Abstract
The purpose of this study was to assess the diagnostic performance of 3T MRI after intratympanic injection of gadodiamide for delayed endolymphatic hydrops (DEH), and assess the relationship between endolymphatic hydrops (ELH) and vestibular function in patients diagnosed with DEH and confirmed by 3T MRI. Nineteen patients clinically diagnosed with DEH (11 ipsilateral DEH, 8 contralateral DEH) participated in this study. Diluted gadodiamide was administered to the bilateral tympanic cavity by injection through the tympanic membrane. At 24 hours post-injection, the ELH was evaluated by MRI. Patient vestibular functions were evaluated by caloric testing and cVEMP. ELH was observed in all patients (19/19: positive rate 100%). The distribution patterns of ELH varied between the cochlear or vestibular region. Vestibular ELH was observed in the affected ear in all ipsilateral DEH patients. In the contralateral DEH patients, however, there were individual differences in the distribution patterns of ELH. Six patients (1 ipsilateral DEH, 5 contralateral DEH) had bilateral ELH. No obvious relationships were observed between ELH and vestibular function. ELH distribution was complicated, particularly in the contralateral DEH cases. It was difficult to identify the existence of ELH by vestibular functional testing alone; therefore, 3T MRI is thought to be useful for identifying the affected ear. A significant number of cases had “bilateral” DEH, particularly among the contralateral DEH cases, indicating that we should pay careful attention to this pathology when treating DEH.
Highlights
Delayed endolymphatic hydrops (DEH) is a disease caused by secondary endolymphatic hydrops (ELH) after profound hearing loss [1]
It is thought that secondary ELH induces symptoms of vertigo and/or fluctuating hearing loss, and ELH is thought to be the true cause of DEH
3 T MRI after intratympanic injection of gadodiamide has enabled us to visualize ELH in Meniere’s disease patients [3], and we proposed that 3 T MRI afforded a more accurate and sensitive evaluation technique than did previous methods, such as electrocochleography and glycerol test [4]
Summary
Delayed endolymphatic hydrops (DEH) is a disease caused by secondary endolymphatic hydrops (ELH) after profound hearing loss [1]. The diagnostic criteria for contralateral type of DEH are as follows: (1) precedent sensorineural hearing loss in one ear; (2) a fluctuating hearing loss in the contralateral ear with or without vertigo attack several years to decade after the onset of hearing loss; and (3) exclusion of central nervous system lesions. In both types, it is thought that secondary ELH induces symptoms of vertigo and/or fluctuating hearing loss, and ELH is thought to be the true cause of DEH
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