Our objective is to determine whether the degree of endolymphatic hydrops as it is detected in vivo in patients with definite Meniere's disease correlates with audiovestibular function. In this prospective study, 37 patients with definite Meniere's disease according to AAO-HNS criteria were included. Intratympanic contrast enhanced temporal bone MRI was performed using a 3D FLAIR protocol. The degree of endolymphatic hydrops in the cochlea and the vestibulum was graded on a Likert scale (0-3). The degree of hydrops was then analyzed with respect to its correlation with audiometric hearing levels, electrocochleographic SP/AP ratios, interaural amplitude ratios of vestibular evoked myogenic potentials and degree of horizontal semicircular canal paresis on caloric irrigation. There was a significant correlation between the degree of hydrops on the one hand and the averaged hearing level at 0.25-1 and 0.5-3 kHz and the vestibular evoked myogenic potential interaural amplitude ratio on the other hand. A trend toward a correlation was noticed between the hydrops and the caloric response, no correlation was noticed between the hydrops and the SP/AP ratio. The degree of endolymphatic hydrops correlates with a progressive loss of auditory and sacculus function in patients with Meniere`s disease.

• Endolymphatic hydrops is the pathological hallmark of Menière's disease. • Endolymphatic hydrops can be visualized by locally enhanced ultra-high-resolution MR imaging. • Computer-aided image processing enables quantification of endolymphatic hydrops. • Endolymphatic hydrops correlates with hearing loss in patients with Menière's disease. • Therapeutic trials in Menière's disease can be monitored with this quantitative approach.

This study aimed to assess whether standard-dose Betahistine (48 mg daily) exerts an effect upon the degree of endolymphatic hydrops in patients with Menière's disease using a retrospective case series in the setting of a tertiary neurotology referral centre. In six patients with definite unilateral Menière's disease, the degree of cochlear and vestibular endolymphatic hydrops was assessed before and after treatment with a standard dose of Betahistine (48 mg daily), using high-resolution 3 T MR imaging after intratympanic contrast medium application. The treatment duration was 3-7 months (mean 5 months), and the patients were followed-up for 6-29 months (mean 11 months). In the study cohort, the standard dose of Betahistine did not have an MR morphologically measurable beneficial effect on the degree of endolymphatic hydrops. The results indicated no effect of standard-dose Betahistine on endolymphatic hydrops found on high-resolution MR imaging. Possible explanations are: (1) insufficient dosage or duration of treatment with betahistine, (2) insufficient resolution of the MR imaging technique, and (3) insufficient length of follow-up. Further studies addressing these issues are warranted.

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