Sousa Rita, Guerreiro Carla, Eça Tiago, Campos Jorge, Luis Leonel
Neuroradiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
Otorhinolaryngology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
Front Surg. 2021 Jul 20;8:667248. doi: 10.3389/fsurg.2021.667248. eCollection 2021.
Menière's disease (MD) is an inner ear disorder characterized by recurrent episodes of spontaneous vertigo, unilateral low-frequency sensorineural hearing loss, tinnitus, and aural fullness. Current diagnosis still often has to rely on subjective and audiometric criteria only, although endolymphatic hydrops is recognized as the pathophysiological substrate of the disease, having been demonstrated in anatomical pathological studies and by magnetic resonance (MRI). The modiolus has a close functional and anatomical relationship with the cochlear nerve and membranous labyrinth and can be evaluated with MRI but no data exist on the modiolar size in MD. Our purpose is to examine the following hypothesis. Is cochlear modiolus smaller in symptomatic ears in MD? We used a retrospective 3 Tesla MR study (heavily T2-weighted 3D fast asymmetric spin-echo images and 0.5 mm slice thickness) comparing the mean modiolar area (MMA) in the index and best ears of eight patients with definite MD based on audiometric data. The obtained MMA values were compared against the audiometric data and the presence of vestibular endolymphatic hydrops. No differences were seen in MMA between best and worst ears. Ears with a pure tone average (PTA) ≥25 dB and more pronounced endolymphatic hydrops showed lower MMA (not statistically significant). Two patients with extreme endolymphatic hydrops showed a noteworthy ipsilateral decrease in the cochlear modiolus area. No differences were seen in MMA between best and worst ears in definite MD. Worse hearing function (PTA ≥ 25dB) and more pronounced endolymphatic hydrops seem to be associated with lower MMA. This might be related to bone remodeling as a consequence of endolymphatic hydrops. Further research is needed to corroborate and explore these findings.
梅尼埃病（MD）是一种内耳疾病，其特征为反复发作的自发性眩晕、单侧低频感音神经性听力损失、耳鸣和耳胀满感。尽管内淋巴积水被认为是该疾病的病理生理基础，已在解剖病理学研究和磁共振成像（MRI）中得到证实，但目前的诊断仍常常只能依赖主观和听力测定标准。蜗轴与耳蜗神经和膜迷路有着密切的功能和解剖关系，可通过MRI进行评估，但关于MD患者蜗轴大小的数据尚无报道。我们的目的是检验以下假设。MD有症状耳的蜗轴是否更小？我们进行了一项回顾性3特斯拉磁共振研究（采用重T2加权3D快速不对称自旋回波图像，层厚0.5毫米），比较了8例根据听力测定数据确诊为MD的患者患侧耳和健侧耳的平均蜗轴面积（MMA）。将获得的MMA值与听力测定数据以及前庭内淋巴积水的情况进行比较。健侧耳和患侧耳的MMA没有差异。纯音平均听阈（PTA）≥25 dB且内淋巴积水更明显的耳显示出较低的MMA（无统计学意义）。两名内淋巴积水极其严重的患者同侧蜗轴面积有明显减小。确诊为MD的患者，健侧耳和患侧耳的MMA没有差异。听力功能较差（PTA≥25dB）和内淋巴积水更明显似乎与较低的MMA有关。这可能与内淋巴积水导致的骨质重塑有关。需要进一步的研究来证实和探索这些发现。
