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Mavrommatis MA, Kaul VF, Chow K, Fan CJ, Bellaire CP, Cosetti MK, Wanna GB, Perez E. Temporal changes in endolymphatic hydrops on MRI with or without intervention: A systematic review. Am J Otolaryngol 2023; 44:103764. [PMID: 36587603 DOI: 10.1016/j.amjoto.2022.103764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The pathophysiology of Meniere's Disease (MD) involves endolymphatic hydrops (ELH) of the inner ear. Magnetic Resonance Imaging (MRI) has been shown to detect ELH, but changes in ELH have been poorly described using this modality. Our objective was to review MRI-measured changes in ELH over time and after medical and/or surgical intervention in patients with MD. We secondarily aim to associate changes in ELH with changes in MD symptomatology. DATABASES REVIEWED Medline, Web of Science, and Embase databases. METHODS A systematic review of articles was performed to identify studies utilizing MRI to measure ELH changes over time, and after medical or surgical treatment. Articles on non-human subjects and without direct measurement of ELH were excluded. RESULTS Of 532 studies identified, 12 were included, involving 170 patients (mean age 56.3 years). Ten studies were prospective; two were retrospective. Five studies strictly utilized medical means of intervention, four utilized surgical treatments, one utilized both, and two observed temporal changes without treatment. Across all interventions, 72.1 % of patients exhibited the same or worsening ELH on imaging. In studies reporting vertigo outcomes, 95.9 % of patients exhibited improvement after the treatment period. CONCLUSION Medical and surgical interventions often yield symptomatic relief of vertigo in MD patients despite stable or increasing ELH volume. MRI may have greater clinical utility in diagnosing ELH as opposed to assessing treatment response.
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Affiliation(s)
- Maria A Mavrommatis
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai, New York, NY, USA
| | - Vivian F Kaul
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kevin Chow
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Caleb J Fan
- Michigan Ear Institute, Farmington Hills, MI, USA
| | | | - Maura K Cosetti
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai, New York, NY, USA
| | - George B Wanna
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai, New York, NY, USA
| | - Enrique Perez
- Department of Otolaryngology - Head & Neck Surgery, Mount Sinai, New York, NY, USA
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Liu Y, Pyykkö I, Naganawa S, Marques P, Gürkov R, Yang J, Duan M. Consensus on MR Imaging of Endolymphatic Hydrops in Patients With Suspected Hydropic Ear Disease (Meniere). Front Surg 2022; 9:874971. [PMID: 35574547 PMCID: PMC9096015 DOI: 10.3389/fsurg.2022.874971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Endolymphatic hydrops (EH) is considered the histological hallmark of Meniere's disease. Visualization of EH has been achieved by special sequences of inner ear magnetic resonance imaging (MRI) with a gadolinium-based contrast agent via intravenous or intratympanic administration. Although it has been applied for more than 10 years since 2007, a unified view on this technique has not yet been achieved. This paper presents an expert consensus on MRI of endolymphatic hydrops in the following aspects: indications and contra-indications for patient selection, methods of contrast-agent administration (intravenous or intratympanic), MRI sequence selection, the specific scanning parameter settings, and standard image evaluation methods and their advantages and disadvantages. For each part of this consensus, a comment is attached to elucidate the reasons for the recommendation.
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Affiliation(s)
- Yupeng Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Ilmari Pyykkö
- Hearing and Balance Research Unit, Field of Otolaryngology, Faculty of Medicine and Health Technology, School of Medicine, Tampere University, Tampere, Finland
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Pedro Marques
- Unit of Otorhinolaryngology, Department of Surgery and Physiology, University of Porto Medical School, Porto, Portugal
| | - Robert Gürkov
- ENT Centre at Red Cross Square, University of Munich, Munich, Germany
| | - Jun Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- *Correspondence: Jun Yang
| | - Maoli Duan
- Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Maoli Duan
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Basura GJ, Adams ME, Monfared A, Schwartz SR, Antonelli PJ, Burkard R, Bush ML, Bykowski J, Colandrea M, Derebery J, Kelly EA, Kerber KA, Koopman CF, Kuch AA, Marcolini E, McKinnon BJ, Ruckenstein MJ, Valenzuela CV, Vosooney A, Walsh SA, Nnacheta LC, Dhepyasuwan N, Buchanan EM. Clinical Practice Guideline: Ménière's Disease. Otolaryngol Head Neck Surg 2020; 162:S1-S55. [PMID: 32267799 DOI: 10.1177/0194599820909438] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Ménière's disease (MD) is a clinical condition defined by spontaneous vertigo attacks (each lasting 20 minutes to 12 hours) with documented low- to midfrequency sensorineural hearing loss in the affected ear before, during, or after one of the episodes of vertigo. It also presents with fluctuating aural symptoms (hearing loss, tinnitus, or ear fullness) in the affected ear. The underlying etiology of MD is not completely clear, yet it has been associated with inner ear fluid (endolymph) volume increases, culminating in episodic ear symptoms (vertigo, fluctuating hearing loss, tinnitus, and aural fullness). Physical examination findings are often unremarkable, and audiometric testing may or may not show low- to midfrequency sensorineural hearing loss. Conventional imaging, if performed, is also typically normal. The goals of MD treatment are to prevent or reduce vertigo severity and frequency; relieve or prevent hearing loss, tinnitus, and aural fullness; and improve quality of life. Treatment approaches to MD are many and typically include modifications of lifestyle factors (eg, diet) and medical, surgical, or a combination of therapies. PURPOSE The primary purpose of this clinical practice guideline is to improve the quality of the diagnostic workup and treatment outcomes of MD. To achieve this purpose, the goals of this guideline are to use the best available published scientific and/or clinical evidence to enhance diagnostic accuracy and appropriate therapeutic interventions (medical and surgical) while reducing unindicated diagnostic testing and/or imaging.
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Affiliation(s)
| | | | | | | | | | | | - Matthew L Bush
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Julie Bykowski
- University of California San Diego, San Diego, California, USA
| | - Maria Colandrea
- Duke University School of Nursing and Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | | | | | - Kevin A Kerber
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | | | | | - Evie Marcolini
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Brian J McKinnon
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | | - Sandra A Walsh
- Consumers United for Evidence-Based Healthcare, Baltimore, Maryland, USA
| | - Lorraine C Nnacheta
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | - Nui Dhepyasuwan
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
| | - Erin M Buchanan
- American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA
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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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Seo T, Shiraishi K, Kobayashi T, Mutsukazu K, Fujita T, Saito K, Doi K. Revision of a furosemide-loading vestibular-evoked myogenic potential protocol for detecting endolymphatic hydrops. Acta Otolaryngol 2017; 137:1244-1248. [PMID: 28749204 DOI: 10.1080/00016489.2017.1355565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The presence of endolymphatic hydrops can be suggested by improving the amplitude of vestibular-evoked myogenic potential (VEMP) after furosemide administration (furosemide loading VEMP [FVEMP]). The authors aimed to determine a stimulation frequency and judgment criteria to ascertain whether a revised FVEMP protocol can be applied to clinical settings. METHODS The study included 25 individuals with unilateral Meniere's disease (MD) and 11 normal healthy volunteers. Normalized amplitude of VEMP, using a tone burst sound at 250, 500, 700, 1000, 1500 and 2000 Hz, was measured before and after furosemide administration in the two groups. Improvement ratio (IR) of amplitude was calculated at each frequency. RESULTS There were no significant differences in IR between the control group and the MD group at each frequency, except at 500 Hz. Receiver operating characteristic curve analysis revealed an IR cut-off value of 14.2% at 500 Hz, with a sensitivity of 0.706 and a specificity of 0.810. CONCLUSIONS The revised FVEMP protocol using a 500 Hz tone burst stimulus and normalized amplitudes was defined as positive when IR exceeded 14.2% or when a biphasic wave could be detected after furosemide administration in cases without a detectable biphasic wave before administration.
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Affiliation(s)
- Toru Seo
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama City, Japan
| | - Ko Shiraishi
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama City, Japan
| | - Takaaki Kobayashi
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama City, Japan
| | - Kitano Mutsukazu
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama City, Japan
| | - Takeshi Fujita
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama City, Japan
| | - Kazuya Saito
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama City, Japan
| | - Katsumi Doi
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osakasayama City, Japan
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Fukushima M, Kitahara T, Oya R, Akahani S, Inohara H, Naganawa S, Takeda N. Longitudinal up-regulation of endolymphatic hydrops in patients with Meniere's disease during medical treatment. Laryngoscope Investig Otolaryngol 2017; 2:344-350. [PMID: 29299506 PMCID: PMC5743151 DOI: 10.1002/lio2.115] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/31/2017] [Accepted: 09/16/2017] [Indexed: 12/13/2022] Open
Abstract
Objective/Hypothesis Meniere's disease (MD) is a common inner ear disease characterized by repeated episodic vertigo, fluctuating sensorineural hearing loss, and tinnitus. Its pathology is defined as endolymphatic hydrops (EH) in the inner ear and EH has been hypothesized to correlate with the clinical symptoms of MD. We presented the dynamics of in vivo EH in MD patients during medical treatments. Study Design Prospective, single-arm repeated measures. Methods Eleven MD patients were enrolled. All subjects prospectively underwent gadolinium-enhanced inner ear magnetic resonance (MR) imaging and neuro-otological testing before and after medical treatment. The volume of EH was quantitatively evaluated by processing MR images. All MD patients were administered continuous medication and followed up for more than 12 months. Results The frequency of vertigo episodes decreased in all patients and vestibular function decreased to 13-91% of the pre-treatment level. The volume ratio of post-treatment EH-to-pre-treatment EH ranged from 1.01-3.22. The total volume of pre-treatment EH was significantly correlated with cochlear symptom disease duration and the affected ear's hearing level. Conclusion EH in MD patients developed longitudinally with deterioration of inner ear function during medical treatment. The natural course of MD may progress with development of EH at least for a certain period. Level of Evidence 2b.
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Affiliation(s)
- Munehisa Fukushima
- Department of Otolaryngology and Head and Neck Surgery Kansai Rosai Hospital Hyogo Japan.,Department of Otolaryngology and Head and Neck Surgery Osaka University, Graduate School of Medicine Osaka Japan
| | - Tadashi Kitahara
- Department of Otolaryngology and Head and Neck Surgery Nara Medical University Nara Japan
| | - Ryohei Oya
- Department of Otolaryngology and Head and Neck Surgery Osaka University, Graduate School of Medicine Osaka Japan
| | - Shiro Akahani
- Department of Otolaryngology and Head and Neck Surgery Kansai Rosai Hospital Hyogo Japan
| | - Hidenori Inohara
- Department of Otolaryngology and Head and Neck Surgery Osaka University, Graduate School of Medicine Osaka Japan
| | - Shinji Naganawa
- Department of Radiology Nagoya University Graduate School of Medicine Aichi Japan
| | - Noriaki Takeda
- Department of Otolaryngology University of Tokushima School of Medicine Tokushima Japan
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Medications for Ménière's disease? The Journal of Laryngology & Otology 2016; 130:213. [DOI: 10.1017/s0022215116000347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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