Degree Of Endolymphatic Hydrops Research Articles

Optimization of delivering minimum Gd-DTPA at the posterior upper point on tympanic medial wall and hT2W-3D-FLAIR sequence for detecting endolymphatic hydrops

Objective: To optimize delivery of gadolinium-diethylenetriamine pentaacetic acid(Gd-DTPA) at the posterior upper point on tympanic medial wall and heavily T2-weighted 3-dimensional fluid-attenuated inversion recovery (hT2W-3D-FLAIR) sequence, and to implement the technique of detecting endolymphatic hydrops using gadolinium-enhancement MRI. Methods: Thirteen patients with periphery vertigo, who visited Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Changhai Hospital during June and December of 2017, were enrolled in the study.0.10-0.20 ml of Gd-DTPA in various dilutions (10, 20, and 40-fold) were delivered at the posterior upper point on tympanic medial wall using a soft-tipped tympanic suction and drug-spraying needle through an artificially perforated tympanic membrane. Inner ear MRI was performed at 8, 24 h after Gd-DTPA administration using a 3T MR machine in combination with a 20-channel Tim 4G head/neck coil and the sequence of hT2W-3D-FLAIR to detect the gadolinium-enhancement signal within the inner ear and possible endolymphatic hydrops. The scanning time was either 8 min 35 s or 15 min 11 s. Results: Efficient inner ear uptake of Gd-DTPA was detected and induced high signal to noise ratio of MRI in patients receiving targeted delivery of 0.15-0.20 ml of 10-fold diluted contrast agent at the posterior upper point on tympanic medial wall. At 8 h after delivery, significant uptake was detected in the scala tympani and vestibuli of hook region and basal turn of the cochlea, and perilymhatic compartment of the vestibule. At 24 h after delivery, the distribution of Gd-DTPA became homogenous in each turn of the cochlea and perilymphatic compartment of the vestibule. However, obvious individual variance existed in the inner ear uptake when 0.10 ml of 40-fold diluted Gd-DTPA was delivered. Efficient inner ear uptake and high quality images that generated in patients receiving 0.10, 0.15, and 0.20 ml of 20-fold Gd-DTPA demonstrated endolymphatic hydrops with minor individual variance. There was insignificant difference in the enhancement signal of inner ear between 0.15 and 0.10 ml groups when Gd-DTPA was diluted at 20-fold except for the signal of semicircular canal of 0.15 ml group (190.00±53.95 vs 165.50±42.13, t=2.61, P<0.05). There was insignificant difference in the image quality between 8 min 35 s and 15 min 11 s canning time. Various degrees of endolymphatic hydrops were detected in 7 cochleae and 11 vestibule, and both simultaneous cochlear and vestibular endolymphatic hydrops were detected in 4 ears. Cochlear endolymphatic hydrops was detected in all the 3 patients with definite Meniere's disease, and 2 of them had combined cochlear and vestibular endolymphatic hydrops. Endolymphatic hydrops was not detected in patients with possible Meniere's disease nor with symptoms of superior semicircular canal dehiscence. Conclusion: Targeted delivery of 0.10 ml with 20-fold diluted Gd-DTPA (total dosage of 5 μmol) at the posterior upper point on tympanic medial wall in combination with 8 min 35 s scanning time hT2W-3D-FLAIR sequence for inner ear MRI in a 3T MR machine is a clinically practical method to detect endolymphatic hydrops, and reduce the requirement for MRI hardware.

Usefulness of Intravenous Gadolinium Inner Ear MR Imaging in Diagnosis of M\xe9ni\xe8re\u2019s Disease

This study aimed to investigate the usefulness of the intravenous gadolinium enhanced inner ear magnetic resonance imaging (IV-Gd inner ear MRI) in diagnosing Ménière’s disease(MD) and find a correlation between the degree of endolymphatic hydrops(EH) and the audiovestibular tests. Total 29 patients diagnosed with unilateral definite MD were enrolled. All patients underwent IV-Gd inner ear MRI and auditory and vestibular function tests such as pure tone audiometry (PTA), electrocochleography (ECoG), cervical vestibular evoked myogenic potential (cVEMP) and caloric test. The hydrops ratio in the cochlea and vestibule were significantly higher in the affected side than the unaffected side (p < 0.001). Average pure-tone thresholds for 0.5, 1 k, 2 k, and 4 k Hz correlated significantly with cochlear and vestibular hydrops (p < 0.01) in the affected side. When comparing the SP/AP ratio of ECoG with hydrops ratio in the vestibule, the affected and unaffected ears showed a significant difference (p < 0.05). Similarly, the results of the caloric test also showed a significant correlation (p < 0.05) with relative vestibular hydrops. However, the cVEMP response was not related to the hydrops ratio in the cochlea or vestibule. This study presents pertinent data with appropriate correlations with auditory vestibular functional testing which demonstrates the usefulness of IV-Gd inner ear MRI as a diagnostic method for visualizing the endolymphatic hydrops in MD.

Age Dependence of Gadolinium Leakage from the Cortical Veins into the Cerebrospinal Fluid Assessed with Whole Brain 3D-real Inversion Recovery MR Imaging.

Purpose:It has been reported that intravenously administered gadolinium-based contrast agents (IV-GBCAs) leak into the cerebrospinal fluid (CSF) even in healthy subjects. The purpose of this study was to evaluate GBCA leakage from the cortical veins in patients with delayed imaging after IV-GBCA.Materials and Methods:There are two parts of retrospective study. In the first part, we reviewed six patients with suspected endolymphatic hydrops (EH) who received a single dose of IV-GBCA (37–58 years old). The 3D-real inversion recovery images were obtained prior to the contrast administration as well as 5 min and 4 h after IV-GBCA. Leakage from the cortical veins to the CSF was graded as positive if enhancement around the cortical veins at 5 min was observed and had further spread into the CSF at 4 h after IV-GBCA. In the second part of this study, we reviewed 21 patients with suspected EH (17–69 years old). Images were obtained only at 4 h after IV-GBCA. The number of slices (NOS) with a positive GBCA leakage from the cortical veins was counted. The correlation of the NOS with age, gender, and degree of EH was evaluated by Spearman’s rank correlation coefficient.Results:In the first part of the study, the GBCA leakage from the cortical veins was positive in all patients. In the second part of the study, the GBCA leakage from the cortical veins was seen in all older patients (above 37 years old), but not in the five younger patients (younger than 37 years old). The NOS correlated significantly only with age (r = 0.755, P < 0.01), but not with gender or degree of EH.Conclusion:IV-GBCA leaks from the cortical veins into the surrounding CSF. The leakiness of the cortical veins significantly correlated with age, but not with gender or degree of EH.

Clinical features and imaging characteristics of Meniere's disease verified by intravenous gadolinium contrast-enhanced magnetic resonance imaging

Objective: To analyze the clinical features and imaging characteristics of Meniere's disease (MD)verified by intravenous gadolinium contrast-enhanced magnetic resonance imaging(MRI). Methods: A total of 174 patients with Meniere's disease were involved in this study between March 2016 and October 2017. All of them underwent 3D-fluid attenuated inversion recovery (FLAIR) MRI and presented endolymphatic hydrops and clinical characteristics of suspected Meniere's disease. The clinical characteristics, the grades of endolymphatic hydrops (EH) using Nakashima grading standard were analyzed, and the correlation between grade and clinical features was evaluated. Results: There were totally 174 patients (88 males, 86 females), with the age of 7-83 years [mean age of (51.0±15.0)] years. Age of onset and disease course was 7-83 years [mean age of (44.6±16.6) years], 36.0 (12.0, 111.0) months (from 2 days to 70 years), respectively. EH was found in all the patients, and 169 cases (97.1%) manifested as modest or severe hydrops. Among the 174 patients, 139 cases (79.9%) presented unilateral EH, and 35 cases (20.1%) presented bilateral EH. The degree of EH in the latter was more serious than the former. For 174 patients, clinical characteristics were inconsistent, which was not in accord with the existing diagnostic criteria. Furthermore, there was a correlation between degree of hydrops and degree of hearing loss (P<0.05). Conclusions: EH in Meniere's disease can be measured objectively by intravenous gadolinium contrast-enhanced MRI. Clinical characteristics in MD verified by EH are not accordant with the existing criteria, which means the significance of EH in diagnosis of MD. Moreover, there's a correlation between degree and distribution of hydrops and degree of hearing loss.

Correlations Between the Degree of Endolymphatic Hydrops and Symptoms and Audiological Test Results in Patients With Menière's Disease: A Reevaluation.

This study was performed to reevaluate the diagnostic significance of clinically well-accepted audiological tests in indicating endolymphatic hydrops (EH) in Menière's disease (MD). Retrospective case review. Hospital. Fifty patients (52 affected ears) diagnosed with MD were enrolled. Diagnostic. To analyze the correlations between endolymphatic hydrops and results of audiological test including the pure-tone audiometry threshold, suprathreshold function tests, electrocochleogram, and glycerol test. Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging demonstrated EH in either the vestibule or cochlea to various degrees in all of the MD patients, 24 hours after intratympanic gadolinium chelate injection. Both vestibular and cochlear EH were significantly correlated with PTA threshold. However, EH was not associated with alternate binaural loudness balance or the tone decay test, although a correlation was observed with the short-increment sensitivity index. There was also a correlation between vestibular EH, but not cochlear EH, and the negative summating potential/action potential (-SP/AP) ratio. Neither vestibular EH nor cochlear EH was correlated with the glycerol test results. In addition, the frequency of vertigo attacks, the existence of tinnitus, and aural fullness did not correlate with EH. Disrupted ionic homeostasis in the inner ear, but not the EH, may contribute to changes in the -SP/AP ratio. The relevance of glycerol test in identifying EH through detection of hearing changes needs further investigation in the future.

Relationship Between the Extent of Endolymphatic Hydrops and the Severity and Fluctuation of Audiovestibular Symptoms in Patients With Menière's Disease and MRI Evidence of Hydrops.

To characterize the short-, middle-, and long-term occurrence of vertigo attacks in a large population of Menière's disease (MD) and to investigate the relationship between the extent of endolymphatic hydrops (ELH) and the severity of audiovestibular symptoms. Prospective observational study. One hundred ninety-two patients with clinically definite MD participated in this study. The degree of ELH was visualized by locally enhanced inner ear magnetic resonance imaging. The occurrence and intensity of vertigo attacks, hearing loss, tinnitus, and aural fullness were documented in patient diaries. There was no significant correlation between the extent of cochlear or vestibular hydrops and the number of definite vertigo days, neither with regard to a short-term nor with regard to a middle-term time period. There was also no correlation between the extent of ELH and the intensity or activity of the coexisting aural symptoms hearing loss, tinnitus, and aural fullness. The duration of the disease significantly correlated with the extent of both cochlear and vestibular hydrops, but not with the number of definite vertigo days. The ELH was progressive in the long-term course of the disease in this large population of definite MD patients, but short-term and middle-term fluctuations of the symptom severity did not involve measurable variations of the ELH. Furthermore, the symptom severity did not decrease with increasing disease duration.

Significance of Endolymphatic Hydrops in Ears With Unilateral Sensorineural Hearing Loss.

The purpose of this study was to investigate the existence of endolymphatic hydrops (EH) in affected and unaffected ears in patients with unilateral sensorineural hearing loss (SNHL) using contrast-enhanced magnetic resonance imaging (MRI), and to evaluate the significance of EH in various otological diseases. Retrospective study. University hospital. One hundred eighty-two ears from 91 patients with unilateral SNHL were studied. The endolymphatic space was evaluated using 3-Tesla MRI with gadodiamide hydrate. Imaging data about the degree of EH in the cochlea and vestibule were analyzed and compared between ears with various otological diseases. All affected ears with delayed endolymphatic hydrops had EH. In affected ears with definite Menière's disease, cochlear EH was observed in all ears and vestibular EH in 93% of ears, and these rates were significantly higher in the affected than in the unaffected ears. EH was also observed in the cochlea and vestibule in 66% and 41%, respectively, of the affected ears with idiopathic sudden SNHL; however, these percentages did not differ significantly from those in the unaffected ears (52% and 38%, respectively). MRI showed that a high percentage of ears affected by Menière's disease or delayed endolymphatic hydrops had EH. Further studies should evaluate the implications of EH in ears, especially in those with sudden SNHL, in terms of secondary or pre-existing EH.

Assessment of Cochlea Endolymphatic Hydrops Using 3-D FLAIR and 3-D Real IR Sequence in Guinea Pigs via 3T MRI After Intratympanic Gadolinium: A Histopathological Comparison.

We assessed whether the three-dimensional fluid-attenuated inversion-recovery (3-D FLAIR) and three-dimensional inversion-recovery with real reconstruction (3-D real IR) sequences can be used to detect cochlea endolymphatic hydrops (EHs) in guinea pigs using 3 Tesla magnetic resonance imaging (3T MRI). The results of 3-D real IR imaging were compared with histopathological outcomes. Fourteen healthy men and women albino guinea pigs were used in this study. Their right ears received procedures that promoted EHs, and their left ears were used as untreated controls. High-resolution 3T MRI, combined with the intratympanic injection of gadolinium (Gd) in both ears, was performed 8 to 12 weeks after surgery. Both sides of the cochlea midmodiolar sections were observed under a light microscope and saved as the histopathological images. The signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) between the T2-weighted 3-D FLAIR and T2-weighted 3-D real IR sequences were compared. The appearance of EHs in the basal, second, third, and apical turns of the cochlea was further evaluated using 3-D FLAIR, 3-D real IR, and the histopathological images. Moreover, the maximum scala media area ratios (SMRs) on the histopathological sections were compared with the grading of the EHs on the 3-D real IR sequence with regard to each turn of the cochlea. Significant differences were found between the 3-D FLAIR and 3-D-real IR sequences with regard to the SNRs and CNRs (p < 0.05): the 3-D FLAIR sequence exhibited higher SNRs (SNRROI: 347.95 ± 105.01; SNRB: 103.28 ± 17.61) compared with the 3-D real IR sequence (SNRROI: 86.71 ± 30.11; SNRB: 11.11 ± 3.45), whereas the 3-D real IR sequence showed higher CNRs (2.78 ± 0.58) compared with the 3-D FLAIR sequence (2.18 ± 0.55). Various degrees of EHs were observed in each turn of the cochlea in the experimental ears on the basis of the histopathological images. Thirteen, 10, 4, and 0 EHs were observed in the basal, second, third, and apical turns of the cochlear using 3-D FLAIR images, respectively, whereas 14, 14, 14, and 13 EHs were found using 3-D real IR images, respectively. Significant differences were found between the two sequences when evaluating the second, third, and apical turns of the cochlear but not with regard to the basal turn (p < 0.05). The SMRs were proportional to the extent of the EHs on 3-D real IR imaging in each turn of the cochlea. 3-D real IR images are clearer than 3-D FLAIR images, and they can display cochlea EHs more precisely using 3T MRI in guinea pigs. The extent of the EHs on 3-D real IR imaging was more consistent with the histopathological observations in each turn of the cochlea.

Magnetic resonance imaging of intratympanic gadolinium helps differentiate vestibular migraine from Ménière disease.

To study the differential diagnosis of vestibular migraine (VM) and Ménière disease (MD) by using magnetic resonance imaging (MRI) of intratympanic gadolinium. Prospective cohort study. Definite MD patients (n = 30) and definite or probable VM patients (n = 30) were included, and the two groups were age and sex matched. Three-dimensional real inversion recovery (3D-real-IR) MRI was performed 24 hours after bilateral intratympanic gadolinium to assess the presence and degree of endolymphatic hydrops (EH). Response rates, amplitudes, latency, and response threshold of cervical and ocular vestibular evoked myogenic potentials (c/oVEMPs) were tested by using air-conducted sound. Pure tone audiometry was used to evaluate the level of hearing loss. Different degrees of EH were observed in the cochlea and vestibule in the affected ears of MD patients, but only suspicious cochlear hydrops and no vestibular hydrops was noted in the VM patients. The correlation between the degree of EH and low-frequency hearing loss was statistically significant. Only the response threshold for c/oVEMP differentiated the MD-affected side from VM. The latency and amplitude for c/oVEMP showed no significant difference between groups. Characteristic pathological changes of MD include EH in the inner ear, and 3D-real-IR MRI helps differentiate VM from MD. VM and MD behaved similarly in vestibular dysfunction and their transduction pathway, but MD appeared to be more severe than VM. An association in their pathophysiology may play a part in these responses. 4 Laryngoscope, 127:2382-2388, 2017.

Magnetic resonance imaging evaluation of endolymphatic hydrops andpost-operative findings in cases with otosclerosis

Conclusions: The presence of endolymphatic hydrops (EH) in the vestibule on magnetic resonance imaging (MRI) might be a high-risk factor for complications in cases that are candidates for stapes surgery.Objective: Pre-operative detection of EH could be valuable in cases that are candidates for stapes surgery to prevent unpredictable complications following surgery. Pre-operative MRI findings and post-operative findings following stapes surgery were compared to evaluate the efficacy of such MRI evaluation for the management of cases with otosclerosis.Subjects and methods: Sixteen cases who underwent pre-operative evaluation by 3T MRI performed 4 h after intravenous injection of gadolinium and stapes surgery for otosclerosis were recruited. Imaging data concerning the degree of EH in the vestibule and cochlea were compared with post-operative clinical findings for all cases.Results: Mild EH in the cochlea or the vestibule was observed in eight ears and one ear, respectively, whereas one ear showed significant EH both in the cochlea and the vestibule. The post-operative course was uneventful in 12 of 14 cases with no EH in the vestibule, and the other two cases had a short period of dizziness, but two cases with EH in the vestibule had a long period of dizziness.

Focal Endolymphatic Hydrops as Seen in the Pars Inferior of the Human Inner Ear.

Endolymphatic hydrops of the human inner ear may be localized focally in the pars inferior of the human inner ear. Endolymphatic hydrops may be found in the human inner ear in patients who in life had suffered from Ménière's syndrome or a variety of other disorders. The degree of endolymphatic hydrops may differ based on location in the inner ear. A computer-assisted search of all cases in the collection of the Massachusetts Eye and Ear Infirmary in which endolymphatic hydrops was found in the inner ear yielded 13 specimens in which there was good evidence for focal endolymphatic hydrops in the pars inferior. Temporal bones were prepared for light microscopy. Semi-serial sections were reviewed to generate localization data for endolymphatic hydrops and also to search for evidence of a previous inflammatory process, including fibrosis or new bone formation. Endolymphatic hydrops was present in the saccule in 10 of 13 specimens. In the cochlear duct, there were segments of the cochlea in which there was no cochlear hydrops juxtaposed to other regions in which there was severe endolymphatic hydrops. Transition between hydropic and non-hydropic status in the cochlear duct was often abrupt.Evidence for a previous inflammation process was found in 6 of 13 specimens including fibrosis because of temporal bone fracture, or traumatic stapedectomy and in those cases in which the cause of hearing loss was idiopathic, fibrosis, and osteoid between the labyrinthine surface of the footplate and the hydropic saccular wall, and/or osteoid in the scala vestibuli, or in the proximate Rosenthal's canal. Evidence of a previous inflammatory process was uniformly seen in the perilymphatic compartment. Endolymphatic hydrops of the pars inferior in the human may have a focal distribution. This study suggests that the pathogenesis of endolymphatic hydrops is unlikely to be because of distal obstruction of longitudinal flow and was more consistent with the hypothesis that homeostasis of the endolymphatic and perilymphatic volumes occurs all along the cochlear duct. Other factors including variable distensibility of Reissner's membrane or disturbance of local solute homeostatic mechanisms may be responsible for wide variations in the degree of hydrops. A focal inflammatory process during life may be one cause of focal endolymphatic hydrops as seen histopathologically.

3D reconstruction of cochlea using optical coherence tomography.

Recently, in vivo visualization of the cochlea and the smaller structures inside of it has been achieved by optical coherence tomography (OCT). This makes it possible to use OCT imaging for diagnosis of diseases such as Meniere's disease through measuring the degree of endolymphatic hydrops. To this end, we present a novel method for 3D segmentation of these cochlear OCT images that is based on superpixels and diffusion maps. The method takes as input grayscale volumetric OCT images and outputs a binary image with the segmented cochlea. We show that the proposed method is suitable for segmenting the data for visualization as well as for preprocessing the data for future automated grading of endolymphatic hydrops.

Preceding profound deafness and co-factors promote development of endolymphatic hydrops in preliminary patients with delayed endolymphatic hydrops

Conclusion: Profound deafness (PD) is unlikely to be the only cause of endolymphatic hydrops (EH) in patients with delayed endolymphatic hydrops (DEH). Further studies in large patient cohorts are required to determine the etiologic co-factors involved in the development of EH in patients with PD and DEH.Objectives: DEH usually occurs in patients with sustained unilateral PD who then develop episodic vertigo or fluctuating hearing loss. The latency can vary markedly between PD and development of DEH, but the factors affecting inner ear homeostasis and causing EH during this latency period remain unclear. The study aimed to assess the differences in EH and functional status of the inner ear between patients with PD only and those with DEH.Method: Two PD and 10 DEH patients who had developed PD in early childhood were enrolled. Gadolinium-enhanced magnetic resonance imaging of the inner ear was performed in all patients to assess the degree of EH in the vestibule and cochlea.Results: There was no evidence of EH in the affected ears of patients with PD alone. DEH patients, however, showed significant EH in either the cochlea or vestibule, suggesting that EH development and DEH onset were strongly correlated.

Effects of Intralabyrinthine Hemorrhage on the Cochlear Elements: A Human Temporal Bone Study.

To compare histopathologic findings in the cochlea of human temporal bones with versus without intralabyrinthine hemorrhage. Hemorrhagic labyrinthitis can cause sensorineural damage, sudden hearing loss, and vertigo. Yet, to our knowledge, no studies have quantitatively described histopathologic effects of intralabyrinthine hemorrhage on the elements of the cochlea. We analyzed 46 human temporal bone samples from 23 patients with unilateral intralabyrinthine hemorrhage (23 samples from ears with intralabyrinthine hemorrhage and 23 samples from contralateral ears without). We noted the location of hemorrhage in the inner ear, the degree of endolymphatic hydrops, the number of spiral ganglion cells and hair cells, mean loss of fibrocytes in spiral ligament, and areas of the stria vascularis and spiral ligament. Intralabyrinthine hemorrhage caused significant loss of outer hair cells in the lower basal (p = 0.001), upper basal (p = 0.005), and lower middle (p = 0.012) cochlear turns. The degree of endolymphatic hydrops was significantly different between the hemorrhagic and contralateral sides (p = 0.011). But we found no significant difference between the 2 sides in the number of inner hair cells, spiral ganglion cells, and fibrocytes, or in the areas of the stria vascularis and spiral ligament between the two groups (p > 0.05). These findings suggest that such patients could be good candidates for hearing aid or cochlear implant if they have profound sensorineural hearing loss.

Endolymphatic hydrops in superior canal dehiscence and large vestibular aqueduct syndromes.

Pathologic third window lesions, such as superior semicircular canal dehiscence syndrome (SCDS) or large vestibular aqueduct syndrome (LVAS), cause several auditory and vestibular symptoms, which might affect perilymphatic pressure and induce endolymphatic hydrops (EH). In this study, the existence of EH in subjects with SCDS or LVAS was investigated using contrast-enhanced magnetic resonance imaging (MRI). Case series at university hospital. Seventeen ears from nine subjects who were diagnosed as having SCDS (five ears from three cases) or LVAS (12 ears from six cases) were studied. Ears were evaluated by 3-T MRI performed 4 hours after intravenous injection of gadodiamide hydrate. Imaging data concerning the degree of EH in the cochlea and the vestibule were compared with clinical symptoms and hearing levels for all ears. All ears showed air-bone gaps at low frequencies on pure tone audiometry. None of the subjects with SCDS had episodes of acute sensorineural hearing loss (SNHL) or vestibular symptoms, except for one patient who complained of head vibration induced by loud noise. Conversely, five of six subjects with LVAS had episodes of acute SNHL or vestibular symptoms. Four of five ears with SCDS showed severe EH in the cochlea, and two ears showed mild EH in the vestibule. All ears with LVAS showed mild to severe EH in both the cochlea and vestibule. The present study demonstrated the existence of EH in ears with pathologic third window lesions, which might affect patients' auditory or vestibular symptoms. 4 Laryngoscope, 126:1446-1450, 2016.

Cochlear changes in serous labyrinthitis associated with silent otitis media: A human temporal bone study

PurposeTo determine histopathological findings in the cochlea of human temporal bones with serous labyrinthitis. Materials and methodsWe compared human temporal bones with serous labyrinthitis (20 cases) associated with silent otitis media and without serous labyrinthitis (20 cases) to study location of serous labyrinthitis, the degree of endolymphatic hydrops, number of spiral ganglion cells and hair cells, loss of fibrocytes in the spiral ligament, and areas of the spiral ligament and stria vascularis. ResultsThe serous labyrinthitis caused significant loss of outer hair cells in the lower basal (P=0.006), upper basal (P=0.005), and lower middle (P=0.011) cochlear turns, and significant increase in the degree of endolymphatic hydrops than the control group (P=0.036). No significant difference was found in the loss of inner hair cells, in the number of spiral ganglion cells and fibrocytes in the spiral ligament, and in areas of the stria vascularis and spiral ligament (P>0.05). ConclusionsSerous labyrinthitis resulted in significant loss of outer hair cells and significant increase in the degree of endolymphatic hydrops.

The correlation between symptoms of definite Meniere's disease and endolymphatic hydrops visualized by magnetic resonance imaging.

This study aimed at investigating the correlation between a battery of diagnostic symptoms of definite Meniere's disease (MD) and the degree of endolymphatic hydrops (EH) in the inner ear. Prospective study. Fifty-four patients diagnosed with unilateral definite MD were enrolled in the study. The hearing levels of all patients at the low, middle, and high frequencies were evaluated. Three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and three-dimensional real inversion recovery (3D-real IR) magnetic resonance imaging (MRI) were performed 24 hours after bilateral intratympanic injection of gadolinium to assess the presence and grading of EH. Various degrees of EH were observed in the vestibule and/or each turn of the cochlea in the affected ears of all patients. The duration of MD disease and low-tone and middle-tone hearing thresholds were proportional to the extent of EH in the vestibule and cochlear. However, no significant correlation was demonstrated between EH and other aspects of symptoms such as high-tone hearing loss, tinnitus, and aural fullness. Of all subjects, 16.7% exhibited bilateral EH on MRI exam who were diagnosed with unilateral MD based on diagnostic criteria. EH in the inner ear of MD patients exhibits a progressive deteriorative trend over time. Low-tone and middle-tone hearing thresholds can indirectly reflect the severity of EH in the cochlea. EH may not be the primary cause of tinnitus and aural fullness in patients with MD. Patients diagnosed with unilateral MD should maintain long-term regular follow-ups for the possibility of developing bilateral EH. 4.

Magnetic Resonance Imaging Evaluation of Endolymphatic Hydrops in Cases With Otosclerosis.

Endolymphatic hydrops (EH) has been reported in cases with otosclerosis, and preoperative EH could be a risk factor for inner ear disturbances after stapes surgery. Visualization of EH has recently become possible using magnetic resonance imaging (MRI) with contrast agents. This study investigated the presence of EH on MRI in ears with clinical otosclerosis. Retrospective case series. University hospital. 27 ears of 15 cases diagnosed with otosclerosis. Ears were evaluated by 3-T MRI performed 4 hours after intravenous injection of gadolinium. The degree of EH in the vestibule and cochlea was classified into three grades (none, mild, and significant). Imaging data were compared with clinical findings for all ears. Imaging and clinical findings. Varying degrees of cochlear EH and vestibular EH were observed in 20 and 15 ears, respectively. Episodes of acute sensorineural hearing loss with rotatory vertigo occurred in four ears that showed severe EH in the cochleae and vestibules. Severe EH, however, was also observed in ears without such symptoms. The presence of EH in ears with otosclerosis was clearly visualized in the present patient series. Such MRI evaluation could provide useful information for managing symptoms related to EH.

Changes in endolymphatic hydrops in patients with Ménière’s disease treated conservatively for more than 1 year

Conclusion: This study revealed that endolymphatic hydrops (EH) reduced in some cases with Ménière’s disease (MD) treated conservatively. It appears that the EH reduction was associated with improvement of the clinical symptoms. Objectives: The relationship between the degree of EH and clinical symptoms is not clear at present. The purpose of the present study was to investigate the time course of the relationship in patients with MD treated conservatively. Patients: Twelve patients with MD treated conservatively for more than 1 year in a university hospital. Methods: Twenty ears of 12 patients with MD treated conservatively were evaluated. The presence or absence of vertigo, tinnitus and ear fullness was confirmed when magnetic resonance imaging (MRI) was performed. Using a 3 T MRI scanner, three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) MRI was performed 2 or 3 times 24 hours after intra-tympanic gadolinium injection or 4 hours after intravenous gadolinium injection. Results: In the three ears in which the symptoms alleviated, EH was reduced in two ears, but EH was reduced in only one of 17 ears in which the symptoms did not alleviate. The Fisher exact test revealed that EH reduction occurred more frequently in ears with alleviation of the symptoms (p < 0.05).

Semi-quantitative vs. volumetric determination of endolymphatic space in Menière's disease using endolymphatic hydrops 3T-HR-MRI after intravenous gadolinium injection.

Magnetic resonance imaging enhances the clinical diagnosis of Menière's disease. This is accomplished by in vivo detection of endolymphatic hydrops, which are graded using different semi-quantitative grading systems. We evaluated an established, semi-quantitative endolymphatic hydrops score and with a quantitative method for volumetric assessment of the endolymphatic size. 11 patients with Menière's disease and 2 healthy subjects underwent high resolution endolymphatic hydrops 3 Tesla MRI with highly T2 weighted FLAIR and T2DRIVE sequences. The degree of endolymphatic hydrops was rated semi-quantitatively and compared to the results of 3D-volumetry. Moreover, the grade of endolymphatic hydrops was correlated with pure tone audiometry. Semi-quantitative grading and volumetric evaluation of the endolymphatic hydrops are in accordance (r = 0.92) and the grade of endolymphatic hydrops correlates with pure tone audiometry. Patients with a sickness duration of ≥ 30 months showed a significant higher total labyrinth fluid volume (p = 0.03). Fast, semi-quantitative evaluation of endolymphatic hydrops is highly reliable compared to quantitative/volumetric assessment. Endolymphatic space is significantly higher in patients with longer sickness duration.