Abstract
The objective of the study was to compare the outcomes of a series of diagnostic parameters in Ménière’s disease (MD) patients with the extent of endolymphatic hydrops (EH) as shown by magnetic resonance imaging (MRI) performed after intra-tympanic gadolinium administration using 18 patients (13 males and 5 females, age 25–78 years, median age 54.3 years) with definite MD. A 0.6-ml solution of Gadobutrol (1 mmol/ml) diluted 1:7 in saline was injected through the inferior-posterior quadrant of the tympanic membrane, using a 22-gauge spinal needle. The patient was kept with the head rotated 45° contralaterally for 30 min after the injection. Twenty-four hours later, three-dimensional fluid-attenuated inversion recovery MRI, using a 3-Tesla unit, was performed. Prevalence and extension of EH in MD patients was evaluated and correlated with age, duration and stage of the disease, frequency of attacks, time interval from the last attack, functional level scale, tinnitus, aural fullness, caloric stimulation, electrocochleography, and vestibular evoked myogenic potentials. All patients showed impaired enhancement of the inner ear of variable degree with the vestibular portion of the labyrinth more frequently involved than the cochlea. Abnormal vestibular evoked myogenic potentials, duration, and stage of the disease were significantly correlated to the number of inner ear sites involved. Modern imaging makes possible the identification of the endolymphatic hydrops in MD patients, improving diagnostic accuracy. The role of hydrops in the clinical manifestations and its correlation with most of the diagnostic parameters remain, however, not completely clear.
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References
Schuknecht HF, Gulya AJ (1983) Endolymphatic hydrops: an overview and classification. Ann Otol Rhinol Laryngol Suppl 106:1–20
Kimura RS, Schuknecht HF, Ota CY, Jones DD (1980) Obliteration of the ductus reuniens. Acta Otolaryngol 89:295–309
Dauman R, Aran JM, de Sauvage RC, Portmann M (1988) Clinical significance of the summating potential in Ménière’s disease. Am J Otol 9:31–38
Durrant JD, Dallos P (1974) Modification of DIF summating potential components by stimulus biasing. J Acoust Soc Am 56:562–570
Nakashima T, Naganawa S, Sugiura M, Teranishi M, Sone M, Hayashi H, Nakata S, Katayama N, Ispida IM (2007) Visualization of endolymphatic hydrops in patients with Ménière’s disease. Laryngoscope 17:415–420
Naganawa S, Satake H, Kawamura M, Fukatsu H, Sone M, Nakashima T (2008) Separate visualization of endolymphatic space, perilymphatic space and bone by a single pulse sequence; 3D-inversion recovery imaging utilizing real reconstruction after intratympanic Gd-DTPA administration at 3 Tesla. Eur Radiol 18:920–924
Ito T, Naganawa S, Fukatsu H, Ishiguchi T, Ishigaki T, Kobayashi M, Kobayashi K, Ichinose N, Miyazaki M, Kassai Y (1999) High-resolution MR images of inner ear internal anatomy using a local gradient coil at 1.5 Tesla: correlation with histological specimen. Radiat Med 17:343–347
Naganawa S, Koshikawa T, Fukatsu H, Ishigaki T, Aoki I, Ninomiya A (2002) Fast recovery 3D fast spin-echo MR imaging of the inner ear at 3 T. AJNR 23:299–302
Niyazov DM, Andrews JC, Strelioff D, Sinha S, Lufkin R (2001) Diagnosis of endolymphatic hydrops in vivo with magnetic resonance imaging. Otol Neurotol 22:813–817
Koizuka I, Seo Y, Murakami M, Seo R, Kato I (1997) Micro-magnetic resonance imaging of the inner ear in the guinea pig. NMR Biomed 10:31–34
Zou J, Pyykkö I, Bjelke B, Dastidar P, Toppila E (2004) Communication between the perilymphatic scalae and spiral ligament visualized by in vivo MRI. Audiol Neurotol 10:145–152
Koizuka I, Seo R, Kubo T, Matsunaga T, Murakami M, Seo Y, Watari H (1995) High-resolution MRI of the human cochlea. Acta Otolaryngol Suppl 520:256–257
Koizuka I, Seo R, Sano M, Matsunaga T, Murakami M, Seo Y, Watari H (1991) High-resolution magnetic resonance imaging of the human temporal bone. ORL J Otorhinolaryngol Relat Spec 53:357–361
Committee on Hearing and Equilibrium (1995) Committee on Hearing and Equilibrium Guidelines for the diagnostic and evaluation of therapy in Ménière’s disease. Otolaryngol Head Neck Surg 113:181–185
Jongkees LB, Maas JP, Philipszoon AJ (1962) Clinical nystagmography. A detailed study of electro-nystagmography in 341 patients with vertigo. Pract Otorhinolaryngol 24:65–93
Welgampola MS, Colebatch JG (2005) Characteristics and clinical applications of vestibular-evoked myogenic potentials. Neurology 64:1682–1688
Okuno T, Sando I (1987) Localization, frequency, and severity of endolymphatic hydrops and the pathology of the labyrinthine membrane in Ménière’s disease. Ann Otol Rhinol Laryngol 96:438–445
Ohashi T, Nishino H, Arai Y, Hyodo M, Takatsu M (2009) Clinical significance of the summating potential—action potential ratio and the action potential latency difference for condensation and rarefaction clicks in Ménière’s disease. Ann Otol Rhinol Laryngol 118:307–312
Paparella MM (1985) The cause (multifactorial inheritance) and pathogenesis (endolymphatic malabsorption) of Ménière’s disease and its symptoms (mechanical and chemical). Acta Otolaryngol 99:445–451
Tran Ba Huy P (1984) Electrophysiological and biochemical findings in four cases of Ménière’s disease. Acta Otolaryngol 97:571–579
Gibson WPR (2009) A comparison of two methods of using transtympanic electrocochleography for the diagnosis of Ménière’s disease: click summating potential/action potential ratio measurements and tone burst summating potential measurements. Acta Otolaryngol 129:38–42
Murofushi T, Halmagyi GM, Yavor RA, Colebatch JG (1996) Absent vestibular evoked myogenic potentials in vestibular neurolabyrinthitis. An indicator of inferior vestibular nerve involvement? Arch Otolaryngol Head Neck Surg 122:845–848
Helling K, Schönfeld U, Clarke AH (2007) Treatment of Ménière’s disease by low-dosage intratympanic gentamicin application: effect on otolith function. Laryngoscope 117:2244–2250
Rauch SD (2006) Vestibular evoked myogenic potentials. Curr Opin Otolaryngol Head Neck Surg 14:299–304
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Fiorino, F., Pizzini, F.B., Beltramello, A. et al. MRI performed after intratympanic gadolinium administration in patients with Ménière’s disease: correlation with symptoms and signs. Eur Arch Otorhinolaryngol 268, 181–187 (2011). https://doi.org/10.1007/s00405-010-1353-5
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DOI: https://doi.org/10.1007/s00405-010-1353-5