Abstract
Background: Endolymphatic hydrops (EH) is the histopathological hallmark of Ménière's disease (MD) and has been found by in vivo magnetic resonance imaging (MRI) in patients with several inner ear syndromes without definite MD criteria. The incidence and relevance of this finding is under debate.Purpose: The purpose of the study is to evaluate the prevalence and characteristics of EH and audiovestibular test results in groups of patients with fluctuating audiovestibular symptoms not fulfilling the actual criteria for definite MD and compare them with a similar group of patients with definite MD and a group of patients with recent idiopathic sudden neurosensory hearing loss (ISSNHL).Material and Methods: 170 patients were included, 83 with definite MD, 38 with fluctuating sensorineural hearing loss, 34 with recurrent vertigo, and 15 with ISSNHL. The clinical variables, audiovestibular tests, and EH were evaluated and compared. Logistic proportional hazard models were used to obtain the odds ratio for hydrops development, including a multivariable adjusted model for potential confounders.Results: No statistical differences between groups were found regarding disease duration, episodes, Tumarkin spells, migraine, vascular risk factors, or vestibular tests; only hearing loss showed differences. Regarding EH, we found significant differences between groups, with odds ratio (OR) for EH presence in definite MD group vs. all other patients of 11.43 (4.5–29.02; p < 0.001). If the ISSNHL group was used as reference, OR was 55.2 (11.9–253.9; p < 0.001) for the definite MD group, 9.9 (2.1–38.9; p = 0.003) for the recurrent vertigo group, and 5.1 (1.2–21.7; p = 0.03) for the group with fluctuating sensorineural hearing loss.Conclusion: The percentage of patients with EH varies between groups. It is minimal in the ISSNHL group and increases in groups with increasing fluctuating audiovestibular symptoms, with a rate of severe EH similar to the known rate of progression to definite MD in those groups, suggesting that presence of EH by MRI could be related to the risk of progression to definite MD. Thus, EH imaging in these patients is recommended.
Highlights
In recent years, the diagnostic approach to patients with Ménière’s disease (MD) has undergone a major challenge
The main differences between the published diagnostic criteria of MD have been critically reviewed by previous authors and show that some are extremely restrictive to a complex symptom presentation or, on the contrary, permit partial manifestations that resemble the main fluctuating nature of symptoms in the disease [1]
We have shown in this paper that endolymphatic hydrops (EH), as detected by magnetic resonance imaging (MRI), is a major finding in patients with any type of inner ear disorder in which auditory or vestibular symptoms fluctuate, and its presence could, imply an increased risk of evolution to definite MD in those patients
Summary
The diagnostic approach to patients with Ménière’s disease (MD) has undergone a major challenge. As MD is part of a wider scenario of fluctuating hearing loss or recurrent vertigo, most of the guidelines do not consider some forms of staging or of status, both of which influence vestibular function [2] and auditory tests results [3] Another generalized deficiency in the guidelines is the absence of complete oto-neurological examinations to further categorize the level of vestibular deficit. A detailed scrutiny of symptoms has shown the existence of different subtypes or clinical variants in the unilateral [4] and bilateral [5] presentations of definite MD This has occurred in the case of bedside vestibular examination [6], auditory [7], and vestibular testing [8, 9]. Purpose: The purpose of the study is to evaluate the prevalence and characteristics of EH and audiovestibular test results in groups of patients with fluctuating audiovestibular symptoms not fulfilling the actual criteria for definite MD and compare them with a similar group of patients with definite MD and a group of patients with recent idiopathic sudden neurosensory hearing loss (ISSNHL)
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