Abstract
Background: Although magnetic resonance imaging (MRI) of the membranous labyrinth and electrocochleography (ECochG) have been used to diagnose endolymphatic hydrops (ELH) in patients with Ménière's disease (MD), the relationship between imaging and ECochG is not well-documented.Objectives: This study evaluates the ELH using 3D-FLAIR MRI and extra-tympanic ECochG (ET-ECochG) and correlates the results from 3D-FLAIR MRI to those from ET-ECochG.Materials and Methods: 3D-FLAIR MRI images of 50 patients were assessed using a 2D volume-referencing grading system (VR scores, relative scores according to the known volumes of the cochlea, vestibule, and semicircular canals). Forty healthy subjects were included and compared to 51 definite MD ears of 50 patients while analyzing the ET-ECochG, which used a self-made bronze foil electrode. The amplitude ratio of the summating potential (SP) to the action potential (AP) (SP/AP) and the area ratio of SP to AP (Asp/Aap) were collected. Relative ELH grade scores were then correlated to ET-ECochG (SP/AP, Asp/Aap).Results: The VR scores showed a better correlation (r = 0.88) with the pure tone average (PTA), disease duration, and vertigo frequency of MD than the Bernaerts scores (grading the cochlea and vestibule separately) (r = 0.22). The SP/AP and Asp/Aap of the unilateral MD patients were statistically comparable to those measured in contralateral ears and the results between the definite MD ears with healthy ears were statistically comparable (p < 0.05). In a ROC analysis Asp/Aap (area under curve, AUC 0.98) significantly (p = 0.01) outperformed SP/AP (AUC 0.91). The total score of ELH, vestibular ELH, and cochlear ELH were also correlated with SP/AP and Asp/Aap. The strongest correlation was found between the Asp/Aap and cochlear ELH (r = 0.60).Conclusion: The 2D volume-referencing grading system was more meaningful than the Bernaerts scores. A correlation was found between ELH revealed by 3D-FLAIR MRI and the SP/AP of ET-ECochG in evaluating definite MD patients. The Asp/Aap appeared a more sensitive and reliable parameter than SP/AP for diagnosing the ELH of the membranous labyrinth.
Highlights
Menière’s disease (MD) is a multifactorial inner ear disorder characterized by fluctuating sensorineural hearing loss, spontaneous vertigo attacks, tinnitus, and aural fullness [1]
The development and progress in magnetic resonance imaging (MRI) techniques has enabled the visualization of endolymph hydrops (ELH) separately in cochlea and vestibule using a 3.0 Tesla (T) scanner and a gadolinium-based contrast agent [5,6,7]
The volume ratio and the semicircular canals should be taken into consideration to better represent the total ELH of inner ears
Summary
Menière’s disease (MD) is a multifactorial inner ear disorder characterized by fluctuating sensorineural hearing loss, spontaneous vertigo attacks, tinnitus, and aural fullness [1]. Volume quantification methods of the inner ear, especially the endolymph, have been introduced. These methods require specific scan sequences, 3D workstations [8,9,10], or probabilistic atlas [11] that require imaging processing capabilities and may be difficult to establish in a clinical setting. 2D ELH grading methods grade ELH in the cochlea and vestibule separately [13,14,15] without considering the volume ratio between cochlea and the vestibule and excluded the semicircular canals. The volume ratio and the semicircular canals should be taken into consideration to better represent the total ELH of inner ears. Magnetic resonance imaging (MRI) of the membranous labyrinth and electrocochleography (ECochG) have been used to diagnose endolymphatic hydrops (ELH) in patients with Ménière’s disease (MD), the relationship between imaging and ECochG is not well-documented
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