Clinical and radiological characteristics of patients with collapse or fistula of the saccule as evaluated by inner ear MRI.

Delayed 3D-FLAIR sequences enable the distinction between the utricle and the saccule. We sought to evaluate the clinical and radiological findings in patients with no visible saccule (NVS) on 4-hour post-contrast MRI. We retrospectively assessed the presence of NVS signs in 400 patients who underwent delayed inner ear MRI. We reported on 28 patients with NVS. Among this group, on the NVS affected side: 14 had isolated sensorineural hearing loss (SNHL); 4 had fluctuating cochleo-vestibular disease; 3 had definite Menière's disease; 3 had Minor syndrome; 2 had delayed endolymphatic hydrops (EH); 2 had inner ear malformations; 1 had sudden cochleo-vestibular deficit following stapes surgery; 1 had a perilymphatic fistula and 1 had a contralateral fluctuating SNHL. Sixteen out of these 28 patients (57.1%) had cochlear hydrops on the same side as the NVS, while 10 patients (35.7%) had saccular hydrops on the contralateral side. Moreover, isolated blood labyrinth barrier (BLB) impairment on the NVS side was observed in 7 patients. Two patients (7.1%) had large vestibular aqueduct and NVS on the same side and one patient had perilymphatic fistula. NVS seems to be multifactorial and could be linked to hydropic ear disease, third-mobile window pathologies and congenital malformation.