Relationship between video head impulse test, ocular and cervical vestibular evoked myogenic potentials, and compartmental magnetic resonance imaging classification in menière's disease.
Currently, it is possible to assess in vivo the morphology of each compartment of the endolymphatic spaces 4 hours after an intravenous administration of gadolinium on magnetic resonance imaging (MRI). The aim of this study was to assess the correlation between otolithic and ampullar functions (cervical vestibular evoked myogenic potential [cVEMP], ocular vestibular evoked myogenic potential [oVEMP], video head impulse test [VHIT]) and delayed inner ear MRI based on a compartmental, anatomically based classification that included the cochlea, the saccule, the utricle, and the ampullas.
Retrospective case-control study.
In this retrospective study, we performed three-dimensional fluid-attenuated inversion recovery sequences with delayed acquisition in 26 healthy subjects and 31 definite Menière's disease (MD) patients. Each subject was then graded on MRI on the basis on cochlear, saccular, utricular, and ampullar hydrops in MD patients. All patients underwent pure-tone audiometry, VHIT, cVEMP, and oVEMP testing.
Cochlear, saccular, utricular, and ampullar hydrops were found on MRI in 88%, 91%, 50%, and 8.5% respectively. We found no significant correlation between the presence of saccular hydrops versus cVEMP, utricular hydrops versus oVEMP, and ampullar hydrops versus VHIT. However, the severity of endolymphatic hydrops on MRI was correlated to the degree of hearing loss.
We proposed a compartmental, anatomically based classification for endolymphatic hydrops on MRI, which included the whole vestibular compartment. Using this classification, we observed increasing morphological changes as the disease evolved, affecting first the saccule, then the utricle, and finally the ampullas. The severity of vestibular endolymphatic hydrops is only correlated to hearing loss severity.
3 Laryngoscope, 130:E444-E452, 2020.
Kahn L
，Hautefort C
，Guichard JP
，Toupet M
，Jourdaine C
，Vitaux H
，Herman P
，Kania R
，Houdart E
，Attyé A
，Eliezer M
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Visualization of endolymphatic hydrops and correlation with audio-vestibular functional testing in patients with definite Meniere's disease.
Visulization of endolymphatic hydrops has been reported using magnetic resonance imaging (MRI) in patients with Meniere's disease. However, the relationship between the endolymphatic hydrops visualized by MRI and audio-vestibular functional tests have not been sufficiently investigated, such as pure tone audiometry (PTA), electrocochleography (EcoG), and vestibular evoked myogenic potential (VEMP).
Here we attempted to visualize endolymphatic hydrops in patients with Meniere's disease using 3Tesla (3T)-MRI following intratympanic gadolinium-diethylene-triamnie petaaetic acidbis (Gd-DTPA) injection and correlated the presence of hydrops with auditory testing. Following intratympanic Gd-DTPA contrast injections in 26 patients diagnosed as having definite Meniere's disease, 3D-fluid-attenuated inversion recovery (3D-FLAIR) sequence imagings were performed. The PTA, EcoG, and VEMP testing was done bilaterally. Patients had typical results of auditory testing for Meniere's disease.
The 3D-FLAIR MRI clearly demonstrated endolymphatic hydrops with signal voids in the cochlea (81%) and saccule (69%) in the definite Meniere's disease group. Auditory tests verified that the visualized cochlear hydrops (basal turn) was correlated with a high tone hearing threshold in PTA and an abnormal EcoG. Though the absence of VEMP did not correlate with vestibular hydrops on MRI, large vestibular hydrops were detected by imaging. This study demonstrates that endolymphatic hydrops could be visualized by 3D-FLAIR MRI in Meniere's disease patients.
Cochlea hydrops and vestibular (saccular) hydrops are readily visualized using these techniques. Hydrops, as visualized on MRI, may be a reliable means to diagnosis Meniere's disease; this is supported by appropriate correlations with auditory vestibular functional testing.
Seo YJ
，Kim J
，Choi JY
，Lee WS
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Endolymphatic hydrops severity in magnetic resonance imaging evidences disparate vestibular test results.
It has been suggested that in Ménière's disease (MD) a dissociated result in the caloric test (abnormal result) and video head-impulse test (normal result) probably indicates that hydrops affects the membranous labyrinth in the horizontal semicircular canal (HSC). The hypothesis in this study is that based on endolymphatic hydrops' cochleocentric progression, hydrops should also be more severe in the vestibule of these patients than in those for whom both tests are normal.
22 consecutive patients with unilateral definite MD were included and classified as NN if both tests were normal or AN if the caloric test was abnormal. MRI evaluation of endolymphatic hydrops was carried out with a T2-FLAIR sequence performed 4h after intravenous gadolinium administration. The laterality and degree of vestibular endolymphatic hydrops and the presence or absence of cochlear endolymphatic hydrops were recorded. Demographic data, audiometric and vestibular evoked myogenic potentials were collected, and video head-impulse and caloric tests were performed.
Patients in both groups (NN and AN) were similar in terms of demographic data and hearing loss. The interaural asymmetry ratio was significantly higher for ocular and cervical VEMP in patients in the AN group. There was a significantly higher degree of hydrops in the vestibule of the affected ear of AN patients (χ2; p=0.028).
Significant canal paresis in the caloric test is associated with more severe endolymphatic hydrops in the vestibule as detected with gadolinium-enhanced MRI and with a more severe vestibular deficit.
2a.
Pérez-Fernández N
，Dominguez P
，Manrique-Huarte R
，Calavia D
，Arbizu L
，Garcia-Eulate R
，Alvarez-Gomez L
，Guajardo C
，Zubieta JL
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