Diagnostic and Interventional Neuroradiology.
Department of Clinical Radiology, University Hospital Muenster, Muenster, Germany.
Otol Neurotol. 2018 Dec;39(10):e1091-e1099. doi: 10.1097/MAO.0000000000002016.
To assess three strategies for evaluation and description of potential endolymphatic hydrops (EH) gradients along the cochlea in patients with Menière's disease.
Prospective observational study.
Ten patients with definite Menière's disease revealed by magnetic resonance imaging were included in this prospectively conducted pilot study. The presence of cochlear endolymphatic hydrops as well as a potential hydrops gradient along the cochlea were subjectively evaluated by two readers. Furthermore, both readers performed planimetric measurements of the relative extent of endolymphatic hydrops in the cochlear turns for calculation of an apico-basal-index (ABI) and an average gradient slope of the endolymphatic hydrops. These models were correlated with the available pure tone audiometry (PTA).
Qualitatively, 13 of 16 inner ears presented an apical EH distribution. The median ABI was 1.69 for patients with low-tone hearing loss and 1.17 for patients with a flat PTA curve (p = 0.03). The median EH slope was 7.44 and correlated with the steepness of the PTA (ρ = 0.583; p = 0.018). The subjective analysis and the slope model were best fit for prediction of a low-tone hearing loss type with sensitivities of 100% (specificity, 42.86%) and 88.9% (specificity, 71.4%), respectively. The inter-reader agreement in all three approaches was considered substantial to perfect.
The presented qualitative approach and the slope model represent reliable methods for the description of a potential EH gradient along the cochlea. Furthermore, the average EH steepness along the cochlea correlates with the type of hearing loss.
评估三种策略，以评估和描述梅尼埃病患者耳蜗内潜在内淋巴积水（EH）梯度。
前瞻性观察研究。
本前瞻性试点研究纳入了 10 例经磁共振成像证实的明确梅尼埃病患者。两名读者主观评估耳蜗内淋巴积水的存在以及耳蜗内潜在的积水梯度。此外，两位读者均对内淋巴积水在耳蜗转中的相对程度进行了平面测量，以计算耳蜗顶底指数（ABI）和内淋巴积水的平均梯度斜率。这些模型与可获得的纯音听阈（PTA）相关。
16 个内耳中有 13 个呈顶端 EH 分布。低频听力损失患者的平均 ABI 为 1.69，PTA 曲线平坦患者的平均 ABI 为 1.17（p = 0.03）。EH 斜率的中位数为 7.44，与 PTA 的陡峭程度相关（ρ = 0.583；p = 0.018）。主观分析和斜率模型最适合预测低频听力损失类型，其敏感性分别为 100%（特异性，42.86%）和 88.9%（特异性，71.4%）。三种方法的读者间一致性均被认为是实质性的到极好的。
所提出的定性方法和斜率模型是描述耳蜗内潜在 EH 梯度的可靠方法。此外，耳蜗内 EH 的平均陡峭程度与听力损失的类型相关。
