Is Vestibular Meniere's Disease Associated With Endolymphatic Hydrops?

Morita, Yuka; Takahashi, Kuniyuki; Ohshima, Shinsuke; Yagi, Chihiro; Kitazawa, Meiko; Yamagishi, Toshio; Izumi, Shuji; Horii, Arata

doi:10.3389/fsurg.2020.601692

Cited by 12 publications

(5 citation statements)

References 21 publications

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“…Attyé et al (44) found that 48.4% of patients with BRV showed vestibular hydrops and/or cochlear hydrops on MRI. Some authors suggest that there is a subtype of vestibular MD presenting with recurrent attacks of vertigo without fluctuating hearing loss and symptoms of aural fullness (45). In the present study, BRV was the most common cause of spontaneous UBN in patients with EVS, two of the four patients with BRV showed mixed SN with a non-predominant upbeat component, and the other two showed pure UBN.…”

Section: Brvsupporting

confidence: 59%

Spontaneous nystagmus with an upbeat component: Central or peripheral vestibular disorders?

Xia

Wu²,

Feng³

et al. 2023

Front. Neurol.

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ObjectiveTo determine the topical diagnosis and etiologies of spontaneous nystagmus (SN) with an upbeat component.MethodsWe retrospectively recruited 43 patients with SN with an upbeat component at a university hospital in China from 2020 to 2022. SN with an upbeat component was divided into pure upbeat nystagmus (UBN), SN with a predominant upbeat component, and SN with a non-predominant upbeat component. We analyzed their clinical and neurotologic findings and the final diagnosis.ResultsFourteen (32.6%) of them showed pure UBN, while 29 (67.4%) exhibited SN mixed with an upbeat component, mixed upbeat-horizontal in 15, mixed upbeat-horizontal-torsional in 13, and upbeat-torsional in the remaining one. Pure UBN and SN with a predominant upbeat component were more common in central than in peripheral vestibular disorders [16 (80.0%) vs. 0 (0%), Chi-Square test, p < 0.001]. Central vestibular disorders were diagnosed in 20 (46.5%) patients, peripheral in 14 (32.6%), and undetermined in nine (20.9%) patients. The underlying causes mainly included acute unilateral peripheral vestibulopathy (n = 11), posterior circulation infarction (n = 9), benign recurrent vertigo (n = 4), vestibular migraine (VM, n = 3), and VM of childhood (n = 2).ConclusionSN with an upbeat component can be seen in both central and peripheral vestibular disorders. Pure UBN was a characteristic sign of central vestibular dysfunction. Central vestibular disorders should be highly suspected when patients show pure UBN or SN with a predominant upbeat component.

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Section: Brvsupporting

confidence: 59%

Spontaneous nystagmus with an upbeat component: Central or peripheral vestibular disorders?

Xia

Wu²,

Feng³

et al. 2023

Front. Neurol.

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“…Li et al also detected asymptomatic endolymphatic effusion on the non affected side of 32 patients (18%) through MRI of 178 unilateral Meniere’s patients [ 8 ]. In addition, some scholars also confirmed the existence of cochlear and vestibular hydrops on the opposite side of unilateral Meniere’s disease patients, and the amount of bilateral hydrops in vestibule is higher than that in cochlea [ 9 ]. In our study, 11 of 70 ears of unilateral Meniere’s disease patients had no V-EH, and the most patients had significant hydrops.…”

Section: Discussionmentioning

confidence: 99%

Endolymphatic hydrops imaging and correlation with clinical characteristics, audiovestibular function and mental impairment in patients with Meniere’s disease

Zhang

Zhao

et al. 2023

Eur Arch Otorhinolaryngol

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Purpose MR imaging was used to visualize the vestibular and cochlear endolymphatic hydrops in patients with Meniere’s disease (MD). The relationship between the degree of hydrops and clinical characteristics, audiovestibular function, anxiety and depression state in MD patients. Methods 70 patients with definitely or probably unilateral Meniere’s disease received bilateral intratympanic gadolinium administration and MR scanning. The degree of bilateral vestibular and cochlea hydrops were analyzed and evaluated by three-dimensional real inversion recovery (3D-real IR) sequence, and the correlation between the grades of endolymphatic hydrops (EH) and disease course, vertigo grading assessment, the duration of vertigo, hearing loss level, caloric test, vestibular myogenic evoked potential (VEMP), electrocochleogram (EcoG), vertigo disability scale (physical, emotional, functional), anxiety and depression scale were studied. Results It was found that the vestibule and cochlea EH of the affected and the contralateral ear had different degrees of hydrops and there was no statistical difference between the left and right vestibules. The degree of vestibule EH (V-EH) was significantly positively correlated with the degree of cochlear EH (C-EH). C-EH and hearing loss level were positively correlated with EcoG. There was positive correlation between vestibular EH and hearing loss level, VEMP, caloric test, disease course or vertigo duration. There was a negative relationship between Dizziness Handicap Inventory (Emotion) (DHI(E)) and VEMP. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores were positive correlated with DHI(E) and DHI total scores in MD patients. Conclusion Endolymph-enhancing MRI was used as an important imaging method for the diagnosis of labyrinthine hydrops in Meniere’s disease. There were certain correlation between EH and the degree of vertigo attack, hearing loss level, vestibular function, and further changes in anxiety and depression emotion.

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“…In clinical studies, the first problem encountered with the VES/vestibule ratio was that mild vEH was not only reported in the greatest majority of symptomatic ears of MD patients, but also in more than half of the asymptomatic contralateral ears ( 19 , 34 , 58 , 60 ). Moreover, EH has been detected also in healthy individuals ( 11 , 61 , 62 ), and this challenges its correlation with MD ( 63 ).…”

Section: Discussionmentioning

confidence: 99%

“…The majority of ongoing studies is currently aimed at targeting the correlation between the morphologic findings and the symptomatology ("the whole symptoms triad") and, especially, with the results of the functional audio-vestibular testing and with the outcomes of treatment (37,41,48,51,52,62,63,67). In general, the literature agrees that the presence of EH at MRI, independently from the cut-off values for definition of vEH, strongly correlates with the side of the disease in MD patients (47,50), but it lacks specificity in differentiating MD from other inner ear disturbances, in the absence of clinical/instrumental confirmation (64).…”

Section: Recent Advancesmentioning

confidence: 99%

Advanced Imaging of the Vestibular Endolymphatic Space in Ménière's Disease

et al. 2021

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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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Is Vestibular Meniere's Disease Associated With Endolymphatic Hydrops?

Cited by 12 publications

References 21 publications

Spontaneous nystagmus with an upbeat component: Central or peripheral vestibular disorders?

Spontaneous nystagmus with an upbeat component: Central or peripheral vestibular disorders?

Endolymphatic hydrops imaging and correlation with clinical characteristics, audiovestibular function and mental impairment in patients with Meniere’s disease

Advanced Imaging of the Vestibular Endolymphatic Space in Ménière's Disease

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