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Lorente-Piera J, Prieto-Matos C, Manrique-Huarte R, Garaycochea O, Domínguez P, Manrique M. Otic Capsule Dehiscences Simulating Other Inner Ear Diseases: Characterization, Clinical Profile, and Follow-Up-Is Ménière's Disease the Sole Cause of Vertigo and Fluctuating Hearing Loss? Audiol Res 2024; 14:372-385. [PMID: 38666903 PMCID: PMC11047452 DOI: 10.3390/audiolres14020032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
INTRODUCTION We present a series of six cases whose clinical presentations exhibited audiovestibular manifestations of a third mobile window mechanism, bearing a reasonable resemblance to Ménière's disease and otosclerosis. The occurrence of these cases in such a short period has prompted a review of the underlying causes of its development. Understanding the pathophysiology of third mobile window syndrome and considering these entities in the differential diagnosis of conditions presenting with vertigo and hearing loss with slight air-bone gaps is essential for comprehending this group of pathologies. MATERIALS AND METHODS A descriptive retrospective cohort study of six cases diagnosed at a tertiary center. All of them went through auditive and vestibular examinations before and after a therapeutic strategy was performed. RESULTS Out of 84 cases of dehiscences described in our center during the period from 2014 to 2024, 78 belonged to superior semicircular canal dehiscence, while 6 were other otic capsule dehiscences. Among these six patients with a mean age of 47.17 years (range: 18-73), all had some form of otic capsule dehiscence with auditory and/or vestibular repercussions, measured through hearing and vestibular tests, with abnormalities in the results in five out of six patients. Two of them were diagnosed with Ménière's disease (MD). Another two had cochleo-vestibular hydrops without meeting the diagnostic criteria for MD. In two cases, the otic capsule dehiscence diagnosis resulted from an intraoperative complication due to a gusher phenomenon, while in one case, it was an accidental radiological finding. All responded well to the proposed treatment, whether medical or surgical, if needed. CONCLUSIONS Otic capsule dehiscences are relatively new and unfamiliar entities that should be considered when faced with cases clinically suggestive of Ménière's disease, with discrepancies in complementary tests or a poor response to treatment. While high-sensitivity and specificity audiovestibular tests exist, completing the study with imaging, especially petrous bone CT scans, is necessary to locate and characterize the otic capsule defect responsible for the clinical presentation.
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Affiliation(s)
- Joan Lorente-Piera
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Navarra, Spain
| | - Carlos Prieto-Matos
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Navarra, Spain
| | - Raquel Manrique-Huarte
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Navarra, Spain
| | - Octavio Garaycochea
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Navarra, Spain
| | - Pablo Domínguez
- Radiology Department, University of Navarra Clinic, 31008 Pamplona, Navarra, Spain
| | - Manuel Manrique
- Otorhinolaryngology Department, University of Navarra Clinic, 31008 Pamplona, Navarra, Spain
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Yan H, Young Y. Role of conventional MD staging in modern era of hydrops MR imaging. Laryngoscope Investig Otolaryngol 2024; 9:e1213. [PMID: 38362181 PMCID: PMC10866591 DOI: 10.1002/lio2.1213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/02/2024] [Indexed: 02/17/2024] Open
Abstract
Objective/Hypothesis This study correlated stage of Meniere's disease (MD) with MR imaging of endolymphatic hydrops (EH) to assess the role of MD staging in modern era. Study Design Retrospective study. Methods Fifty-four MD patients (60 ears) underwent an inner ear test battery and were further confirmed by MR imaging. Sixty MD ears were divided into stages I-IV, and hydrops MR images at each stage were compared. Results Hydrops MRI demonstrated that EH at the cochlea with respective Grades 0/I/II were 3/7/1 ears for stage I, 0/5/3 ears for stage II, 1/6/26 ears for stage III and 0/2/6 ears for stage IV. Significant relationship was not identified between MD stage and grades of cochlear hydrops. Similarly, no significant relationship was shown between MD stage and grades of vestibular (saccular/utricular) hydrops. The optimal cutoff value of four-tone average for predicting severe type (Grade II-III) cochlear/vestibular EH was 48 dB, which was within the stage III. Hence, prevalence of severe type (Grade II) cochlear EH in stages III (79%) and IV (75%) was significantly higher than stages I (9%) and II (38%). Similarly, severe type saccular/utricular EH in stages III (64%) and IV (75%) also showed significantly higher than stages I (18%) and II (25%). Conclusion Although conventional MD staging fails to correlate with the grades of EH on hydrops MRI, late-stage MD may indicate heightened EH severity in the cochlea and vestibule. Level of Evidence 4.
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Affiliation(s)
- Hong‐Yu Yan
- Department of OtolaryngologyNational Taiwan University HospitalTaipeiTaiwan
| | - Yi‐Ho Young
- Department of OtolaryngologyFar Eastern Memorial HospitalNew TaipeiTaiwan
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Young YH, Lin KT. Potential Application of Hydrops MR Imaging: A Systematic Review. J Otolaryngol Head Neck Surg 2024; 53:19160216241250350. [PMID: 38888936 PMCID: PMC11098000 DOI: 10.1177/19160216241250350] [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: 12/21/2023] [Accepted: 04/01/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Diagnostic dilemma between clinical Meniere's disease and radiological endolymphatic hydrops (EH) has emerged since the introduction of hydrops magnetic resonance imaging (MRI). The aim of this study is to explore the potential application of hydrops MRI on diagnosing the EH. METHODS This review was developed from peer-reviewed articles published in those journals listed on journal of citation reports. The MEDLINE database of the US National Library of Medicine, Scopus, and Google Scholar were used to collect articles based on the guidelines (PRISMA 2020 statement) for reporting reviews. RESULTS Initially, 470 articles were retrieved from 1983 to 2023, and 80 relevant articles were ultimately selected. The sensitivity (69%-92%) and specificity (78%-96%) values varied from each laboratory for detecting EH via hydrops MRI, probably due to candidate selection and the grading system employed. CONCLUSION The application of hydrops MRI allows (1) differentiation between EH and sudden sensorineural hearing loss; (2) determination of the affected side of EH; and (3) confirmation of the diagnosis of EH concomitant with other disorders. Notably, not all differentials for EH can be visualized on MR images. One of the existing gaps to be filled is that updated hydrops MRI fails to identify distortion, that is, rupture, collapse, fistula, or fibrosis of the inner ear compartments, akin to what histopathological evidence can demonstrate. Hence, enhanced ultrahigh resolution of hydrops MRI is required for demonstrating fine structures of the inner ear compartments in the future.
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Affiliation(s)
- Yi-Ho Young
- Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Kao-Tsung Lin
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
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Melliti A, van de Berg M, van de Berg R. Capturing nystagmus during vertigo attacks using a smartphone: adherence, characteristics, pearls and pitfalls. J Neurol 2023; 270:6044-6056. [PMID: 37653139 PMCID: PMC10632223 DOI: 10.1007/s00415-023-11965-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To investigate adherence, characteristics, and first clinical experiences of capturing ictal nystagmus at home, which can be performed to complement the diagnostic process in patients with episodic vestibular symptoms. METHODS Patients were recruited at a tertiary referral center in case capturing ictal nystagmus could contribute to the diagnostic process (e.g., to detect or rule out BPPV). They were asked to capture ictal nystagmus with their own smartphone at home, using a smartphone-based adapter (Nystagmocatcher, Balansdiagnos, Stockholm, Sweden). All recordings were analyzed by the last author (RvdB), and the adherence, characteristics, and first clinical experiences were evaluated. RESULTS Seventy patients with vestibular symptoms were asked to participate in this study. Sixty-two (89%) agreed to participate. The median period of participation was 86 days. Fifty-one patients experienced attacks during the study period. Eventually, 51% of them provided eye movement recordings sufficient for analysis. Different types of nystagmus were observed: positional nystagmus related to BPPV, positional nystagmus not related to BPPV, functional eye movements, and the absence of nystagmus or functional eye movements. Capturing ictal nystagmus could contribute to the diagnostic process in several ways, including to detect or rule out BPPV, to detect or rule out vestibular origin of symptoms, to determine the affected side, telemedicine, to monitor attack frequency, and to detect malingering. Furthermore, strict guidance of patients was necessary, which could be time-consuming. CONCLUSION Capturing ictal nystagmus can contribute to the diagnostic process in several ways, which motivates to rethink current clinical workflow in vestibular medicine. However, strict guidance is necessary and not all patients provide ictal recordings. In an outpatient setting, it would be advised to use ictal nystagmus recordings on indication, to complement the diagnostic process.
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Affiliation(s)
- Ali Melliti
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Maurice van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Quint R, Vaussy A, Stemmer A, Hautefort C, Houdart E, Eliezer M. Iterative Denoising Accelerated 3D FLAIR Sequence for Hydrops MR Imaging at 3T. AJNR Am J Neuroradiol 2023; 44:1064-1069. [PMID: 37536733 PMCID: PMC10494947 DOI: 10.3174/ajnr.a7953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/27/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND PURPOSE 3D FLAIR sequences have become the criterion standard for identifying endolymphatic hydrops, but scan time remains an important limitation to their widespread use. Our purpose was to evaluate the diagnostic performance and image quality of an accelerated 3D FLAIR sequence combined with an iterative denoising algorithm. MATERIALS AND METHODS This was a retrospective study performed on 30 patients with clinical suspicion of endolymphatic hydrops who underwent 3T MR imaging 4 hours after gadolinium injection using two 3D FLAIR sequences. The first (conventional FLAIR) was accelerated with a conventional turbo factor of 187. The second was accelerated with an increased turbo factor of 263, resulting in a 33% scan time reduction (5 minutes 36 seconds versus 8 minutes 15 seconds, respectively). A sequence was reconstructed in-line immediately after the accelerated 3D FLAIR acquisition from the same raw data with iterative denoising (accelerated-FLAIR iterative denoising). The signal intensity ratio image quality score and endolymphatic hydrops diagnosis were evaluated. RESULTS The mean signal intensity ratio for symptomatic and asymptomatic ears of accelerated-FLAIR iterative denoising was significantly higher than the mean SNR of conventional FLAIR (29.5 versus 19 and 25.9 versus 16.3, P < .001). Compared with the conventional FLAIR sequence, the image-quality score was higher with accelerated-FLAIR iterative denoising (mean image-quality score, 3.8 [SD, 0.4] versus 3.3 [SD, 0.6] for accelerated-FLAIR iterative denoising and conventional FLAIR, respectively, P = .003). There was no significant difference in the diagnosis of endolymphatic hydrops between the 2 sequences. Interreader agreement was good-to-excellent. CONCLUSIONS The iterative denoising algorithm applied to an accelerated 3D FLAIR sequence for exploration of endolymphatic hydrops enabled significantly reducing the scan time without compromising image quality and diagnostic performance.
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Affiliation(s)
- R Quint
- From the Department of Neuroradiology (R.Q., E.H., M.E.), Lariboisière University Hospital, Paris, France
| | - A Vaussy
- Siemens Healthineers France (A.V.), Saint-Denis, France
| | - A Stemmer
- Siemens Healthineers (A.S.), Erlangen, Germany
| | - C Hautefort
- Department of Head and Neck Surgery (C.H.), Lariboisière University Hospital, Paris, France
| | - E Houdart
- From the Department of Neuroradiology (R.Q., E.H., M.E.), Lariboisière University Hospital, Paris, France
- Faculté de Médecine (E.H.), Université de Paris, Paris, France
| | - M Eliezer
- From the Department of Neuroradiology (R.Q., E.H., M.E.), Lariboisière University Hospital, Paris, France
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Inui H, Sakamoto T, Ueda K, Ito T, Kitahara T. Volume ratio and distribution rate in patients with orthostatic vertigo/dizziness using MR imaging: a comparison with vertiginous diseases. Acta Otolaryngol 2023; 143:631-635. [PMID: 37537926 DOI: 10.1080/00016489.2023.2238760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Orthostatic dizziness/vertigo (ODV) is characterized by lightheadedness owing to postural changes. AIMS/OBJECTIVES To measure the endolymphatic space (ELS)/total fluid space (TFS) volume ratio and the distribution rate of endolymphatic fluid (ELF) of patients with ODV and compare them with those of control subjects (CS). MATERIALS AND METHODS This study included 22 patients (44 ears) with ODV and 52 controls (104 ears, CS). The ELS/TFS volume ratio (%) and distribution rate (%) of the inner ear components were measured using 3-dimensional magnetic resonance imaging. RESULTS In the ODV group, the mean ELS/TFS volume ratios of the cochlea, vestibule, and semi-circular canals (SCCs) were 12.1%, 18.6%, and 18.1%, respectively; the mean ELS distribution rates for the cochlea, vestibule, and SCCs were 27.3%, 26.2%, and 46.6%, respectively. The ELS distribution rate of the vestibule was significantly lower (p < .01) and the ELS distribution rate of the SCCs was significantly higher in the ODV than in the CS group (p < .01). CONCLUSIONS AND SIGNIFICANCE The ELS distribution rate in the vestibule + SCCs among patients with ODV did not differ from that in the CS; ELF in the vestibule moved to the SCCs, and a large amount of ELF was distributed only in the SCCs.
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Affiliation(s)
| | | | - Keita Ueda
- Department of Otorhinolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Taeko Ito
- Department of Otorhinolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Tadashi Kitahara
- Department of Otorhinolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan
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Chuan W, Yuan L, Wen J, Jianwei Z, Caiji W, Zeqi Z, Yalan L, Renlong J, Kang L, Wei L, Houguang L, Wen L, Yuehua Q, Xuanyi L. cAMP-Epac1 signaling is activated in DDAVP-induced endolymphatic hydrops of guinea pigs. Braz J Otorhinolaryngol 2023; 89:469-476. [PMID: 37116375 PMCID: PMC10165185 DOI: 10.1016/j.bjorl.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/07/2023] [Accepted: 03/03/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVE To explore whether Cyclic Adenosine Monophosphate (cAMP)-Epac1 signaling is activated in 1-Desamino-8-D-arginine-Vasopressin-induced Endolymphatic Hydrops (DDAVP-induced EH) and to provide new insight for further in-depth study of DDAVP-induced EH. METHODS Eighteen healthy, red-eyed guinea pigs (36 ears) weighing 200-350 g were randomly divided into three groups: the control group, which received intraperitoneal injection of sterile saline (same volume as that in the other two groups) for 7 consecutive days; the DDAVP-7d group, which received intraperitoneal injection of 10 mg/mL/kg DDAVP for 7 consecutive days; and the DDAVP-14d group, which received intraperitoneal injection of 10 μg/mL/kg DDAVP for 14 consecutive days. After successful modeling, all animals were sacrificed, and cochlea tissues were collected to detect the mRNA and protein expression of the exchange protein directly activated by cAMP-1 and 2 (Epac1, Epac2), and Repressor Activator Protein-1 (Rap1) by Reverse Transcription (RT)-PCR and western blotting, respectively. RESULTS Compared to the control group, the relative mRNA expression of Epac1, Epac2, Rap1A, and Rap1B in the cochlea tissue of the DDAVP-7d group was significantly higher (p < 0.05), while no significant difference in Rap1 GTPase activating protein (Rap1gap) mRNA expression was found between the two groups. The relative mRNA expression of Epac1, Rap1A, Rap1B, and Rap1gap in the cochlea tissue of the DDAVP-14d group was significantly higher than that of the control group (p < 0.05), while no significant difference in Epac2 mRNA expression was found between the DDAVP-14d and control groups. Comparison between the DDAVP-14d and DDAVP-7d groups showed that the DDAVP-14d group had significantly lower Epac2 and Rap1A (p < 0.05) and higher Rap1gap (p < 0.05) mRNA expression in the cochlea tissue than that of the DDAVP-7d group, while no significant differences in Epac1 and Rap1B mRNA expression were found between the two groups. Western blotting showed that Epac1 protein expression in the cochlea tissue was the highest in the DDAVP-14d group, followed by that in the DDAVP-7d group, and was the lowest in the control group, showing significant differences between groups (p < 0.05); Rap1 protein expression in the cochlea tissue was the highest in the DDAVP-7d group, followed by the DDAVP-14d group, and was the lowest in the control group, showing significant differences between groups (p < 0.05); no significant differences in Epac2 protein expression in the cochlea tissue were found among the three groups. CONCLUSION DDAVP upregulated Epac1 protein expression in the guinea pig cochlea, leading to activation of the inner ear cAMP-Epac1 signaling pathway. This may be an important mechanism by which DDAVP regulates endolymphatic metabolism to induce EH and affect inner ear function. OXFORD CENTRE FOR EVIDENCE-BASED MEDICINE 2011 LEVELS OF EVIDENCE: Level 5.
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Affiliation(s)
- Wang Chuan
- The Suqian Clinical College of Xuzhou Medical University, Department of Otorhinolaryngology-Head and Neck Surgery, Suqian, China; Affiliated Hospital of Xuzhou Medical University, Department of Otorhinolaryngology-Head and Neck Surgery, Xuzhou, China; Xuzhou Medical University, Institute of Audiology and Balance Science, Xuzhou, China; Xuzhou Medical University, Artificial Auditory Laboratory of Jiangsu Province, Xuzhou, China
| | - Li Yuan
- Affiliated Hospital of Xuzhou Medical University, Department of Radiology, Xuzhou, China
| | - Jiang Wen
- Affiliated Hospital of Xuzhou Medical University, Department of Otorhinolaryngology-Head and Neck Surgery, Xuzhou, China; Xuzhou Medical University, Institute of Audiology and Balance Science, Xuzhou, China; Xuzhou Medical University, Artificial Auditory Laboratory of Jiangsu Province, Xuzhou, China
| | - Zeng Jianwei
- Affiliated Hospital of Xuzhou Medical University, Department of Radiology, Xuzhou, China
| | - Wang Caiji
- Affiliated Hospital of Xuzhou Medical University, Department of Otorhinolaryngology-Head and Neck Surgery, Xuzhou, China; Xuzhou Medical University, Institute of Audiology and Balance Science, Xuzhou, China; Xuzhou Medical University, Artificial Auditory Laboratory of Jiangsu Province, Xuzhou, China
| | - Zhao Zeqi
- Affiliated Hospital of Xuzhou Medical University, Department of Otorhinolaryngology-Head and Neck Surgery, Xuzhou, China; Xuzhou Medical University, Institute of Audiology and Balance Science, Xuzhou, China; Xuzhou Medical University, Artificial Auditory Laboratory of Jiangsu Province, Xuzhou, China
| | - Li Yalan
- Gulou Hospital Affiliated to Medical College of Nanjing University, Department of Otolaryngology Head and Neck Surgery, Nanjing, China
| | - Ji Renlong
- Affiliated Hospital of Xuzhou Medical University, Department of Otorhinolaryngology-Head and Neck Surgery, Xuzhou, China; Xuzhou Medical University, Institute of Audiology and Balance Science, Xuzhou, China; Xuzhou Medical University, Artificial Auditory Laboratory of Jiangsu Province, Xuzhou, China
| | - Li Kang
- Affiliated Hospital of Xuzhou Medical University, Department of Otorhinolaryngology-Head and Neck Surgery, Xuzhou, China; Xuzhou Medical University, Institute of Audiology and Balance Science, Xuzhou, China; Xuzhou Medical University, Artificial Auditory Laboratory of Jiangsu Province, Xuzhou, China
| | - Li Wei
- Fudan University, Hearing Research Key Lab of Health Ministry of China, Eye and Ear Nose and Throat Hospital, Department of Otology and Skull Base Surgery, Shanghai, China
| | - Liu Houguang
- China University of Mining and Technology, School of Mechatronic Engineering, Xuzhou, China
| | - Liu Wen
- Xuzhou Medical University, Jiangsu Key Laboratory of New Drug Research and Clinical Pharmacy, Xuzhou, China; Affiliated Hospital of Xuzhou Medical University, Department of Otorhinolaryngology-Head and Neck Surgery, Xuzhou, China
| | - Qiao Yuehua
- Affiliated Hospital of Xuzhou Medical University, Department of Otorhinolaryngology-Head and Neck Surgery, Xuzhou, China; Xuzhou Medical University, Institute of Audiology and Balance Science, Xuzhou, China; Xuzhou Medical University, Artificial Auditory Laboratory of Jiangsu Province, Xuzhou, China
| | - Li Xuanyi
- Affiliated Hospital of Xuzhou Medical University, Department of Otorhinolaryngology-Head and Neck Surgery, Xuzhou, China; Xuzhou Medical University, Institute of Audiology and Balance Science, Xuzhou, China; Xuzhou Medical University, Artificial Auditory Laboratory of Jiangsu Province, Xuzhou, China.
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Sone M, Kobayashi M, Yoshida T, Naganawa S. Pathophysiological analysis of idiopathic sudden sensorineural hearing loss by magnetic resonance imaging: A mini scoping review. Front Neurol 2023; 14:1193104. [PMID: 37153681 PMCID: PMC10159174 DOI: 10.3389/fneur.2023.1193104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
Objective To summarize the pathophysiological analysis of idiopathic sudden sensorineural hearing loss (ISSNHL) by magnetic resonance imaging (MRI), focusing on the findings of high signal or endolymphatic hydrops (EH) in the inner ear. Methods We summarize the published studies of our research group regarding the pathophysiological analysis of ISSNHL on MRI and review related clinical articles that have reported significantly high signal or the existence of EH in ears with ISSNHL. Results Pre-contrast high signal on MRI may indicate minor hemorrhage or increased permeability of surrounding vessels to the perilymph, whereas post-contrast high signal indicates breakdown of the blood-labyrinth barrier, in which irreversible changes would lead to poor prognosis. In some cases of ISSNHL, primary EH could be pre-existing and may be a risk factor for the onset of ISSNHL. Conclusion Analysis of ISSNHL by cutting-edge MRI evaluation could provide useful information for elucidating its pathophysiology and for predicting prognosis in this disease.
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Affiliation(s)
- Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- *Correspondence: Michihiko Sone,
| | - Masumi Kobayashi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadao Yoshida
- 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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Gürkov R, Barath K, de Foer B, Fukushima M, Gluth M, Hornibrook J, Perez-Fernandez N, Pyykkö I, Sone M, Usami SI, Wang W, Zou J, Naganawa S. A plea for systematic literature analysis and conclusive study design, comment on: "Systematic review of magnetic resonance imaging for diagnosis of Meniere disease". J Vestib Res 2023; 33:151-157. [PMID: 31658075 DOI: 10.3233/ves-190662] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Robert Gürkov
- Department of Otorhinolaryngology Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
| | - Krisztina Barath
- Radiologie und Neuroradiologie am Glattzentrum, Wallisellen, Switzerland
| | - Bert de Foer
- Department of Radiology, GZA Hospitals Antwerp, Belgium
| | - Munehisa Fukushima
- Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Michael Gluth
- Section of Otolaryngology- Head & Neck Surgery, The University of Chicago Medicine & Biological Sciences, Chicago, USA
| | - Jermy Hornibrook
- Canterbury District Health Board, Department of Otolaryngology, Christchurch, New Zealand
| | | | | | | | - Shin-Ichi Usami
- Department of Otorhinolaryngology, Shinshu University School of Medicine, China
| | - Wuqing Wang
- Eye Ear Nose and Throat Hospital of Fudan University, China
| | - Jing Zou
- Department of Otolaryngology, Changhai Hospital Second Military Medical University, Shanghai, China
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Gürkov R. Retraction to: A plea for systematic literature analysis and conclusive study design. J Vestib Res 2023; 33:163. [PMID: 31177255 DOI: 10.3233/ves-180662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Robert Gürkov
- Department of Otorhinolaryngology Head and Neck Surgery, Klinikum Bielefeld, Bielefeld, Germany
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Lopez-Escamez JA, Attyé A. Magnetic resonance imaging of endolymphatic hydrops: Controversies and common ground, comment on: "A plea for systematic literature analysis and conclusive study design". J Vestib Res 2023; 33:159-162. [PMID: 31177256 DOI: 10.3233/ves-180663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Jose A Lopez-Escamez
- Department of Genomic Medicine- Centro de Genómica e Investigación Oncológica - Pfizer/Universidad de Granada/Junta de Andalucía (Genyo), Otology & Neurotology Group CTS495, PTS, Granada, Spain
- Department of Otolaryngology, Instituto de Investigacion Biosanitaria, ibs.Granada, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Arnaud Attyé
- Department of Neuroradiology and MRI, Grenoble, France
- IRMaGe Facility, Grenoble Alps University, Grenoble, France
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Naganawa S. Editorial: Hydropic Ear Disease: Imaging and Functional Evaluation. Front Surg 2022; 9:913741. [PMID: 35574539 PMCID: PMC9091436 DOI: 10.3389/fsurg.2022.913741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
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Lei P, Leng Y, Li J, Zhou R, Liu B. Anatomical variation of inner ear may be a predisposing factor for unilateral Ménière's disease rather than for ipsilateral delayed endolymphatic hydrops. Eur Radiol 2022; 32:3553-3564. [PMID: 34978581 PMCID: PMC9038801 DOI: 10.1007/s00330-021-08430-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 01/18/2023]
Abstract
Objective Radiological anatomical variations, measured by magnetic resonance imaging (MRI), were evaluated in patients with ipsilateral delayed endolymphatic hydrops (DEH) and unilateral Ménière’s disease (MD). The role of anatomical variations in different subtypes of hydropic ear disease was investigated. Methods Twenty-eight patients with ipsilateral DEH, 76 patients with unilateral MD, and 59 control subjects were enrolled. The radiological indices included the distance between the vertical part of the posterior semicircular canal and the posterior fossa (MRI-PP distance) and the visibility of vestibular aqueduct (MRI-VA). These variations among patients with DEH, MD, and control subjects were compared. The correlation between radiological anatomical variations and clinical features or audio-vestibular findings was also examined. Results (1) MRI-PP distance in the affected side of unilateral MD was shorter than that in ipsilateral DEH (Z = − 2.481, p = 0.013) and control subjects (Z = − 2.983, p = 0.003), while the difference of MRI-PP distance between the affected side of ipsilateral DEH and control subjects was not statistically significant (Z = − 0.859, p = 0.391). (2) There was no significant interaural difference of MRI-PP distance in patients with unilateral MD (Z = − 0.041, p = 0.968) and ipsilateral DEH (t = − 0.107, p = 0.915) respectively. (3) No significant interaural difference of MRI-VA visibility was observed in patients with unilateral MD (χ2 = 0.742, p = 0.389) and ipsilateral DEH (χ2 = 0.327, p = 0.567) respectively. (4) No correlation was found between these anatomical variables and clinical features or audio-vestibular findings in patients with unilateral MD and ipsilateral DEH respectively (p > 0.05). Conclusions Anatomical variations of inner ear may be a predisposing factor in the pathogenesis of unilateral MD rather than ipsilateral DEH. Key Points • Patients with ipsilateral delayed endolymphatic hydrops showed normal distance between the vertical part of the posterior semicircular canal and the posterior fossa. • Compared to patients with ipsilateral delayed endolymphatic hydrops and control subjects, patients with unilateral Ménière’s disease exhibited shorter distance between the vertical part of the posterior semicircular canal and the posterior fossa. • Anatomical variations of inner ear may be a predisposing factor in the pathogenesis of unilateral Ménière’s disease rather than ipsilateral delayed endolymphatic hydrops. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08430-7.
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Affiliation(s)
- Ping Lei
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yangming Leng
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Jing Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Renhong Zhou
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bo Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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14
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AIM in Ménière’s Disease. Artif Intell Med 2022. [DOI: 10.1007/978-3-030-64573-1_271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Grosser D, Willenborg K, Dellani P, Avallone E, Götz F, Böthig D, Warnecke A, Lanfermann H, Lenarz T, Giesemann A. Vestibular Aqueduct Size Correlates With the Degree of Cochlear Hydrops in Patients With and Without Menière's Disease. Otol Neurotol 2021; 42:e1532-e1536. [PMID: 34766949 DOI: 10.1097/mao.0000000000003300] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To correlate the CT imaging findings of the visibility and size of the vestibular aqueduct (VA) with the degree of the cochlear hydrops determined in MRI late imaging of the hydrops. Study Design: Retrospective study. Setting: Tertiary referral center. Patients: A total of 127 patients (62 women, 65 men, average age 55.6 yrs): 86 of these were diagnosed with Menière's disease (American Academy of Otolaryngology-Head and Neck Surgery [AAO-HNS] criteria; 67 unilateral, 19 bilateral). INTERVENTIONS Temporal bone CT and hydrops MRI were performed in all patients. MAIN OUTCOME MEASURES Visibility/width of the VA in temporal bone CT and grade of cochlear hydrops evaluated by MRI. RESULTS The width of the VA is significantly smaller in patients diagnosed with Menière's disease (30% non-visible VA), compared with the patients who did not fulfill the diagnostic criteria of Menière's disease (12% non-visible VA) (double sided Spearman correlation, p < 0.001). In all ears of patients diagnosed with Menière's disease the width of the VA was significantly correlated with the degree of the cochlear hydrops (in cases of non-visible VA 65% [34/52] ears presented with hydrops grade 3 or 4; 13% [7/52] ears presented with hydrops grade 1 or 2 and 21% [11/52] ears showed no hydrops) (Spearman correlation p = 0.001/p < 0.01). This is also true for all ears that can be summarized as hydrophic ear disease (symptomatic ears that present with a hydrops in MRI). CONCLUSIONS The results of our study could confirm the importance of the VA in the pathogenesis of the endolymphatic hydrops in vivo.
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Affiliation(s)
- Desiree Grosser
- Institute for Diagnostic and Interventional Neuroradiology
- Institute for Otorhinolaryngology
| | | | - Paulo Dellani
- Institute for Diagnostic and Interventional Neuroradiology
| | - Emilio Avallone
- Diagnostic and Interventional Radiology, Klinikum Region Hannover
| | - Friedrich Götz
- Institute for Diagnostic and Interventional Neuroradiology
| | - Dietmar Böthig
- Clinic for Pediatric Cardiology and Intensive Care, Hannover Medical school, Hannover, Germany
| | | | | | - Thomas Lenarz
- Diagnostic and Interventional Radiology, Klinikum Region Hannover
| | - Anja Giesemann
- Institute for Diagnostic and Interventional Neuroradiology
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16
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de Pont LMH, van Steekelenburg JM, Verhagen TO, Houben M, Goeman JJ, Verbist BM, van Buchem MA, Bommeljé CC, Blom HM, Hammer S. Hydropic Ear Disease: Correlation Between Audiovestibular Symptoms, Endolymphatic Hydrops and Blood-Labyrinth Barrier Impairment. Front Surg 2021; 8:758947. [PMID: 34805261 PMCID: PMC8601159 DOI: 10.3389/fsurg.2021.758947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/12/2021] [Indexed: 01/23/2023] Open
Abstract
Research Objective: To investigate the correlation between clinical features and MRI-confirmed endolymphatic hydrops (EH) and blood-labyrinth barrier (BLB) impairment. Study Design: Retrospective cross-sectional study. Setting: Vertigo referral center (Haga Teaching Hospital, The Hague, the Netherlands). Methods: We retrospectively analyzed all patients that underwent 4 h-delayed Gd-enhanced 3D FLAIR MRI at our institution from February 2017 to March 2019. Perilymphatic enhancement and the degree of cochlear and vestibular hydrops were assessed. The signal intensity ratio (SIR) was calculated by region of interest analysis. Correlations between MRI findings and clinical features were evaluated. Results: Two hundred and fifteen patients with MRI-proven endolymphatic hydrops (EH) were included (179 unilateral, 36 bilateral) with a mean age of 55.9 yrs and median disease duration of 4.3 yrs. Hydrops grade is significantly correlated with disease duration (P < 0.001), the severity of low- and high-frequency hearing loss (both P < 0.001), and the incidence of drop attacks (P = 0.001). Visually increased perilymphatic enhancement was present in 157 (87.7%) subjects with unilateral EH. SIR increases in correlation with hydrops grade (P < 0.001), but is not significantly correlated with the low or high Fletcher index (P = 0.344 and P = 0.178 respectively). No significant differences were found between the degree of EH or BLB impairment and vertigo, tinnitus or aural fullness. Conclusion: The degree of EH positively correlates with disease duration, hearing loss and the incidence of drop attacks. The BLB is impaired in association with EH grade, but without clear contribution to the severity of audiovestibular symptoms.
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Affiliation(s)
- Lisa M H de Pont
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Thijs O Verhagen
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, Netherlands
| | - Maartje Houben
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands
| | - Jelle J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Berit M Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Claire C Bommeljé
- Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands
| | - Henk M Blom
- Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands.,Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, Netherlands.,Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium
| | - Sebastiaan Hammer
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands
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17
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Li M, Leng Y, Liu B. Clinical Implication of Caloric and Video Head Impulse Tests for Patients With Enlarged Vestibular Aqueduct Presenting With Vertigo. Front Neurol 2021; 12:717035. [PMID: 34707555 PMCID: PMC8542699 DOI: 10.3389/fneur.2021.717035] [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: 05/30/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background: By examining the clinical features and results of video head impulse test (vHIT) and caloric tests in patients with enlarged vestibular aqueduct (EVA) presenting with vertigo, we aimed to investigate the function of angular vestibulo-ocular reflex (VOR) and its clinical implications. Methods: Nine patients with EVA manifesting with vertigo were enrolled. The medical history, audiological examination, imaging, and the results of the caloric test and the vHIT were analyzed. Results: Of the nine patients with EVA (eight bilateral and one unilateral case), five were pediatric cases. All 17 ears exhibited sensorineural hearing loss (SNHL). Enlarged vestibular aqueduct patients can present with recurrent (seven cases) or single (two cases) vertigo attack, trauma-induced (two cases), or spontaneous (seven cases) vertigo. Diminished caloric responses were observed in 77.8% (7/9) of the patients (four cases unilaterally and three bilaterally), while unilateral abnormal vHIT results in 11.1% (1/9) patients. Abnormal caloric and normal horizontal vHIT responses were found in 66.7% (6/9) of EVA patients. Conclusions: Vestibular manifestations in EVA are diverse. Enlarged vestibular aqueduct patients with vertigo can present with a reduced caloric response and normal horizontal vHIT, and this pattern of angular VOR impairment was also found in other hydropic ear diseases.
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Affiliation(s)
- Ming Li
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yangming Leng
- 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
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18
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Park CJ, Cho YS, Chung MJ, Kim YK, Kim HJ, Kim K, Ko JW, Chung WH, Cho BH. A Fully Automated Analytic System for Measuring Endolymphatic Hydrops Ratios in Patients With Ménière Disease via Magnetic Resonance Imaging: Deep Learning Model Development Study. J Med Internet Res 2021; 23:e29678. [PMID: 34546181 PMCID: PMC8493456 DOI: 10.2196/29678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/15/2021] [Accepted: 07/27/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recently, the analysis of endolymphatic hydropses (EHs) via inner ear magnetic resonance imaging (MRI) for patients with Ménière disease has been attempted in various studies. In addition, artificial intelligence has rapidly been incorporated into the medical field. In our previous studies, an automated algorithm for EH analysis was developed by using a convolutional neural network. However, several limitations existed, and further studies were conducted to compensate for these limitations. OBJECTIVE The aim of this study is to develop a fully automated analytic system for measuring EH ratios that enhances EH analysis accuracy and clinical usability when studying Ménière disease via MRI. METHODS We proposed the 3into3Inception and 3intoUNet networks. Their network architectures were based on those of the Inception-v3 and U-Net networks, respectively. The developed networks were trained for inner ear segmentation by using the magnetic resonance images of 124 people and were embedded in a new, automated EH analysis system-inner-ear hydrops estimation via artificial intelligence (INHEARIT)-version 2 (INHEARIT-v2). After fivefold cross-validation, an additional test was performed by using 60 new, unseen magnetic resonance images to evaluate the performance of our system. The INHEARIT-v2 system has a new function that automatically selects representative images from a full MRI stack. RESULTS The average segmentation performance of the fivefold cross-validation was measured via the intersection of union method, resulting in performance values of 0.743 (SD 0.030) for the 3into3Inception network and 0.811 (SD 0.032) for the 3intoUNet network. The representative magnetic resonance slices (ie, from a data set of unseen magnetic resonance images) that were automatically selected by the INHEARIT-v2 system only differed from a maximum of 2 expert-selected slices. After comparing the ratios calculated by experienced physicians and those calculated by the INHEARIT-v2 system, we found that the average intraclass correlation coefficient for all cases was 0.941; the average intraclass correlation coefficient of the vestibules was 0.968, and that of the cochleae was 0.914. The time required for the fully automated system to accurately analyze EH ratios based on a patient's MRI stack was approximately 3.5 seconds. CONCLUSIONS In this study, a fully automated full-stack magnetic resonance analysis system for measuring EH ratios was developed (named INHEARIT-v2), and the results showed that there was a high correlation between the expert-calculated EH ratio values and those calculated by the INHEARIT-v2 system. The system is an upgraded version of the INHEARIT system; it has higher segmentation performance and automatically selects representative images from an MRI stack. The new model can help clinicians by providing objective analysis results and reducing the workload for interpreting magnetic resonance images.
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Affiliation(s)
- Chae Jung Park
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Young Sang Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Jin Chung
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yi-Kyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung-Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyunga Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea.,Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae-Wook Ko
- Department of Clinical Pharmacology and Therapeutics, Samsung Medical Center, Seoul, Republic of Korea
| | - Won-Ho Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Baek Hwan Cho
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
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19
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Zanetti D, Conte G, Scola E, Casale S, Lilli G, Di Berardino F. Advanced Imaging of the Vestibular Endolymphatic Space in Ménière's Disease. Front Surg 2021; 8:700271. [PMID: 34497826 PMCID: PMC8419327 DOI: 10.3389/fsurg.2021.700271] [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: 04/25/2021] [Accepted: 07/19/2021] [Indexed: 02/04/2023] Open
Abstract
The diagnosis of "definite" Méniére's disease (MD) relies upon its clinical manifestations. MD has been related with Endolymphatic Hydrops (EH), an enlargement of the endolymphatic spaces (ES) (cochlear duct, posterior labyrinth, or both). Recent advances in Magnetic Resonance (MR) imaging justify its increasing role in the diagnostic workup: EH can be consistently recognized in living human subjects by means of 3-dimensional Fluid-Attenuated Inversion-Recovery sequences (3D-FLAIR) acquired 4 h post-injection of intra-venous (i.v.) Gadolinium-based contrast medium, or 24 h after an intratympanic (i.t.) injection. Different criteria to assess EH include: the comparison of the area of the vestibular ES with the whole vestibule on an axial section; the saccule-to-utricle ratio ("SURI"); and the bulging of the vestibular organs toward the inferior 1/3 of the vestibule, in contact with the stapedial platina ("VESCO"). An absolute link between MD and EH has been questioned, since not all patients with hydrops manifest MD symptoms. In this literature review, we report the technical refinements of the imaging methods proposed with either i.t. or i.v. delivery routes, and we browse the outcomes of MR imaging of the ES in both MD and non-MD patients. Finally, we summarize the following imaging findings observed by different researchers: blood-labyrinthine-barrier (BLB) breakdown, the extent and grading of EH, its correlation with clinical symptoms, otoneurological tests, and stage and progression of the disease.
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Affiliation(s)
- Diego Zanetti
- Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Audiology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giorgio Conte
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Scola
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Casale
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Lilli
- Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Audiology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Federica Di Berardino
- Audiology Unit, Department of Specialistic Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Audiology Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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20
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Eliezer M, Attyé A, Toupet M, Hautefort C. Imaging of endolymphatic hydrops: A comprehensive update in primary and secondary hydropic ear disease. J Vestib Res 2021; 31:261-268. [PMID: 33646188 DOI: 10.3233/ves-200786] [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: 01/03/2023]
Abstract
BACKGROUND Since the first description by Hallpike and Cairns, the excess of endolymphatic fluid, also known as endolymphatic hydrops (EH), has been established as being the main biomarker in patients with Menière's disease. Recently, the concept of primary (PHED) and secondary hydropic ear disease (SHED) has been introduced. PHED corresponded to Menière's disease while SHED was defined as the presence of EH in patients with pre-existing inner ear disease. OBJECTIVE In this article, we would like to summarize the methodology of hydrops exploration using MRI and the previously published radiological findings in patients with PHED and SHED. RESULTS Before the emergence of delayed inner ear MRI, the presence of EH was assumed based on clinical symptoms. However, because of the recent technical developments, inner ear MRI became an important tool in clinical settings for identifying EH in vivo, in patients with PHED and SHED. The presence of EH on MRI is related with the degree of sensorineural hearing loss whether in patients with PHED or SHED. By contrast, in PHED or SHED patients without sensorineural hearing loss, MRI showed no sign of EH. CONCLUSIONS Thanks to the recent technical developments, inner ear MRI became an important tool in clinical settings for identifying EH in vivo, in patients with PHED and SHED.
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Affiliation(s)
- Michael Eliezer
- Department of Neuroradiology, Lariboisière University Hospital, Paris, France
| | - Arnaud Attyé
- Department of Neuroradiology, Lariboisière University Hospital, Paris, France.,Grenoble Alps University Hospital, IRMaGe, Grenoble, France
| | - Michel Toupet
- Centre d'Explorations Fonctionnelles Otoneurologiques, Paris, France
| | - Charlotte Hautefort
- Department of Head and Neck Surgery, Lariboisière University Hospital, Paris, France
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21
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Sousa R, Guerreiro C, Eça T, Campos J, Luis L. MR Imaging of Cochlear Modiolus and Endolymphatic Hydrops in Patients With Menière's Disease. Front Surg 2021; 8:667248. [PMID: 34355012 PMCID: PMC8329086 DOI: 10.3389/fsurg.2021.667248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Menière's disease (MD) is an inner ear disorder characterized by recurrent episodes of spontaneous vertigo, unilateral low-frequency sensorineural hearing loss, tinnitus, and aural fullness. Current diagnosis still often has to rely on subjective and audiometric criteria only, although endolymphatic hydrops is recognized as the pathophysiological substrate of the disease, having been demonstrated in anatomical pathological studies and by magnetic resonance (MRI). The modiolus has a close functional and anatomical relationship with the cochlear nerve and membranous labyrinth and can be evaluated with MRI but no data exist on the modiolar size in MD. Purpose: Our purpose is to examine the following hypothesis. Is cochlear modiolus smaller in symptomatic ears in MD? Methods: We used a retrospective 3 Tesla MR study (heavily T2-weighted 3D fast asymmetric spin-echo images and 0.5 mm slice thickness) comparing the mean modiolar area (MMA) in the index and best ears of eight patients with definite MD based on audiometric data. The obtained MMA values were compared against the audiometric data and the presence of vestibular endolymphatic hydrops. Results: No differences were seen in MMA between best and worst ears. Ears with a pure tone average (PTA) ≥25 dB and more pronounced endolymphatic hydrops showed lower MMA (not statistically significant). Two patients with extreme endolymphatic hydrops showed a noteworthy ipsilateral decrease in the cochlear modiolus area. Conclusion: No differences were seen in MMA between best and worst ears in definite MD. Worse hearing function (PTA ≥ 25dB) and more pronounced endolymphatic hydrops seem to be associated with lower MMA. This might be related to bone remodeling as a consequence of endolymphatic hydrops. Further research is needed to corroborate and explore these findings.
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Affiliation(s)
- Rita Sousa
- Neuroradiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Carla Guerreiro
- Neuroradiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Tiago Eça
- Otorhinolaryngology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Jorge Campos
- Imaging Department, Red Cross Hospital, Lisbon, Portugal
| | - Leonel Luis
- Otorhinolaryngology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Clinical Physiology Translational Unit, Institute of Molecular Medicine, University of Lisbon, Lisbon, Portugal
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22
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Zou J, Chen L, Li H, Zhang G, Pyykkö I, Lu J. High-quality imaging of endolymphatic hydrops acquired in 7 minutes using sensitive hT 2W-3D-FLAIR reconstructed with magnitude and zero-filled interpolation. Eur Arch Otorhinolaryngol 2021; 279:2279-2290. [PMID: 34145490 PMCID: PMC8986670 DOI: 10.1007/s00405-021-06912-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
Background It is still challenging to detect endolymphatic hydrops (EH) in patients with Meniere’s disease (MD) using MRI. The aim of the present study was to optimize a sensitive technique generating strong contrast enhancement from minimum gadolinium–diethylenetriamine pentaacetic acid (Gd–DTPA) while reliably detecting EH in the inner ear, including the apex. Materials and methods All imaging was performed using a 3.0 T MR system 24 h after intratympanic injection of low-dose Gd–DTPA. Heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery reconstructed with magnitude and zero-filled interpolation (hT2W–FLAIR–ZFI) was optimized and validated in phantom studies and compared with medium inversion time inversion recovery imaging with magnitude reconstruction (MIIRMR). The following parameters were used in hT2W–FLAIR–ZFI: repetition time 14,000 ms, echo time 663 ms, inversion time 2900 ms, flip angle 120°, echo train length 271, and field of view 166 × 196 mm2. Results MRI obtained using hT2W–FLAIR–MZFI yielded high-quality images with sharper and smoother borders between the endolymph and perilymph and a higher signal intensity ratio and more homogenous perilymph enhancement than those generated with MIIRMR (p < 0.01). There were predominantly grade II EHs in the cochleae and grade III EHs in the vestibule in definite MD. EH was detected in the apex of 11/16 ipsilateral ears, 3/16 contralateral ears in unilateral definite MD and 3/6 ears in bilateral MD. Conclusions The novel hT2W–FLAIR–MZFI technique is sensitive and demonstrates strong and homogenous enhancement by minimum Gd–DTPA in the inner ear, including the apex, and yields high-quality images with sharp borders between the endolymph and perilymph. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-06912-4.
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Affiliation(s)
- Jing Zou
- 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.
- Hearing and Balance Research Unit, Field of Otolaryngology, School of Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Luguang Chen
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Hongbin Li
- 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
| | - Guoping Zhang
- 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
| | - Ilmari Pyykkö
- Hearing and Balance Research Unit, Field of Otolaryngology, School of Medicine, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jianping Lu
- Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China
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Domínguez P, Manrique-Huarte R, Suárez-Vega V, López-Laguna N, Guajardo C, Pérez-Fernández N. Endolymphatic Hydrops in Fluctuating Hearing Loss and Recurrent Vertigo. Front Surg 2021; 8:673847. [PMID: 34136529 PMCID: PMC8202684 DOI: 10.3389/fsurg.2021.673847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Endolymphatic hydrops (EH) is the histopathological hallmark of Ménière's disease (MD) and has been found by in vivo magnetic resonance imaging (MRI) in patients with several inner ear syndromes without definite MD criteria. The incidence and relevance of this finding is under debate. Purpose: The purpose of the study is to evaluate the prevalence and characteristics of EH and audiovestibular test results in groups of patients with fluctuating audiovestibular symptoms not fulfilling the actual criteria for definite MD and compare them with a similar group of patients with definite MD and a group of patients with recent idiopathic sudden neurosensory hearing loss (ISSNHL). Material and Methods: 170 patients were included, 83 with definite MD, 38 with fluctuating sensorineural hearing loss, 34 with recurrent vertigo, and 15 with ISSNHL. The clinical variables, audiovestibular tests, and EH were evaluated and compared. Logistic proportional hazard models were used to obtain the odds ratio for hydrops development, including a multivariable adjusted model for potential confounders. Results: No statistical differences between groups were found regarding disease duration, episodes, Tumarkin spells, migraine, vascular risk factors, or vestibular tests; only hearing loss showed differences. Regarding EH, we found significant differences between groups, with odds ratio (OR) for EH presence in definite MD group vs. all other patients of 11.43 (4.5–29.02; p < 0.001). If the ISSNHL group was used as reference, OR was 55.2 (11.9–253.9; p < 0.001) for the definite MD group, 9.9 (2.1–38.9; p = 0.003) for the recurrent vertigo group, and 5.1 (1.2–21.7; p = 0.03) for the group with fluctuating sensorineural hearing loss. Conclusion: The percentage of patients with EH varies between groups. It is minimal in the ISSNHL group and increases in groups with increasing fluctuating audiovestibular symptoms, with a rate of severe EH similar to the known rate of progression to definite MD in those groups, suggesting that presence of EH by MRI could be related to the risk of progression to definite MD. Thus, EH imaging in these patients is recommended.
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Affiliation(s)
- Pablo Domínguez
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | | | - Nieves López-Laguna
- Department of Emergency Medicine, Clínica Universidad de Navarra, Madrid, Spain
| | - Carlos Guajardo
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, Pamplona, Spain.,Escuela de Fonoaudiología, Universidad Austral de Chile, Sede Puerto Montt, Valdivia, Chile
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Abstract
: The relationship between Menière's disease and endolymphatic hydrops is ambiguous. On the one hand, the existence of cases of endolymphatic hydrops lacking the classic symptoms of Menière's disease has prompted the assertion that endolymphatic hydrops alone is insufficient to cause symptoms and drives the hypothesis that endolymphatic hydrops is a mere epiphenomenon. Yet, on the other hand, there is considerable evidence suggesting a relationship between the mechanical pressure effects of endolymphatic hydrops and resultant disordered auditory physiology and symptomatology. A critical appraisal of this topic is undertaken, including a review of key histopathologic data chiefly responsible for the epiphenomenon hypothesis. Overall, a case is made that A) the preponderance of available evidence suggests endolymphatic hydrops is likely responsible for some of the auditory symptoms of Menière's disease, particularly those that can be modulated by mechanical manipulation of the basilar membrane and cochlear microphonic; B) Menière's disease can be reasonably considered part of a larger spectrum of hydropic inner ear disease that also includes some cases that lack vertigo. C) The relationship with endolymphatic hydrops sufficiently robust to consider its presence a hallmark defining feature of Menière's disease and a sensible target for diagnostic detection.
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Laterality of Audiovestibular Symptoms Predicts Laterality of Endolymphatic Hydrops in Hydropic Ear Disease (Menière). Otol Neurotol 2021; 41:e1140-e1144. [PMID: 32925855 DOI: 10.1097/mao.0000000000002775] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND For clinical confirmation of the diagnosis of hydropic ear disease (HED) (Menière) by MR imaging, two routes of contrast enhancement of the perilymphatic space are currently being used: intratympanic and intravenous. While unilateral intratympanic contrast application generally enables a higher perilymph signal intensity and image quality, the intravenous route allows for imaging of both inner ears simultaneously. It is conceivable that intratympanic contrast application to one ear would result in a failure to detect endolymphatic hydrops in a given patient if the hydrops is present only in the other ear. Therefore, in this study we examined the question whether the ear with the greater degree of endolymphatic hydrops may be predicted based on clinical features. METHODS Retrospective study of 50 patients with HED confirmed on MR imaging. Three tesla MR imaging with 3D fluid attenuated inversion recovery 4 hours after intravenous gadolinium contrast application was used to detect endolymphatic hydrops. The index ear was defined by auditory symptoms during attacks, low frequency hearing loss, and caloric canal paresis. RESULTS In all patients the ear with more severe symptoms corresponded with the ear showing the more severe hydrops on MR imaging. CONCLUSION In summary, in this study population the degree of low-frequency hearing loss (250 Hz-1 kHz) in combination with auditory symptoms during attacks identified the ear with the greater extent of endolymphatic hydrops in all patients. In conclusion, intratympanic contrast application to the index ear seems to be sufficient to confirm the diagnosis of HED (Menière) on MR imaging.
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Oh SY, Dieterich M, Lee BN, Boegle R, Kang JJ, Lee NR, Gerb J, Hwang SB, Kirsch V. Endolymphatic Hydrops in Patients With Vestibular Migraine and Concurrent Meniere's Disease. Front Neurol 2021; 12:594481. [PMID: 33776877 PMCID: PMC7991602 DOI: 10.3389/fneur.2021.594481] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/09/2021] [Indexed: 12/17/2022] Open
Abstract
Objective: Intravenous contrast agent enhanced, high-resolution magnetic resonance imaging of the inner ear (iMRI) confirmed that patients with Menière's disease (MD) and vestibular migraine (VM) could present with endolymphatic hydrops (EH). The present study aimed to investigate EH characteristics and their interrelation to neurotologic testing in patients with VM, MD, or VM with concurrent MD (VM-MD). Methods: Sixty–two patients (45 females, aged 23–81 years) with definite or probable VM (n = 25, 19 definite), MD (n = 29, 17 definite), or showing characteristics of both diseases (n = 8) were included in this study. Diagnostic workup included neurotologic assessments including video-oculography (VOG) during caloric stimulation and head-impulse test (HIT), ocular and cervical vestibular evoked myogenic potentials (o/cVEMP), pure tone audiometry (PTA), as well as iMRI. EH's degree was assessed visually and via volumetric quantification using a probabilistic atlas-based segmentation of the bony labyrinth and volumetric local thresholding (VOLT). Results: Although a relevant number of VM patients reported varying auditory symptoms (13 of 25, 52.0%), EH in VM was only observed twice. In contrast, EH in VM-MD was prevalent (2/8, 25%) and in MD frequent [23/29, 79.3%; χ2(2) = 29.1, p < 0.001, φ = 0.7]. Location and laterality of EH and neurophysiological testing classifications were highly associated (Fisher exact test, p < 0.005). In MD, visual semi-quantitative grading and volumetric quantification correlated highly to each other (rS = 0.8, p < 0.005, two-sided) and to side differences in VOG during caloric irrigation (vestibular EH ipsilateral: rS = 0.6, p < 0.05, two-sided). In VM, correlations were less pronounced. VM-MD assumed an intermediate position between VM and MD. Conclusion: Cochlear and vestibular hydrops can occur in MD and VM patients with auditory symptoms; this suggests inner ear damage irrespective of the diagnosis of MD or VM. The EH grades often correlated with auditory symptoms such as hearing impairment and tinnitus. Further research is required to uncover whether migraine is one causative factor of EH or whether EH in VM patients with auditory symptoms suggests an additional pathology due to MD.
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Affiliation(s)
- Sun-Young Oh
- Department of Neurology, School of Medicine, Jeonbuk National University, Jeonju, South Korea.,Research Institute of Clinical Medicine, Jeonbuk National University Hospital-Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea
| | - 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.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Bit Na Lee
- Department of Neurology, School of Medicine, Jeonbuk National University, Jeonju, South Korea
| | - 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
| | - Jin-Ju Kang
- Department of Neurology, School of Medicine, Jeonbuk National University, Jeonju, South Korea
| | - Na-Ri Lee
- Research Institute of Clinical Medicine, Jeonbuk National University Hospital-Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea.,Division of Oncology and Hematology, Department of Internal Medicine, Jeonbuk National University Hospital and School of Medicine, Jeonju, South Korea
| | - 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
| | - Seung-Bae Hwang
- Research Institute of Clinical Medicine, Jeonbuk National University Hospital-Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea.,Department of Radiology, Jeonbuk National University Hospital and School of Medicine, Jeonju, South Korea
| | - 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
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27
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Clinical high-resolution imaging and grading of endolymphatic hydrops in Hydropic Ear Disease at 1.5 T using the two-slice grading for vestibular endolymphatic hydrops in less than 10 min. Eur Arch Otorhinolaryngol 2021; 279:751-757. [PMID: 33687507 DOI: 10.1007/s00405-021-06731-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hydropic Ear Disease (Menière) is one of the most common inner ear disorders and one of the most common causes of vertigo attacks. The underlying pathology is a distension of the endolymphatic space of the inner ear, termed endolymphatic hydrops. However, the unequivocal morphologic confirmation of ELH has been restricted to post-mortem histologic analysis until 2007, when the first clinical MR imaging report demonstrated ELH in living patients with Menière's disease at 3 T combined with intratympanic application of contrast. Imaging techniques have since then evolved further. However, a high magnetic field strength of 3 T has consistently been mandatory for reliable clinical imaging of ELH. This limitation has significantly prevented ELH imaging from being widely available across different health care systems around the world. With the aim of filling this gap, in the present study, we aim to describe the feasibility of ELH imaging at 1.5 T in clinical practice and to develop a dedicated grading system for cochlear and vestibular ELH for MR imaging at 1.5 T. METHODS In this retrospective study, we examined 30 patients with suspected hydropic ear disease undergoing diagnostic MR imaging. Contrast agent was diluted eightfold in saline solution and unilaterally applied by intratympanic injection as described previously. MRI scanning was performed using a 16-channel head coil on a 1.5 T Achieva Philips Medical Systems Scanner using a 3D FLAIR sequence. For the cochlea, a 3-stage grading was developed. For the vestibulum, a 4-stage grading based on two axial slices was developed by analysing both the superior and the inferior part of the vestibulum. The presence of hydropic herniation of the endolymphatic space into the posterior crus of the horizontal semicircular canal was evaluated. RESULTS In all 30 patients, the perilymphatic fluid spaces of the inner ear showed clear and high signal intensity, while the endolymphatic space was not enhanced. In all patients, the vestibular endolymphatic space could be clearly delineated and differentiated from the perilymphatic space. Analysis of the cochlear endolymphatic space revealed no evidence of ELH in 7 patients, a grade 1 cochlear ELH in 11 patients and a grade 2 cochlear ELH in 12 patients. Analysis of the vestibular endoylmphatic space revealed no evidence of ELH in 8 patients, a grade 1 vestibular ELH in 5 patients, a grade 2 vestibular ELH in 9 patients and a grade 3 vestibular ELH in 8 patients. Three patients showed a clear hydropic herniation of the vestibular endolymphatic space into the posterior non-ampullated crus of the horizontal SCC. CONCLUSION In summary, the findings presented in this study offer an easy, reliable and universally available technique of ELH imaging for diagnostic management of patients with suspected Hydropic Ear Disease.
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28
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Cho YS, Chung WH. AIM in Ménière’s Disease. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-58080-3_271-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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State of the Art Imaging in Menière’s Disease. Tips and Tricks for Protocol and Interpretation. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Purpose of Review
Menière’s disease (MD) is a burdensome and not well understood inner ear disorder that has received increasing attention of scientists over the past decade. Until 2007, a certain diagnosis of endolymphatic hydrops (EH) required post-mortem histology. Today, dedicated high-resolution magnetic resonance imaging (MRI) protocols enable detection of disease-related changes in the membranous labyrinth in vivo. In this review, we summarize the current status of MR imaging for MD.
Recent Findings
The mainstays of hydrops imaging are inversion recovery sequences using delayed acquisition after intravenous or intratympanic contrast administration. Based on these techniques, several methods have been developed to detect and classify EH. In addition, novel imaging features of MD, such as blood-labyrinth barrier impairment, have recently been observed.
Summary
Delayed contrast enhanced MRI has emerged as a reliable technique to demonstrate EH in vivo, with promising application in the diagnosis and follow-up of MD patients. Therefore, familiarity with current techniques and diagnostic imaging criteria is increasingly important.
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30
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Grigol TADAES, Lopes KDC, Ganança FF. Cervical vestibular evoked myogenic potentials and video head impulse test in Ménière disease. Braz J Otorhinolaryngol 2020; 86:534-544. [PMID: 30975590 PMCID: PMC9422702 DOI: 10.1016/j.bjorl.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/11/2019] [Indexed: 01/15/2023] Open
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Naganawa S, Nakamichi R, Ichikawa K, Kawamura M, Kawai H, Yoshida T, Sone M. MR Imaging of Endolymphatic Hydrops: Utility of iHYDROPS-Mi2 Combined with Deep Learning Reconstruction Denoising. Magn Reson Med Sci 2020; 20:272-279. [PMID: 32830173 PMCID: PMC8424026 DOI: 10.2463/mrms.mp.2020-0082] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: MRI of endolymphatic hydrops (EH) 4 h after intravenous administration of a single dose of gadolinium-based contrast agent is used for clinical examination in some institutions; however, further improvement in image quality would be valuable for wider clinical utility. Denoising using deep learning reconstruction (Advanced Intelligent Clear-IQ Engine [AiCE]) has been reported for CT and MR. The purpose of this study was to compare the contrast-to-noise ratio of endolymph to perilymph (CNREP) between the improved hybrid of reversed image of the positive endolymph signal and the native image of the perilymph signal multiplied with the heavily T2-weighted MR cisternography (iHYDROPS-Mi2) images, which used AiCE for the three source images (i.e. positive endolymph image [PEI], positive perilymph image [PPI], MR cisternography [MRC]) to those that did not use AiCE. We also examined if there was a difference between iHYDROPS-Mi2 images with and without AiCE for degree of visual grading of EH and in endolymphatic area [EL] ratios. Methods: Nine patients with suspicion of EH were imaged on a 3T MR scanner. iHYDROPS images were generated by subtraction of PEI images from PPI images. iHYDROPS-Mi2 images were then generated by multiplying MRC with iHYDROPS images. The CNREP and EL ratio were measured on the iHYDROPS-Mi2 images. Degree of radiologist visual grading for EH was evaluated. Results: Mean CNREP ± standard deviation was 1681.8 ± 845.2 without AiCE and 7738.6 ± 5149.2 with AiCE (P = 0.00002). There was no significant difference in EL ratio for images with and without AiCE. Radiologist grading for EH agreed completely between the 2 image types in both the cochlea and vestibule. Conclusion: The CNREP of iHYDROPS-Mi2 images with AiCE had more than a fourfold increase compared with that without AiCE. Use of AiCE did not adversely affect radiologist grading of EH.
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Affiliation(s)
- Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Rei Nakamichi
- Department of Radiology, Nagoya University Graduate School of Medicine
| | | | - Mariko Kawamura
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Hisashi Kawai
- Department of Radiology, Nagoya University Graduate School of Medicine
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine
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Leng Y, Liu B. Dissociation of Caloric and Video Head Impulse Tests in Patients With Delayed Endolymphatic Hydrops. Front Neurol 2020; 11:362. [PMID: 32528397 PMCID: PMC7247804 DOI: 10.3389/fneur.2020.00362] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
Delayed endolymphatic hydrops (DEH) represents a rare clinical entity characterized by intermittent vertigo attacks mimicking those of Ménière's disease (MD) in a patient with a prior sensorineural hearing loss. Some vestibular tests have been employed in patients with DEH. These tests provide useful diagnostic information and facilitate clinical decision-making. Here, we retrospectively studied the features of video head impulse test (vHIT) and examined its relationship with caloric test used in DEH patients. Included in this study were 17 patients with ipsilateral DEH and 2 with contralateral DEH. Among them, 73.7% (14/19) showed abnormal caloric test response (76.5% in ipsilateral DEH and 50% in contralateral DEH). Meanwhile, only 15.8% (3/19) of patients yielded abnormal horizontal vHIT results (11.8% in ipsilateral DEH and 50% in contralateral DEH). Abnormal caloric response in the presence of a preserved vHIT was common in DEH patients, especially those with ipsilateral DEH. This dissociation might be a distinctive pattern of vestibular deficit in DEH.
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Affiliation(s)
- Yangming Leng
- 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
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Inui H, Sakamoto T, Ito T, Kitahara T. Magnetic resonance imaging of endolymphatic space in patients with sensorineural hearing loss: comparison between fluctuating and idiopathic sudden sensorineural hearing loss. Acta Otolaryngol 2020; 140:345-350. [PMID: 32027202 DOI: 10.1080/00016489.2020.1720919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Recently, 3-Tesla magnetic resonance imaging (MRI) after an intravenous gadolinium injection has been used to describe the endolymphatic space (ELS).Objectives: This study described the histopathological differences between idiopathic sudden sensorineural hearing loss (ISSNHL) and fluctuating sensorineural hearing loss (FSNHL) by examining the ELS. Additionally, the relationship between the affected cochlear and vestibular ELS/total fluid space (TFS) volume ratio and the duration from the onset to MRI in patients with FSNHL were evaluated.Material and methods: This study included 205 individuals without vertigo: 47 controls, 94 with ISSNHL, and 64 with FSNHL. The TFS and ELS volumes were measured and the ELS/TFS volume ratios (%) were evaluated.Results: The cochlear and vestibular ELS/TFS volume ratios of the affected ear in patients with FSNHL were significantly higher than that in those with ISSNHL. There was no correlation between the duration from FSNHL onset to the MRI scan in the affected cochlea and vestibule.Conclusion and significance: There were differences in the form of hearing fluctuation and the extended ELS volume between ISSNHL and FSNHL. ISSNHL cases with severe ELS extension were likely to change to FSNHL.
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Affiliation(s)
| | | | - Taeko Ito
- Department of Otorhinolaryngology Head and Neck Surgery, Nara Medical University, Nara, Japan
| | - Tadashi Kitahara
- Department of Otorhinolaryngology Head and Neck Surgery, Nara Medical University, Nara, Japan
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Cho YS, Cho K, Park CJ, Chung MJ, Kim JH, Kim K, Kim YK, Kim HJ, Ko JW, Cho BH, Chung WH. Automated measurement of hydrops ratio from MRI in patients with Ménière's disease using CNN-based segmentation. Sci Rep 2020; 10:7003. [PMID: 32332804 PMCID: PMC7181627 DOI: 10.1038/s41598-020-63887-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 04/08/2020] [Indexed: 11/09/2022] Open
Abstract
Ménière's Disease (MD) is difficult to diagnose and evaluate objectively over the course of treatment. Recently, several studies have reported MD diagnoses by MRI-based endolymphatic hydrops (EH) analysis. However, this method is time-consuming and complicated. Therefore, a fast, objective, and accurate evaluation tool is necessary. The purpose of this study was to develop an algorithm that can accurately analyze EH on intravenous (IV) gadolinium (Gd)-enhanced inner-ear MRI using artificial intelligence (AI) with deep learning. In this study, we developed a convolutional neural network (CNN)-based deep-learning model named INHEARIT (INner ear Hydrops Estimation via ARtificial InTelligence) for the automatic segmentation of the cochlea and vestibule, and calculation of the EH ratio in the segmented region. Measurement of the EH ratio was performed manually by a neuro-otologist and neuro-radiologist and by estimation with the INHEARIT model and were highly consistent (intraclass correlation coefficient = 0.971). This is the first study to demonstrate that automated EH ratio measurements are possible, which is important in the current clinical context where the usefulness of IV-Gd inner-ear MRI for MD diagnosis is increasing.
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Affiliation(s)
- Young Sang Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongwon Cho
- Medical AI Research Center, Samsung Medical Center, Seoul, Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Chae Jung Park
- Medical AI Research Center, Samsung Medical Center, Seoul, Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Myung Jin Chung
- Medical AI Research Center, Samsung Medical Center, Seoul, Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hyuk Kim
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Kyunga Kim
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
- Statistics & Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Yi-Kyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung-Jin Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Wook Ko
- Department of Clinical Pharmacology and Therapeutics, Samsung Medical Center, Seoul, Korea
| | - Baek Hwan Cho
- Medical AI Research Center, Samsung Medical Center, Seoul, Korea.
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
| | - Won-Ho Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Endolymphatic hydrops evaluation on MRI: Practical considerations. Am J Otolaryngol 2020; 41:102361. [PMID: 31784143 DOI: 10.1016/j.amjoto.2019.102361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 11/21/2022]
Abstract
Four-hour delayed three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequence after intravenous gadolinium-based contrast agent administration is an optimal magnetic resonance imaging technique to evaluate endolymphatic hydrops in patients with known or suspected Ménière's disease. Nonenhanced endolymphatic space surrounded by enhanced perilymphatic space is evaluated in the cochlea and vestibule separately. In cochlear hydrops, the scala media is enlarged, potentially obliterating the scala vestibuli. In vestibular hydrops, the size of the saccule becomes equal to or larger than that of the utricle; as hydrops progresses, the saccule and utricle become larger and confluent until complete obliteration of the vestibule's perilymphatic space. In patients with a unilateral clinical presentation of Ménière's disease, it is possible to depict the asymmetries of perilymph enhancement, which may be increased on the affected side and reflect a permeability alteration of the blood-perilymph barrier. In addition, endolymphatic hydrops can be observed in the asymptomatic ear of these patients with a unilateral clinical presentation, showing that Ménière's disease tends to undergo bilateral evolution over time.
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Diagnostic Value of the Magnetic Resonance Imaging With Intratympanic Gadolinium Administration (IT-Gd MRI) Versus Audio-Vestibular Tests in Menière's Disease: IT-Gd MRI Makes the Difference. Otol Neurotol 2020; 40:e225-e232. [PMID: 30550412 DOI: 10.1097/mao.0000000000002082] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Our aim was to evaluate the validity and reliability of clinically relevant tests in the diagnosis of Menière's disease (MD) according to the criteria formulated during 2015 as well as their efficacy in detecting endolymphatic hydrops (EH). The focus was on: three-dimensional fluid-attenuated inversion recovery-SPectral Attenuated Inversion Recovery (3D-FLAIR-SPAIR) sequences using 3 Tesla magnetic resonance imaging (3T MRI) performed 24 hours after intratympanic Gadolinium injection (IT-Gd) in comparison with the functional tests pure tone audiometry (PTA), caloric test, video head impulse test (vHIT), and cervical-vestibular-evoked-myogenic-potentials (cVEMP). STUDY DESIGN Retrospective study. SETTING Tertiary care center. PATIENTS Primary eligibility criteria were given clinical suspicion of MD and the performance of an IT-Gd MRI leading to a group of 31 patients and 52 ears to be analyzed separately. MAIN OUTCOME MEASURE (S) Reanalysis of the raw diagnostic data leading to comparability of IT-Gd MRI, PTA, caloric test, vHIT, and cVEMP concerning their valency for clinically diagnosed MD and quantifiability of EH. RESULTS Considering sensitivity, specificity, and the likelihood-ratio only the IT-Gd MRI displayed results qualifying it as a viable device for MD-diagnostics in regards to the criteria of 2015 (p = 0.01), it even provides direct imaging evidence for the underlying pathology of the disease. Furthermore, the comparison between MRI images and test results of caloric test, vHIT and cVEMP revealed that neither of these diagnostic functional tests serves as a reliable indicator for EH. CONCLUSIONS It appears that the diagnosing process of MD would benefit from turning IT-Gd MRI into a standard diagnostic procedure in cases of suspected MD, displaying better results than caloric test, vHIT, and cVEMP.
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MRI detection of endolymphatic hydrops in Meniere's disease in 8 minutes using MIIRMR and a 20-channel coil after targeted gadolinium delivery. World J Otorhinolaryngol Head Neck Surg 2020; 5:180-187. [PMID: 32083244 PMCID: PMC7015851 DOI: 10.1016/j.wjorl.2019.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/06/2019] [Accepted: 04/10/2019] [Indexed: 11/21/2022] Open
Abstract
Background Endolymphatic hydrops (EH) become visible in vertigo patients, particularly in those with Meniere's disease (MD), in vivo using gadolinium-enhanced MRI. However, the image quality is not satisfying after intravenous injection of gadolinium chelate (GdC), and occasional failure in GdC uptake has been noticed after traditional intratympanic injection. In the present report, targeted delivery of GdC and using a cost-effective MRI system to obtain high quality images of EH in only 8 min will be introduced. Methods 39 MD patients were recruited in the study. First, 0.1 ml of 20-fold diluted gadolinium-diethylenetriamine acid (Gd-DTPA) was delivered onto the posterior upper part of the tympanic medial wall using a soft-tipped micro-irrigation catheter through an artificially perforated tympanic membrane. Inner ear MRI was performed 24 h after Gd-DTPA administration using a 3T MR machine and a 20-channel head/neck coil with an 8 min sequence of medium inversion time inversion recovery imaging with magnitude reconstruction (MIIRMR). The parameters were as follows: TR 16000 ms, TE 663 ms, inversion time 2700 ms, flip angle 180°, slices per slab 60. Results Efficient inner ear uptake of Gd-DTPA was detected 24 h after delivery and it created excellent contrast in the inner ear of all cases. High quality images demonstrating EH in the vestibule and cochlea were obtained. Conclusion Targeted delivery of minimum Gd-DTPA (0.1 ml, 20-fold dilution) onto the posterior upper portion of the tympanic medial wall and MRI with MIIRMR in a 3T machine and 20-channel head/neck coil are clinically practical to obtain high quality images displaying EH.
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Dean NJ, Pastras C, Brown D, Camp A. Are viral-infections associated with Ménière's Disease? A systematic review and meta-analysis of molecular-markers of viral-infection in case-controlled observational studies of MD. PLoS One 2019; 14:e0225650. [PMID: 31756230 PMCID: PMC6874328 DOI: 10.1371/journal.pone.0225650] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/09/2019] [Indexed: 12/18/2022] Open
Abstract
Despite considerable research, it remains controversial as to whether viral-infections are associated with Meniere’s Disease (MD), a clinically heterogeneous set of chronic inner-ear disorders strongly associated with endolymphatic hydrops. Here, we investigated whether viral-infections are associated with MD through a systematic review and meta-analysis of observational clinical studies using molecular-diagnostics. Eligible for inclusion were case-controlled studies which ascertained molecular-determinants of past or present viral-infection through either viral nucleic acids or host serological marker in MD cases and non-MD controls. Across online databases and grey literature, we identified 210 potentially relevant articles in the English language, from which a total of 14 articles fully satisfied our eligibility criteria such that meta-groups of 611 MD-cases and 373 controls resulted. The aggregate quality of the modest-sized (14 studies) body of evidence was limited and varied considerably with regards to participant selection, matching, and ascertainment(s) and determinant(s) of viral-infection. Most data identified concerned the human cytomegalovirus (CMV), and meta-analysis of eligible studies revealed that evidence of CMV-infection was associated approximately three-fold with MD compared to controls, however the timing of the infections was indeterminate as the pooled analyses combined antiviral serological markers with viral nucleic acid markers. No association was found for any of HSV-1, -2, VZV, or EBV. Associative analyses of any viral species not aforementioned were precluded by limited data, and thus potential associations between other viral species and MD, especially other than Herpesviridae, are yet to be characterised. Overall, we have found a small association between CMV-infection and MD, however it is to be determined for what sub-groups of MD this finding may be relevant, and ideally the reported association remains would be reproduced by a greater volume of higher quality evidence.
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Affiliation(s)
| | - Christopher Pastras
- School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Daniel Brown
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia
| | - Aaron Camp
- School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia
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Kutlubaev MA, Pal'chun VT, Savel'eva EE, Guseva AL. [Vascular mechanisms in Meniere's disease]. Vestn Otorinolaringol 2019; 84:70-77. [PMID: 31198220 DOI: 10.17116/otorino20198402170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Meniere's disease (MD) is chronic multifactorial medical condition caused by endolymphatic hydrops, which etiology is unclear. This review highlights possible vascular mechanisms of MD. Impairment of vascular regulation, further ischemic damage of labyrinth and venous drainage pathology could lead to endolymphatic hydrops. Epidemiologic studies reveal high comorbidity of MD and migraine. Both diseases could be the result of trigeminovascular dysfunction. Betahistine, the medication with vascular effect, is widely used in treatment of MD, the effectiveness of calcium channel blockers is evaluated. Keywords: vertigo, Meniere's disease, endolymphatichydrops, migraine, vascular mechanisms, betahistine.
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Affiliation(s)
- M A Kutlubaev
- Kuvatov Republican Clinical Hospital, Ufa, Russia, 450005,Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russia, 450000
| | - V T Pal'chun
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia, 117997,Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia, 117152
| | - E E Savel'eva
- Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russia, 450000
| | - A L Guseva
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia, 117997
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Loureiro RM, Sumi DV, Lemos MD, Tames HLDVC, Gomes RLE, Daniel MM, Soares CR, Murakoshi RW, Funari MBDG. The role of magnetic resonance imaging in Ménière disease: the current state of endolymphatic hydrops evaluation. EINSTEIN-SAO PAULO 2019; 17:eMD4743. [PMID: 30810586 PMCID: PMC6388723 DOI: 10.31744/einstein_journal/2019md4743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/11/2019] [Indexed: 11/29/2022] Open
Abstract
Technical advances in magnetic resonance imaging have allowed to accurately detect and grade endolymphatic space distension in Ménière disease; this was only possible in post-mortem histological studies until a few years ago. Magnetic resonance imaging rules out other causes of vertigo and hearing loss, and is able to evaluate the cochlear and vestibular compartments of the endolymphatic space using a dedicated protocol.
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Eckhard AH, Zhu M, O'Malley JT, Williams GH, Loffing J, Rauch SD, Nadol JB, Liberman MC, Adams JC. Inner ear pathologies impair sodium-regulated ion transport in Meniere's disease. Acta Neuropathol 2019; 137:343-357. [PMID: 30390121 PMCID: PMC6513907 DOI: 10.1007/s00401-018-1927-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 11/17/2022]
Abstract
Meniere's disease (MD), a syndromal inner ear disease, is commonly associated with a pathological accumulation of endolymphatic fluid in the inner ear, termed "idiopathic" endolymphatic hydrops (iEH). Although numerous precipitating/exacerbating factors have been proposed for MD, its etiology remains elusive. Here, using immunohistochemistry and in situ protein-protein interaction detection assays, we demonstrate mineralocorticoid-controlled sodium transport mechanisms in the epithelium of the extraosseous portion of the endolymphatic sac (eES) in the murine and human inner ears. Histological analysis of the eES in an extensive series of human temporal bones consistently revealed pathological changes in the eES in cases with iEH and a clinical history of MD, but no such changes were found in cases with "secondary" EH due to other otological diseases or in healthy controls. Notably, two etiologically different pathologies-degeneration and developmental hypoplasia-that selectively affect the eES in MD were distinguished. Clinical records from MD cases with degenerative and hypoplastic eES pathology revealed distinct intergroup differences in clinical disease presentation. Overall, we have identified for the first time two inner ear pathologies that are consistently present in MD and can be directly linked to the pathogenesis of EH, and which potentially affect the phenotypical presentation of MD.
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Affiliation(s)
- Andreas H Eckhard
- Otopathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
- Department of Otorhinolaryngology, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.
| | - MengYu Zhu
- Otopathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Jennifer T O'Malley
- Otopathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Gordon H Williams
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Steven D Rauch
- Otopathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
- Vestibular Division, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Joe B Nadol
- Otopathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - M Charles Liberman
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Joe C Adams
- Otopathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
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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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Conte G, Caschera L, Tuscano B, Piergallini L, Barozzi S, Di Berardino F, Zanetti D, Scuffi C, Scola E, Sina C, Triulzi F. Three-Tesla magnetic resonance imaging of the vestibular endolymphatic space: A systematic qualitative description in healthy ears. Eur J Radiol 2018; 109:77-82. [PMID: 30527315 DOI: 10.1016/j.ejrad.2018.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/16/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE A detailed knowledge of the normal Magnetic Resonance (MR) anatomy of the vestibular endolymphatic space (ES) could be useful to understand the linkage between endolymphatic hydrops (EH) and Ménière's disease (MD). Our aim was to describe the MR anatomy of the vestibular ES as depicted by MR imaging in healthy ears. METHODS This report describes a single-center retrospective study. Three readers analyzed the healthy ears of 22 consecutive patients who had undergone MRI for unilateral sudden hearing loss. The readers described the vestibular ES based on a delayed post-contrast 3D-FLAIR sequence according to six well-defined planes, three oblique sagittal (lateral, intermediate and medial) planes and three axial (superior, intermediate and inferior) planes. RESULTS On sagittal lateral and intermediate planes, we identified the SSC ampulla combined with the utricle in 22/22 ears. On the sagittal medial plane, the saccule was detectable in 15/22 (68%) ears, having a club shape with the long axis oriented cranio-caudally; in 7/22 (32%) ears, the saccule presented an oval/round shape that appeared more conspicuously on the axial intermediate plane. The ES occupied the half superior portion of the vestibule in 22/22 ears, never contacting the round and oval windows. On the axial plane, in 17/22 cases, the ES showed a Y-shaped arrangement, while in 5/22 ears (23%), the ES presented a more globular shape. CONCLUSION MR imaging represents a valid tool to explore the in vivo anatomy of the vestibular ES and to highlight its variability in normal ears.
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Affiliation(s)
- Giorgio Conte
- Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Luca Caschera
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Bruno Tuscano
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Piergallini
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Stefania Barozzi
- Audiology Unit, Department of Clinical Sciences and Community, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Federica Di Berardino
- Audiology Unit, Department of Clinical Sciences and Community, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Diego Zanetti
- Audiology Unit, Department of Clinical Sciences and Community, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Chiara Scuffi
- Department of Medicine and Surgery, Università degli Studi di Milano, Milan, Italy
| | - Elisa Scola
- Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Clara Sina
- Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Triulzi
- Neuroradiology Unit, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy; Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Conte G, Caschera L, Calloni S, Barozzi S, Di Berardino F, Zanetti D, Scuffi C, Scola E, Sina C, Triulzi F. MR Imaging in Menière Disease: Is the Contact between the Vestibular Endolymphatic Space and the Oval Window a Reliable Biomarker? AJNR Am J Neuroradiol 2018; 39:2114-2119. [PMID: 30337432 DOI: 10.3174/ajnr.a5841] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/20/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE No reliable MR imaging marker for the diagnosis of Menière disease has been reported. Our aim was to investigate whether the obliteration of the inferior portion of the vestibule and the contact with the stapes footplate by the vestibular endolymphatic space are reliable MR imaging markers in the diagnosis of Menière disease. MATERIALS AND METHODS We retrospectively enrolled 49 patients, 24 affected by unilateral sudden hearing loss and 25 affected by definite Menière disease, who had undergone a 4-hour delayed 3D-FLAIR sequence. Two readers analyzed the MR images investigating whether the vestibular endolymphatic space bulged in the third inferior portion of the vestibule contacting the stapes footplate. This sign was defined as the vestibular endolymphatic space contacting the oval window. RESULTS We analyzed 98 ears: 27 affected by Menière disease, 24 affected by sudden sensorineural hearing loss, and 47 that were healthy. The vestibular endolymphatic space contacting the oval window showed an almost perfect interobserver agreement (Cohen κ = 0.87; 95% CI, 0.69-1). The vestibular endolymphatic space contacting oval window showed the following: sensitivity = 81%, specificity = 96%, positive predictive value = 88%, and negative predictive value = 93% in differentiating Menière disease ears from other ears. The vestibular endolymphatic space contacting the oval window showed the following: sensitivity = 81%, specificity = 96%, positive predictive value = 96%, negative predictive value = 82% in differentiating Menière disease ears from sudden sensorineural hearing loss ears. CONCLUSIONS The vestibular endolymphatic space contacting the oval window has high specificity and positive predictive value in differentiating Menière disease ears from other ears, thus resulting in a valid tool for ruling in Menière disease in patients with mimicking symptoms.
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Affiliation(s)
- G Conte
- From the Neuroradiology Unit (G.C., E.S., C. Sina, F.T.), Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Caschera
- Postgraduation School of Radiodiagnostics (L.C., S.C.)
| | - S Calloni
- Postgraduation School of Radiodiagnostics (L.C., S.C.)
| | - S Barozzi
- Audiology Unit (S.B., F.D.B., D.Z.), Department of Clinical Sciences and Community, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - F Di Berardino
- Audiology Unit (S.B., F.D.B., D.Z.), Department of Clinical Sciences and Community, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - D Zanetti
- Audiology Unit (S.B., F.D.B., D.Z.), Department of Clinical Sciences and Community, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - C Scuffi
- Departments of Medicine and Surgery (C. Scuffi)
| | - E Scola
- From the Neuroradiology Unit (G.C., E.S., C. Sina, F.T.), Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Sina
- From the Neuroradiology Unit (G.C., E.S., C. Sina, F.T.), Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Triulzi
- From the Neuroradiology Unit (G.C., E.S., C. Sina, F.T.), Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Pathophysiology and Transplantation (F.T.), Università degli Studi di Milano, Milan, Italy
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Reynard P, Karkas A, Gavid M, Lelonge Y, Bertholon P. Delayed endolymphatic hydrops. Special emphasis on nystagmus associated with episodes and contribution of chemical labyrinthectomy. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:321-326. [PMID: 30172621 DOI: 10.1016/j.anorl.2018.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The main objective was to describe spontaneous nystagmus characteristics during an episode of delayed endolymphatic hydrops (DEH), including an initial vertical upbeating nystagmus in one patient. The secondary objective was to highlight the contribution of chemical labyrinthectomy. METHODS Episodic vertigo after a prolonged period of time of sensorineural hearing loss (profound or total) in one ear characterized ipsilateral DEH and was associated with the development of hearing loss in the opposite ear in contralateral DEH. RESULTS Ten patients met the criteria for DEH: 7 ipsilateral and 3 contralateral. Three (all ipsilateral DEH) were examined during a vertigo episode. Two patients had a typical horizontal-torsional nystagmus beating contralaterally to the hearing loss. One patient showed atypic initial vertical upbeating nystagmus with a slight torsional component, which secondarily became horizontal-torsional beating contralaterally to the hearing loss. Four patients had disabling vertigo with unilateral total deafness (ipsilateral DEH), successfully treated by 1-3 transtympanic gentamycin (Gentalline®) injections. CONCLUSION Nystagmus direction during vertigo episodes varies, and may initially present as vertical upbeating nystagmus, which, to our knowledge, has not been previously reported in DEH or Menière's disease. This nystagmus might reflect an inhibition of the superior semicircular canal (on the hearing-impaired side), suggesting incipient hydrops in this canal. Chemical labyrinthectomy is a simple and effective procedure in unilateral DEH, especially as the patient often suffers from total deafness.
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Affiliation(s)
- P Reynard
- Département d'ORL, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - A Karkas
- Département d'ORL, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - M Gavid
- Département d'ORL, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - Y Lelonge
- Département d'ORL, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - P Bertholon
- Département d'ORL, centre hospitalier universitaire de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
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A Warning About The Drawing of Wrong Conclusions From a Failure to Reproduce Other Researchers’ Findings. Otol Neurotol 2018; 39:655-658. [DOI: 10.1097/mao.0000000000001770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Endolymphatic Hydrops: A Warning About the Interpretation of Magnetic Resonance Images Without Refreshed Knowledge of Inner Ear Endolymphatic Structure Anatomy. Otol Neurotol 2018; 39:654-655. [DOI: 10.1097/mao.0000000000001769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gürkov R, Kalla R, Maxwell R, Patzig M. Hydropic ear disease—Translation of imaging into clinical practice. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2018. [DOI: 10.1177/2514183x18758588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Robert Gürkov
- Department of Otorhinolaryngology, University of Munich, Munich, Germany
| | - Roger Kalla
- Department of Neurology, Inselspital, Bern, Switzerland
| | - Rebecca Maxwell
- Department of Otorhinolaryngology and German Vertigo Gentre, University of Munich, Munich, Germany
| | - Maximilian Patzig
- Department of Otorhinolaryngology and German Vertigo Gentre, University of Munich, Munich, Germany
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