Endolymphatic Hydrops in Fluctuating Hearing Loss and Recurrent Vertigo

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.

Low-Dose Intratympanic Gentamicin for Unilateral Ménière‘s Disease: Accuracy of Early Vestibulo-Ocular Reflex Gain Reduction in Predicting Long-Term Clinical Outcome

“…There are histopathological and electrophysiological reports suggesting endolymphatic hydrops in the contralateral ear (34)(35)(36). Finally, Pyykkö et al reported the presence of endolymphatic hydrops in 65% of contralateral ears of subjects with clinically unilateral MD as assessed with gadolinium-enhanced MRI (37), and we also in cases with fluctuating auditory or vestibular symptoms (38). Contrary to these hypotheses (the push-pull mechanism between co-planar canals through the commissural system or subclinical disease) is our finding that the modification in the gain of the VOR in those ears is not significantly different to the spontaneous modifications as shown when comparing to results in group 0.…”

Acute histological reactions in the otolith organs to inner ear drug delivery through a cochlear implant

“…However, it is also very important to know in depth the elimination pathways of the substance, not only to prevent possible dysregulation of the labyrinth fluids with the subsequent iatrogenic endolymphatic hydrops but also to assess a possible toxicity effect at the cochlear and vestibular levels ( 40 ). Moreover, it is widely recognized that there is not always a direct correlation between endolymphatic hydrops and the symptomatology experienced by the patient ( 41 , 42 ). To this extent, the histological findings evidenced in this study show only some kinds of hydrops, not necessarily related to functional outcomes, and additional research ought to be done to objectively evaluate the proper performance of the vestibular end organs following inner ear drug delivery.…”

Diagnostic Value of the Vestibular Autorotation Test in Menière’s Disease, Vestibular Migraine and Menière’s Disease with Migraine

“…Similarly, a study by Pérez-Fernández et al [ 29 ] examined the severity of endolymphatic hydrops in the cochlea and vestibule of patients with unilateral definite MD ( n = 22) with respect to the results from the caloric test and vHIT; they found that there was a significantly higher degree of hydrops in the ear of patients with abnormal caloric test findings but normal vHIT results. They were led to conclude that endolymphatic hydrops severity in magnetic resonance imaging (MRI) evidences disparate vestibular test results [ 29 , 30 ]. Additionally, in gadolinium-contrasted MRI, previous studies confirmed that patients with MD showed endolymphatic hydrops (EH) in the vestibulum more frequently than in the cochlea, whereas EH was rare in patients with VM.…”