Hydropic Ear Disease: Correlation Between Audiovestibular Symptoms, Endolymphatic Hydrops and Blood-Labyrinth Barrier Impairment

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.

Visualization and clinical relevance of the endolymphatic duct and sac in Ménière's disease

“…We demonstrated that the MD-140 endotype is associated with bilateral clinical disease and a trend toward a male predominance, which is in accordance with previous studies ( 27 , 29 ). Generally, MD symptoms manifest in the fourth decade of life ( 31 ). The presumed congenital origin of the MD-140 subtype raises the question of whether these patients would manifest symptoms earlier in life compared with the rest of the MD population.…”

“…The methods for evaluating EH and perilymphatic enhancement have been reported previously ( 31 ). Briefly, EH was scored as a blinded consensus reading by one head and neck radiologist (SH) and one PhD student (LP) on a 4-point scale for vestibular hydrops and a 3-point scale for cochlear hydrops, respectively.…”

“…Methods for clinical data collection have been reported previously ( 31 ). Briefly, clinical diagnoses were evaluated as a consensus reading by two otorhinolaryngologists (HB and CB), who were blinded to the MRI results, according to the latest AAO-HNS criteria ( 2 ).…”

Comparison between 3D SPACE FLAIR and 3D TSE FLAIR in Menière’s disease

“…As compared to computed tomography images, MR images cannot be calibrated via an analog to Hounsfield units. Another factor which might explain the large standard deviation in measured evaluation is that the disruption of the BLB, which is responsible for the impaired PE, is correlated to the EH grade and duration of the disease [ 3 , 18 ]. Moreover—in our experience—there seems to be a gradient in the enhancement of the basal turn of the cochlea with a more pronounced enhancement in the posterolateral part of the basal turn.…”

Meniere’s Disease: The Current State of the Problem

“…Распространенность и заболеваемость БМ в целом у мужчин и женщин увеличилась за последние 5 лет [5]. Средний возраст дебюта БМ достигает максимума в 40-50 лет, у 10% пациентов с БМ начало заболевания было в возрасте ≥65 лет [13]. По другим данным, распространенность увеличивается с возрастом, причем пик заболеваемости приходится на возрастную группу 61-70 лет [3,14].…”