Abstract
Objective: Intravenous contrast agent enhanced, high-resolution magnetic resonance imaging of the inner ear (iMRI) confirmed that patients with Menière's disease (MD) and vestibular migraine (VM) could present with endolymphatic hydrops (EH). The present study aimed to investigate EH characteristics and their interrelation to neurotologic testing in patients with VM, MD, or VM with concurrent MD (VM-MD).Methods: Sixty–two patients (45 females, aged 23–81 years) with definite or probable VM (n = 25, 19 definite), MD (n = 29, 17 definite), or showing characteristics of both diseases (n = 8) were included in this study. Diagnostic workup included neurotologic assessments including video-oculography (VOG) during caloric stimulation and head-impulse test (HIT), ocular and cervical vestibular evoked myogenic potentials (o/cVEMP), pure tone audiometry (PTA), as well as iMRI. EH's degree was assessed visually and via volumetric quantification using a probabilistic atlas-based segmentation of the bony labyrinth and volumetric local thresholding (VOLT).Results: Although a relevant number of VM patients reported varying auditory symptoms (13 of 25, 52.0%), EH in VM was only observed twice. In contrast, EH in VM-MD was prevalent (2/8, 25%) and in MD frequent [23/29, 79.3%; χ2(2) = 29.1, p < 0.001, φ = 0.7]. Location and laterality of EH and neurophysiological testing classifications were highly associated (Fisher exact test, p < 0.005). In MD, visual semi-quantitative grading and volumetric quantification correlated highly to each other (rS = 0.8, p < 0.005, two-sided) and to side differences in VOG during caloric irrigation (vestibular EH ipsilateral: rS = 0.6, p < 0.05, two-sided). In VM, correlations were less pronounced. VM-MD assumed an intermediate position between VM and MD.Conclusion: Cochlear and vestibular hydrops can occur in MD and VM patients with auditory symptoms; this suggests inner ear damage irrespective of the diagnosis of MD or VM. The EH grades often correlated with auditory symptoms such as hearing impairment and tinnitus. Further research is required to uncover whether migraine is one causative factor of EH or whether EH in VM patients with auditory symptoms suggests an additional pathology due to MD.
Highlights
The Bárány Society recently published diagnostic criteria for vestibular migraine (VM) and Menière’s disease (MD) [1, 2]
Age between VM, MD and VM with concurrent MD (VM-MD) group differed significantly (A: F = 4.6, D: F = 14.4, p < 0.05, Bonferonicorrected) and the female proportion was higher in VM when compared to MD and VM-MD (6/8, 75%)
Headaches were significantly more frequent [A (=aVM vs. aMD vs. VM-MD): χ 2(2) = 32.1, p < 0.001, φ = 0.7; D (=dVM vs. dMD vs. VM-MD):χ 2(2) = 20.4, p < 0.001, φ =0.7, P (= pVM vs. pMD vs. VM-MD): χ 2(2) = 11.1, p < 0.005, φ = 0.6] in VM when compared to MD or VM-MD (5/8, 62.5%)
Summary
The Bárány Society recently published diagnostic criteria for vestibular migraine (VM) and Menière’s disease (MD) [1, 2]. Their critical clinical symptoms overlap, and no specific diagnostic test can reliably distinguish them: Up to 40% of VM patients present with auditory symptoms such as aural pressure, tinnitus, and sudden sensorineural hearing loss [3, 4]. Fluctuating EH dependent on the time interval after a VM attack was reported recently by longitudinal MRI [12] It remains to be seen whether the EH is a bystander phenomenon or pathophysiological relevant in VM. The EH’s mere verification did not prove the desired clear-cut discriminatory diagnostic criteria between VM and MD
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