Abstract
The cardinal symptoms of Meniere’s disease are episodic vertigo, fluctuating hearing loss and tinnitus. Meniere’s disease runs a chronic course and is often associated with endolymphatic hydrops (EH) in the inner ear. The etiology of the disease is unknown. Using fluid-attenuated inversion recovery (FLAIR) or more advanced techniques with contrast-enhanced magnetic resonance imaging (MRI), we evaluated EH under several conditions in patients with symptoms attributable to Meniere’s disease or inner ear symptoms. To deliver the contrast agent, we used the intratympanic (IT) and/or the intravenous (IV) approach. Potentially higher concentrations of the contrast agent can be introduced into the perilymph via the IT approach than via the IV approach. However, use of the IT approach needs approval of the ethics committee, while use of the IV approach is more acceptable in the clinical setting. In American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, EH was observed more frequently in patients with Definite Meniere’s disease than in those with Possible Meniere’s disease. Meanwhile, EH was also observed in both the cochlea and the vestibule in patients with atypical Meniere’s disease. Of 56 ears (36 patients) of patients with cochlear Meniere’s disease, 38 showed EH in the cochlea and 44 showed EH in the vestibule. Of 56 ears (28 patients) of patients with vestibular Meniere’s disease, 29 showed EH in the cochlea and 47 showed EH in the vestibule. The vestibular Meniere’s disease group showed significant vestibular predominance in the distribution of EH. In 30 patients with tinnitus as the major complaint, EH in the cochlea was present in 14 of 25 symptomatic ears (56%). Significant EH was present in 7 of 14 ears and mild EH in the remaining 7 ears. EH was observed more frequently in patients with fluctuating tinnitus than in patients with stable tinnitus. Inner-ear contrast-enhanced MRI may be useful to identify EH in its early stages.
