The relationship between endolymphatic hydrops in the vestibule and low‐frequency air‐bone gaps

Sugimoto, Satofumi; Yoshida, Tadao; Teranishi, Masaaki; Okazaki, Yuriko; Naganawa, Shinji

doi:10.1002/lary.26898

Cited by 21 publications

(14 citation statements)

References 20 publications

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“…It has already been shown that some cases of endolymphatic hydrops can mimic the TW syndrome with a similar clinical presentation ( 49 – 52 ). Besides, primary overpressure in the endolymphatic or perilymphatic spaces could explain a limited conductive hearing loss as previously reported ( 53 – 55 ). It is worth adding here that the notion of “inner ear conductive hearing loss,” considered lately as specific to TW lesions, was already used by Muchnik et al to describe the air bone gap (ABG) observed in some patients with Menière disease ( 53 ).…”

Section: Discussionsupporting

confidence: 59%

Proposal for a Unitary Anatomo-Clinical and Radiological Classification of Third Mobile Window Abnormalities

et al. 2022

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Introduction: An increased number of otic capsule dehiscence (OCD) variants relying on the third window pathomechanism have been reported lately. Therefore, a characterization of the anatomical structures involved and an accurate radiological description of the third window (TW) interface location have become essential for improving the diagnosis and appropriate therapeutic modalities. The purpose of this article is to propose a classification based on clinical, anatomical, and radiological data of third mobile window abnormalities (TMWA) and to discuss the alleged pathomechanism in lesser-known clinical variants.Materials and Methods: The imaging records of 259 patients who underwent, over the last 6 years, a high-resolution CT (HRCT) of the petrosal bone for conductive hearing loss were analyzed retrospectively. Patients with degenerative, traumatic, or chronic infectious petrosal bone pathology were excluded. As cases with a clinical presentation similar to those of a TW syndrome have recently been described in the literature but without these being confirmed radiologically, we thought it necessary to be integrated in a separated branch of this classification as “CT - TMWA.” The same goes for certain intralabyrinthine pathologies also recently reported in the literature, which mimic to some extent the symptoms of a TW pathology. Therefore, we suggest to call them intralabyrinthine TW-like abnormalities.Results: Temporal bone HRCT and, in some cases, 3T MRI of 97 patients presenting symptomatic or pauci-symptomatic, single or multiple, unilateral or bilateral OCD were used to develop this classification. According to the topography and anatomical structures involved at the site of the interface of the TW, a third-type classification of OCD is proposed.Conclusions: A classification reuniting all types of TMWA as the one proposed in this article would allow for a better systematization and understanding of this complex pathology and possibly paves the way for innovative therapeutic approaches. To encompass all clinical and radiological variants of TMWA reported in the literature so far, TMWAs have been conventionally divided into two major subgroups: Extralabyrinthine (or “true” OCD with three subtypes) and Intralabyrinthine (in which an additional mobile window-like mechanism is highly suspected) or TMWA-like subtype. Along these subgroups, clinical forms of OCD with multiple localization (multiple OCD) and those that, despite the fact that they have obvious characteristics of OCD have a negative CT scan (or CT – TMWA), were also included.

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Section: Discussionsupporting

confidence: 59%

Proposal for a Unitary Anatomo-Clinical and Radiological Classification of Third Mobile Window Abnormalities

et al. 2022

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“…12 First, audiograms of patients with MD showed unexplained air-bone gaps at low frequencies from 13% to 32% in the literature, even though no middle ear pathology could be demonstrated. 13,14 In addition, some methodologic differences between our study and the aforementioned study 12 should be stated to understand why the results are in disagreement. The authors of this study enrolled not only patients with MD (66% of the total) but also patients with other otologic disorders who presented with severe hydrops according to the Nakashima score.…”

Section: Discussionmentioning

confidence: 96%

MR Imaging in Menière Disease: Is the Contact between the Vestibular Endolymphatic Space and the Oval Window a Reliable Biomarker?

Conte

Caschera

Calloni

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:No reliable MR imaging marker for the diagnosis of Menière disease has been reported. Our aim was to investigate whether the obliteration of the inferior portion of the vestibule and the contact with the stapes footplate by the vestibular endolymphatic space are reliable MR imaging markers in the diagnosis of Menière disease. MATERIALS AND METHODS:We retrospectively enrolled 49 patients, 24 affected by unilateral sudden hearing loss and 25 affected by definite Menière disease, who had undergone a 4-hour delayed 3D-FLAIR sequence. Two readers analyzed the MR images investigating whether the vestibular endolymphatic space bulged in the third inferior portion of the vestibule contacting the stapes footplate. This sign was defined as the vestibular endolymphatic space contacting the oval window. RESULTS:We analyzed 98 ears: 27 affected by Menière disease, 24 affected by sudden sensorineural hearing loss, and 47 that were healthy. The vestibular endolymphatic space contacting the oval window showed an almost perfect interobserver agreement (Cohen ϭ 0.87; 95% CI, 0.69 -1). The vestibular endolymphatic space contacting oval window showed the following: sensitivity ϭ 81%, specificity ϭ 96%, positive predictive value ϭ 88%, and negative predictive value ϭ 93% in differentiating Menière disease ears from other ears. The vestibular endolymphatic space contacting the oval window showed the following: sensitivity ϭ 81%, specificity ϭ 96%, positive predictive value ϭ 96%, negative predictive value ϭ 82% in differentiating Menière disease ears from sudden sensorineural hearing loss ears. CONCLUSIONS:The vestibular endolymphatic space contacting the oval window has high specificity and positive predictive value in differentiating Menière disease ears from other ears, thus resulting in a valid tool for ruling in Menière disease in patients with mimicking symptoms.ABBREVIATIONS: AAO-HNS ϭ American Academy of Otolaryngology-Head and Neck Surgery; BLB ϭ blood-labyrinthine barrier; CH ϭ cochlear hydrops; HC ϭ healthy control; MD ϭ Menière disease; nMD ϭ normal in a patient with MD; NPV ϭ negative predictive value; PPV ϭ positive predictive value; SSHL ϭ sudden sensorineural hearing loss; VEH ϭ vestibular endolymphatic hydrops; VES ϭ vestibular endolymphatic space; VESCO ϭ vestibular endolymphatic space contacting the oval window

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“…The significant LFABG was defined to be greater than average 15 dB at 250, 500, and 1 kHz. The definition of LFABG has been reported in some of the Meniere disease research [ 16 , 17 ], but it was the first time covered in PLF research. VNG was tested for identifying the spontaneous and positional nystagmus.…”

Section: Methodsmentioning

confidence: 99%

Significance of Pseudo-Conductive Hearing Loss and Positional Nystagmus for Perilymphatic Fistula: Are They Related to Third-Window Effects?

Kim

Son

Kim

et al. 2021

Clin Exp Otorhinolaryngol

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Objectives. Clinical presentation is critical to identify suspected perilymphatic fistula (PLF). To explain characteristic of PLF, it was hypothesized that a third window lesion might be involved in the pathomechanism. The purpose of this study is to investigate clinical features in PLF and figure out the relationship of third window effect and PLF. Methods. Sixty patients underwent surgical exploration under suspicion of PLF and reinforecmenet of oval window and round window was performed. Clinical features including demographics, pure tone audiometry (PTA), and videonystagmography (VNG) were evaluated preoperatively and 1 month after operation. Surgical outcomes were analyzed according to the improvement of hearing and vestibular symptoms and signs. The conductive components of PTA (air-bone gap (ABG)) were measured, and the relationship between ABG closure after surgery and hearing improvement was analyzed. In addition, the postoperative subjective dizziness was assessed by interview in clinic. The change of positional nystagmus was analyzed according to ABG closure and hearing improvement.Results. ABG at lower frequencies (LFABG, 250 Hz, 500 Hz, 1,000 Hz) was present in 27 patients (45%). Postoperatively, the PTA was significantly improved after surgical repair. Among the patients with preoperative LFABG (n=27), 15 (55.5%) showed postoperative ABG closure and significant improvement in PTA at all frequencies compared with the patients without ABG closure (P=0.012). The subjective dizziness improved in 56 patients (91.8%). Positional nystagmus was found in 45 of 49 patients. Multiple canal involvement was more common than single canal (67% vs. 33%). The horizontal semicircular canal was most commonly involved, followed by the posterior and anterior canals. Postoperatively, the positional nystagmus disappeared, or the number of involved canals decreased in 22 of 34 (64.7%) patients. Conclusions. Pseudo-conductive hearing loss at the lower frequencies and positional nystagmus originating from multiple semicircular canals were common findings in PLF. Surgical reinforcement of the RW and OW improved hearing threshold accompanied by closure of ABG. The third window lesion might explain these clinical features that indicate PLF.

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The relationship between endolymphatic hydrops in the vestibule and low‐frequency air‐bone gaps

Abstract: 4. Laryngoscope, 128:1658-1662, 2018.

Cited by 21 publications

References 20 publications

Proposal for a Unitary Anatomo-Clinical and Radiological Classification of Third Mobile Window Abnormalities

Proposal for a Unitary Anatomo-Clinical and Radiological Classification of Third Mobile Window Abnormalities

MR Imaging in Menière Disease: Is the Contact between the Vestibular Endolymphatic Space and the Oval Window a Reliable Biomarker?

Significance of Pseudo-Conductive Hearing Loss and Positional Nystagmus for Perilymphatic Fistula: Are They Related to Third-Window Effects?

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