity of the endolymphatic space in vestibular migraine – A single case study. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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34
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Kirsch V, Becker-Bense S, Berman A, Kierig E, Ertl-Wagner B, Dieterich M. Transient endolymphatic hydrops after an attack of vestibular migraine: a longitudinal single case study. J Neurol 2018; 265:51-53. [PMID: 29696496 DOI: 10.1007/s00415-018-8870-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Valerie Kirsch
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, Munich, Germany. .,German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians-Universität, Munich, Germany. .,Graduate School of Systemic Neuroscience, Ludwig-Maximilians-Universität, Munich, Germany.
| | - S Becker-Bense
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians-Universität, Munich, Germany
| | - A Berman
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - E Kierig
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians-Universität, Munich, Germany
| | - B Ertl-Wagner
- German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians-Universität, Munich, Germany.,Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - M Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Marchioninistraße 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School of Systemic Neuroscience, Ludwig-Maximilians-Universität, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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35
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Vestibular syncope: A disorder associated with drop attack in Ménière’s disease. Auris Nasus Larynx 2018; 45:234-241. [DOI: 10.1016/j.anl.2017.03.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/11/2017] [Accepted: 03/23/2017] [Indexed: 01/02/2023]
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36
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Evaluation of endolymphatic hydrops using 3-T MRI after intravenous gadolinium injection. Eur Arch Otorhinolaryngol 2017; 274:4103-4111. [PMID: 28948373 DOI: 10.1007/s00405-017-4739-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Abstract
Aim of this work is to establish evaluation criteria for identifying endolymphatic hydrops in the vestibule and cochlea using a magnetic resonance imaging (MRI) scanner. This is a retrospective diagnostic study. We evaluated 70 ears of 35 unilateral Ménière's disease patients. We performed 3-T MRI 4 h after intravenous gadolinium injection. Otologists manually traced the outline of vestibule, cochlea, and endolymphatic space of the vestibule and cochlea on two-dimensional fluid-attenuated inversion-recovery (2D-FLAIR) images. The traced area was measured, and rates of endolymphatic space to the vestibule and cochlea were calculated. The same otologists judged whether the low signal intensity area of the cochlea was at the edge of the cochlea. For measuring the rate of endolymphatic space to the vestibule, when the cut-off value was 30%, the presence of endolymphatic hydrops was determined with sensitivity of 87.1% and specificity of 94.3%. In contrast, the rate of endolymphatic space to the cochlea produced low accuracy. Therefore, when the presence of endolymphatic hydrops in the cochlea was judged by whether the low signal intensity area in the cochlea was at the edge of cochlea, endolymphatic hydrops could be detected with sensitivity of 91.4% and specificity of 94.3%. We were able to identify endolymphatic hydrops in the vestibule when the rate of endolymphatic space to the vestibule was greater than 30%, and could detect endolymphatic hydrops in the cochlea when a low signal intensity area was located at the edge of the cochlea in 2D-FLAIR images. Level of evidence 4.
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Tabet P, Saliba I. Meniere's Disease and Vestibular Migraine: Updates and Review of the Literature. J Clin Med Res 2017; 9:733-744. [PMID: 28811849 PMCID: PMC5544477 DOI: 10.14740/jocmr3126w] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/19/2017] [Indexed: 11/11/2022] Open
Abstract
The diagnosis of Meniere's disease (MD) and vestibular migraine (VM) is primarily based on clinical criteria and their differentiation is often difficult. Currently, there are no known definitive diagnostic tests that can reliably distinguish the two conditions. Patients with MD and patients with VM are treated differently, therefore improving the diagnosis of these two pathologies should avoid errors in management. A systematic review was conducted according to PRISMA guidelines. Medline-Ovid and Embase databases were used to conduct a thorough search of English-language publications dating from 1948 to March 2016. The primary search objective was to identify all papers explicitly comparing MD and VM in order to clarify and validate the diagnosis of these two diseases. A total of 13 articles out of 831 were reviewed. Among other differences, MD showed later age of onset, more hearing loss, tinnitus, aural fullness, abnormal nystagmus, abnormal caloric testing results, abnormal vestibular evoked myogenic potential and endolymphatic hydrops. VM showed more headaches, photophobia, vomiting and aura. Even though differences were noted between the two diseases, only one study focused on assessing the differences between VM, MD and patients fulfilling both diagnostic criteria (MDVM). This study showed no difference between the three groups. Since the introduction of the new International Headache Society and Barany Society criteria for VM, no studies have focused on comparing these three groups. We strongly encourage authors to focus on comparing MD and VM from MDVM in future studies to help adequately distinguish the diagnosis of both diseases.
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Affiliation(s)
- Paul Tabet
- Division of Otolaryngology-Head and Neck Surgery, Montreal University Hospital Center (CHUM), University of Montreal; Montreal, Quebec, Canada
| | - Issam Saliba
- Division of Otolaryngology-Head and Neck Surgery, Montreal University Hospital Center (CHUM), University of Montreal; Montreal, Quebec, Canada
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Murofushi T, Tsubota M, Suizu R, Yoshimura E. Is Alteration of Tuning Property in Cervical Vestibular-Evoked Myogenic Potential Specific for Ménière's Disease? Front Neurol 2017; 8:193. [PMID: 28533763 PMCID: PMC5420551 DOI: 10.3389/fneur.2017.00193] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/20/2017] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The aim of this study is to show sensitivity and specificity of cervical vestibular-evoked myogenic potential (cVEMP) tuning property test to Ménière's disease (MD) in comparison with healthy controls (HC) and patients with other vestibular diseases. SUBJECTS Totally 92 subjects (50 women and 42 men, 20-77 years of age) were enrolled in this study. Subjects were composed of 38 definite unilateral MD patients, 11 unilateral benign paroxysmal positional vertigo patients, 14 vestibular migraine patients, 19 unilateral vestibular neuritis patients, and 10 HC. METHODS The subjects underwent cVEMP testing to 500 and 1,000 Hz short tone bursts (125 dBSPL). The corrected amplitudes of the first biphasic responses (p13-n23) (cVEMP) were measured. Then, a tuning property index (the 500-1,000 Hz cVEMP slope) was calculated. RESULTS The area of under the ROC curve (AUC) was 0.75 in comparison with other vestibular disease patients, while AUC was 0.77 in comparison with other vestibular disease patients plus HC. The best cutoff point of the 500-1,000 Hz cVEMP slope was -19.9. Sensitivity of the tuning property test to MD was 0.74, while specificity was 0.76 to other vestibular disease patients. CONCLUSION The tuning property test of cVEMP is useful as a screening test of MD.
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Affiliation(s)
- Toshihisa Murofushi
- Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital, Kawasaki, Japan
| | - Masahito Tsubota
- Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital, Kawasaki, Japan
| | - Ryota Suizu
- Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital, Kawasaki, Japan
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Sun W, Guo P, Ren T, Wang W. Magnetic resonance imaging of intratympanic gadolinium helps differentiate vestibular migraine from Ménière disease. Laryngoscope 2017; 127:2382-2388. [PMID: 28220492 DOI: 10.1002/lary.26518] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/20/2016] [Accepted: 01/06/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS To study the differential diagnosis of vestibular migraine (VM) and Ménière disease (MD) by using magnetic resonance imaging (MRI) of intratympanic gadolinium. STUDY DESIGN Prospective cohort study. METHODS Definite MD patients (n = 30) and definite or probable VM patients (n = 30) were included, and the two groups were age and sex matched. Three-dimensional real inversion recovery (3D-real-IR) MRI was performed 24 hours after bilateral intratympanic gadolinium to assess the presence and degree of endolymphatic hydrops (EH). Response rates, amplitudes, latency, and response threshold of cervical and ocular vestibular evoked myogenic potentials (c/oVEMPs) were tested by using air-conducted sound. Pure tone audiometry was used to evaluate the level of hearing loss. RESULTS Different degrees of EH were observed in the cochlea and vestibule in the affected ears of MD patients, but only suspicious cochlear hydrops and no vestibular hydrops was noted in the VM patients. The correlation between the degree of EH and low-frequency hearing loss was statistically significant. Only the response threshold for c/oVEMP differentiated the MD-affected side from VM. The latency and amplitude for c/oVEMP showed no significant difference between groups. CONCLUSIONS Characteristic pathological changes of MD include EH in the inner ear, and 3D-real-IR MRI helps differentiate VM from MD. VM and MD behaved similarly in vestibular dysfunction and their transduction pathway, but MD appeared to be more severe than VM. An association in their pathophysiology may play a part in these responses. LEVEL OF EVIDENCE 4 Laryngoscope, 127:2382-2388, 2017.
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Affiliation(s)
- Wenfang Sun
- Department of Otology and Skull Base Surgery, Hearing Research Key Laboratory of the Health Ministry of China, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Ping Guo
- Department of Otology and Skull Base Surgery, Hearing Research Key Laboratory of the Health Ministry of China, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Tongli Ren
- Department of Otology and Skull Base Surgery, Hearing Research Key Laboratory of the Health Ministry of China, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
| | - Wuqing Wang
- Department of Otology and Skull Base Surgery, Hearing Research Key Laboratory of the Health Ministry of China, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China
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Vestibular Migraine: Clinical Challenges and Opportunities for Multidisciplinarity. Behav Neurol 2016; 2016:6179805. [PMID: 28082766 PMCID: PMC5204080 DOI: 10.1155/2016/6179805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 10/05/2016] [Accepted: 10/31/2016] [Indexed: 12/13/2022] Open
Abstract
Migraine and vertigo are two very prevalent conditions in general population. The coexistence of both in the same subject is a significant clinical challenge, since it is not always possible to understand whether they are causally related or associated by chance, requiring different diagnostic and therapeutic approaches. In this review we analyze and summarize the actual knowledge about vestibular migraine (VM), focusing on the new concepts proposed by the International Classification of Headache Disorders 3-beta and by the Bárány Society and also addressing the former concepts, which are still present in clinical practice. We conclude that clinical studies using a multidisciplinary approach are crucial in this field, since different specialists observe the same pathology with different eyes. Clinical presentation of VM is variable in what concerns vestibular symptoms temporal relation with migraine headache, as well as in their accompanying manifestations. Biomarkers, either genomics or functional, and molecular imaging techniques will be helpful to clarify many aspects of the complexity of this entity, helping to define to what extent can VM be considered a separate and independent clinical entity.
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Murofushi T. Clinical application of vestibular evoked myogenic potential (VEMP). Auris Nasus Larynx 2016; 43:367-76. [DOI: 10.1016/j.anl.2015.12.006] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/12/2015] [Accepted: 12/07/2015] [Indexed: 01/31/2023]
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Abstract
Meniere's disease (MD) is a disorder of the inner ear that causes vertigo attacks, fluctuating hearing loss, tinnitus and aural fullness. The aetiology of MD is multifactorial. A characteristic sign of MD is endolymphatic hydrops (EH), a disorder in which excessive endolymph accumulates in the inner ear and causes damage to the ganglion cells. In most patients, the clinical symptoms of MD present after considerable accumulation of endolymph has occurred. However, some patients develop symptoms in the early stages of EH. The reason for the variability in the symptomatology is unknown and the relationship between EH and the clinical symptoms of MD requires further study. The diagnosis of MD is based on clinical symptoms but can be complemented with functional inner ear tests, including audiometry, vestibular-evoked myogenic potential testing, caloric testing, electrocochleography or head impulse tests. MRI has been optimized to directly visualize EH in the cochlea, vestibule and semicircular canals, and its use is shifting from the research setting to the clinic. The management of MD is mainly aimed at the relief of acute attacks of vertigo and the prevention of recurrent attacks. Therapeutic options are based on empirical evidence and include the management of risk factors and a conservative approach as the first line of treatment. When medical treatment is unable to suppress vertigo attacks, intratympanic gentamicin therapy or endolymphatic sac decompression surgery is usually considered. This Primer covers the pathophysiology, symptomatology, diagnosis, management, quality of life and prevention of MD.
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Barbosa F, Villa TR. Vestibular migraine: diagnosis challenges and need for targeted treatment. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:416-22. [DOI: 10.1590/0004-282x20160037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 01/13/2016] [Indexed: 01/03/2023]
Abstract
ABSTRACT Approximately 1% of the general population suffers from vestibular migraine. Despite the recently published diagnostic criteria, it is still underdiagnosed condition. The exact neural mechanisms of vestibular migraine are still unclear, but the variability of symptoms and clinical findings both during and between attacks suggests an important interaction between trigeminal and vestibular systems. Vestibular migraine often begins several years after typical migraine and has a variable clinical presentation. In vestibular migraine patients, the neurological and neurotological examination is mostly normal and the diagnosis will be based in the patient clinical history. Treatment trials that specialize on vestibular migraine are scarce and therapeutic recommendations are based on migraine guidelines. Controlled studies on the efficacy of pharmacologic interventions in the treatment of vestibular migraine should be performed.
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Abstract
During the last decades a new vestibular syndrome has emerged that is now termed vestibular migraine (VM). The main body of evidence for VM is provided by epidemiologic data demonstrating a strong association between migraine and vestibular symptoms. Today, VM is recognized as one of the most common causes of episodic vertigo. The clinical presentation of VM is heterogeneous in terms of vestibular symptoms, duration of episodes, and association with migrainous accompaniments. Similar to migraine, there is no clinical or laboratory confirmation for VM and the diagnosis relies on the history and the exclusion of other disorders. Recently, diagnostic criteria for VM have been elaborated jointly by the International Headache Society and the Bárány Society. Clinical examination of patients with acute VM has clarified that the vast majority of patients with VM suffer from central vestibular dysfunction. Findings in the interval may yield mild signs of damage to both the central vestibular and ocular motor system and to the inner ear. These interictal clinical signs are not specific to VM but can be also observed in migraineurs without a history of vestibular symptoms. How migraine affects the vestibular system is still a matter of speculation. In the absence of high-quality therapeutic trials, treatment is targeted at the underlying migraine.
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Affiliation(s)
- M von Brevern
- Department of Neurology, Park-Klinik Weissensee and Vestibular Research Group, Berlin, Germany.
| | - T Lempert
- Department of Neurology, Schlosspark-Klinik and Vestibular Research Group, Berlin, Germany
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Sone M, Yoshida T, Morimoto K, Teranishi M, Nakashima T, Naganawa S. Endolymphatic hydrops in superior canal dehiscence and large vestibular aqueduct syndromes. Laryngoscope 2015; 126:1446-50. [DOI: 10.1002/lary.25747] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/30/2015] [Accepted: 09/22/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Michihiko Sone
- Department of Otorhinolaryngology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Tadao Yoshida
- Department of Otorhinolaryngology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Kyoko Morimoto
- Department of Otorhinolaryngology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Masaaki Teranishi
- Department of Otorhinolaryngology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Tsutomu Nakashima
- Department of Otorhinolaryngology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Shinji Naganawa
- Department of Radiology; Nagoya University Graduate School of Medicine; Nagoya Japan
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Louza J, Krause E, Gürkov R. Hearing function after intratympanic application of gadolinium-based contrast agent: A long-term evaluation. Laryngoscope 2015; 125:2366-70. [PMID: 25823415 DOI: 10.1002/lary.25259] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/04/2015] [Accepted: 02/17/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of this study was to evaluate the long-term influence of intratympanic gadolinium-based contrast agent on hearing function in patients with possible Ménière's disease and normal auditory thresholds who were undergoing locally enhanced magnetic resonance imaging scans. STUDY DESIGN Prospective observational cohort study in a tertiary referral university hospital ear, nose, and throat department. METHODS Between 2009 and 2012, 17 patients with possible or probable Ménière's disease and a four-tone pure-tone average baseline of <25 dB were recruited for our study. Before undergoing intratympanic injection of gadolinium-based contrast agent, all patients underwent a complete audiological evaluation. The study population was then invited back after at least 6 months postinjection for a follow-up auditory evaluation. This consisted of comprehensive clinical and audiological tests on both sides and were evaluated according to the ototoxicity guidelines. RESULTS A long-term evaluation of our study group revealed no significant difference in the air-conduction pure-tone average. Furthermore, no statistical difference at individual frequencies compared to baseline was found. There was no evidence of ototoxicity in the injected ear. CONCLUSIONS Long-term hearing function assessment after intratympanic application of gadolinium-based agent showed no evidence of ototoxicity. The use of intratympanic gadolinium-based agent in the diagnosis of Ménièrés disease is currently a helpful tool, and seems to be a safe method, especially with regard to auditory function. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Julia Louza
- Department of Otorhinolaryngology-Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Eike Krause
- Department of Otorhinolaryngology-Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Robert Gürkov
- Department of Otorhinolaryngology-Head and Neck Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
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