Correlation of MRI-Detected Endolymphatic Hydrops with Vestibular Function in Ménière’s Disease
Authors List
Aljawahiri, H., Thorne, P., Taylor, R., Auckland University, New Zealand Wu, H., Wong, M., Auckland City Hospital, Auckland, New Zealand Background Ménière’s disease (MD) is characterised by recurrent vertigo, fluctuating hearing loss, tinnitus, and aural fullness. Endolymphatic hydrops (EH) are considered a hallmark feature, detectable by MRI, though the diagnostic reliability varies. Aims This study explored the relationship between inner-ear MRI and vestibular function testing in patients with cochlear or vestibular symptoms. |
Presenter: Harry Wu
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Methods
Participants with vertigo or asymmetrical cochlear symptoms were identified from an ENT specialists database between March-2019 and September-2023. Those with completed audiometry, vestibular function testing (vHIT, oVEMP, cVEMP, Caloric-testing) and MRI hydrops sequence were eligible. MRIs were performed post gadolinium contrast in T2-weighted hydrops sequences to evaluate the endolymphatic and perilymphatic spaces. A radiologist, unaware of vestibular test results, analysed MRI images, while a trainee audiologist, blinded to the imaging results, processed the audiometric and vestibular data.
Results
Thirty-four participants (19-females, 15-males; average 51-years) were included. Based on AAO-HNS Menieres diagnostic criteria. Fourteen had definite MD, two probable MD, six possible MD, and twelve did not meet MD criteria. MRI revealed EH in 21 participants, though not all fulfilled the symptom and audiometric criteria for MD. The presence of EH was significantly associated with cVEMP and caloric results. Abnormalities on each test were significantly more prevalent in ears with (55% and 43%, respectively) compared to those without (15%) cochlear or vestibular EH and median asymmetry ratios lateralized to the affected ear (p< 0.05). There was a trend for abnormal cVEMPs and cochlear and vestibular EH to occur more often in definite MD.
Conclusion
This study found that EH affects the function of the saccule and the horizontal semicircular canal to low but not high velocity stimulation. However, neither MRI nor vestibular test abnormalities were specific to a definite MD diagnosis. MRI and vestibular testing may complement each other, enhancing diagnostic confidence due to the fluctuating nature of MD, particularly in the early disease stages.
Participants with vertigo or asymmetrical cochlear symptoms were identified from an ENT specialists database between March-2019 and September-2023. Those with completed audiometry, vestibular function testing (vHIT, oVEMP, cVEMP, Caloric-testing) and MRI hydrops sequence were eligible. MRIs were performed post gadolinium contrast in T2-weighted hydrops sequences to evaluate the endolymphatic and perilymphatic spaces. A radiologist, unaware of vestibular test results, analysed MRI images, while a trainee audiologist, blinded to the imaging results, processed the audiometric and vestibular data.
Results
Thirty-four participants (19-females, 15-males; average 51-years) were included. Based on AAO-HNS Menieres diagnostic criteria. Fourteen had definite MD, two probable MD, six possible MD, and twelve did not meet MD criteria. MRI revealed EH in 21 participants, though not all fulfilled the symptom and audiometric criteria for MD. The presence of EH was significantly associated with cVEMP and caloric results. Abnormalities on each test were significantly more prevalent in ears with (55% and 43%, respectively) compared to those without (15%) cochlear or vestibular EH and median asymmetry ratios lateralized to the affected ear (p< 0.05). There was a trend for abnormal cVEMPs and cochlear and vestibular EH to occur more often in definite MD.
Conclusion
This study found that EH affects the function of the saccule and the horizontal semicircular canal to low but not high velocity stimulation. However, neither MRI nor vestibular test abnormalities were specific to a definite MD diagnosis. MRI and vestibular testing may complement each other, enhancing diagnostic confidence due to the fluctuating nature of MD, particularly in the early disease stages.
