The “hype” of hydrops in classifying vestibular disorders: a narrative review

Lubbe, Marly F. J. A. van der; Vaidyanathan, Akshayaa; Rompaey, Vincent Van; Postma, Alida A.; Bruintjes, T.; Kimenai, Dorien M; Lambin, Philippe; Hoof, Marc van; Berg, Raymond van de

doi:10.1007/s00415-020-10278-8

Cited by 24 publications

(15 citation statements)

References 97 publications

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“…The enhanced eye velocity is not restricted to patients with MD but occurs in other patient groups: some patients diagnosed as having vestibular migraine show enhanced eye velocity. This is in accord with the hydrops model put forward above because ELH occurs not only in MD but can also occur in other conditions (29,30). The group which is poorly represented in our testing is healthy subjects because enhanced eye velocity was so rarely found in their results, as has been reported in a large study (7).…”

Section: Patient Groupssupporting

confidence: 91%

Enhanced Eye Velocity in Head Impulse Testing—A Possible Indicator of Endolymphatic Hydrops

Curthoys

Manzari²,

Rey-Martínez

et al. 2021

Front. Surg.

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Introduction: On video head impulse testing (vHIT) of semicircular canal function, some patients reliably show enhanced eye velocity and so VOR gains >1.0. Modeling and imaging indicate this could be due to endolymphatic hydrops. Oral glycerol reduces membranous labyrinth volume and reduces cochlear symptoms of hydrops, so we tested whether oral glycerol reduced the enhanced vHIT eye velocity.Study Design: Prospective clinical study and retrospective analysis of patient data.Methods: Patients with enhanced eye velocity during horizontal vHIT were enrolled (n = 9, 17 ears) and given orally 86% glycerol, 1.5 mL/kg of body weight, dissolved 1:1 in physiological saline. Horizontal vHIT testing was performed before glycerol intake (time 0), then at intervals of 1, 2, and 3 h after the oral glycerol intake. Control patients with enhanced eye velocity (n = 4, 6 ears) received water and were tested at the same intervals. To provide an objective index of enhanced eye velocity we used a measure of VOR gain which captures the enhanced eye velocity which is so clear on inspecting the eye velocity records. We call this measure the initial VOR gain and it is defined as: (the ratio of peak eye velocity to the value of head velocity at the time of peak eye velocity). The responses of other patients who showed enhanced eye velocity during routine clinical testing were analyzed to try to identify how the enhancement occurred.Results: We found that oral glycerol caused, on average, a significant reduction in the enhanced eye velocity response, whereas water caused no systematic change. The enhanced eye velocity during the head impulses is due in some patients to a compensatory saccade-like response during the increasing head velocity.Conclusion: The significant reduction in enhanced eye velocity during head impulse testing following oral glycerol is consistent with the hypothesis that the enhanced eye velocity in vHIT may be caused by endolymphatic hydrops.

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Section: Patient Groupssupporting

confidence: 91%

Enhanced Eye Velocity in Head Impulse Testing—A Possible Indicator of Endolymphatic Hydrops

Curthoys

Manzari²,

Rey-Martínez

et al. 2021

Front. Surg.

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“…While a "double-peak" pattern was observed for attack frequency and duration on the RVS-NOS group level, MD patients displayed a single peak for both parameters (Figure 4). The marked stereotypic pattern of MD attacks might be due to a common underlying pathology in these patients, such as endolymphatic hydrops (35), which is present on inner ear hydrops MRI in almost all patients with MD (36,37).…”

Section: Menière's Diseasementioning

confidence: 99%

Recurrent Vestibular Symptoms Not Otherwise Specified: Clinical Characteristics Compared With Vestibular Migraine and Menière's Disease

et al. 2021

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Despite the huge progress in the definition and classification of vestibular disorders within the last decade, there are still patients whose recurrent vestibular symptoms cannot be attributed to any of the recognized episodic vestibular syndromes, such as Menière's disease (MD), vestibular migraine (VM), benign paroxysmal positional vertigo (BPPV), vestibular paroxysmia, orthostatic vertigo or transient ischemic attack (TIA). The aim of the present international, multi-center, cross-sectional study was to systematically characterize the clinical picture of recurrent vestibular symptoms not otherwise specified (RVS-NOS) and to compare it to MD and VM. Thirty-five patients with RVS-NOS, 150 patients with VM or probable VM and 119 patients with MD were included in the study. The symptoms of RVS-NOS had been present for 5.4 years on average before inclusion, similar to VM and MD in this study, suggesting that RVS-NOS is not a transitory state before converting into another diagnosis. Overall, the profile of RVS-NOS vestibular symptoms was more similar to VM than MD. In particular, the spectrum of vestibular symptom types was larger in VM and RVS-NOS than in MD, both at group comparison and the individual level. However, in contrast to VM, no female preponderance was observed for RVS-NOS. Positional, head-motion and orthostatic vertigo were reported more frequently by patients with RVS-NOS than MD, while external vertigo was more prevalent in the MD group. At group level, the spectrum of attack durations from minutes to 3 days was evenly distributed for VM, while a small peak for short and long attacks in RVS-NOS and a big single peak of hours in MD were discernible. In general, vertigo attacks and associated vegetative symptoms (nausea and vomiting) were milder in RVS-NOS than in the other two disorders. Some patients with RVS-NOS described accompanying auditory symptoms (tinnitus: 2.9%, aural fullness and hearing loss: 5.7% each), migrainous symptoms (photophobia, phonophobia or visual aura in 5.7% each) or non-migrainous headaches (14%), but did not fulfill the diagnostic criteria for MD or VM. Absence of a life time diagnosis of migraine headache and attack duration of <5 min were further reasons not to qualify for VM. In some RVS-NOS patients with accompanying ear symptoms, attack durations of <20 min excluded them from being diagnosed with MD. These findings suggest that RVS-NOS is a stable diagnosis over time whose overall clinical presentation is more similar to VM than to MD. It is more likely to be composed of several disorders including a spectrum of mild or incomplete variants of known vestibular disorders, such as VM and MD, rather than a single disease entity with distinct pathognomonic features.

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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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The “hype” of hydrops in classifying vestibular disorders: a narrative review

Cited by 24 publications

References 97 publications

Enhanced Eye Velocity in Head Impulse Testing—A Possible Indicator of Endolymphatic Hydrops

Enhanced Eye Velocity in Head Impulse Testing—A Possible Indicator of Endolymphatic Hydrops

Recurrent Vestibular Symptoms Not Otherwise Specified: Clinical Characteristics Compared With Vestibular Migraine and Menière's Disease

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

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