Leng Yangming, Fan Wenliang, Liu Yingzhao, Xia Kaijun, Zhou Renhong, Liu Jingjing, Wang Hongchang, Ma Hui, Liu Bo
Department of Otorhinolaryngology Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Neurosci. 2023 Mar 13;17:1128942. doi: 10.3389/fnins.2023.1128942. eCollection 2023.
The diagnosis of Ménière's disease (MD), characterized by idiopathic endolymphatic hydrops (ELH), remains a clinical priority. Many ancillary methods, including the auditory and vestibular assessments, have been developed to identify ELH. The newly emerging delayed magnetic resonance imaging (MRI) of the inner ear after intratympanic gadolinium (Gd) has been used for identifying ELH . We aimed to investigate the concordance of audio-vestibular and radiological findings in patients with unilateral MD.
In this retrospective study, 70 patients with unilateral definite MD underwent three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequences following intratympanic application of Gd. Audio-vestibular evaluations were performed, including pure tone audiometry, electrocochleogram (ECochG), glycerol test, caloric test, cervical and ocular vestibular evoked myogenic potentials (VEMPs), and video head impulse test (vHIT). The relationship between imaging signs of ELH and audio-vestibular results was investigated.
The incidence of radiological ELH was higher than that of neurotological results, including the glycerol test, caloric test, VEMPs, and vHIT. Poor or slight agreement was observed between audio-vestibular findings and radiological ELH in cochlear and/or vestibular (kappa values <0.4). However, the pure tone average (PTA) in the affected side significantly correlated with the extent of both cochlear ( = 0.26795, = 0.0249) and vestibular ( = 0.2728, = 0.0223) hydrops. Furthermore, the degree of vestibular hydrops was also positively correlated with course duration ( = 0.2592, = 0.0303) and glycerol test results ( = 0.3944, = 0.0061) in the affected side.
In the diagnosis of MD, contrast-enhanced MRI of the inner ear is advantageous in detecting ELH over the conventional audio-vestibular evaluations, which estimates more than hydropic dilation of endolymphatic space.
以特发性膜迷路积水（ELH）为特征的梅尼埃病（MD）的诊断仍然是临床重点。已经开发了许多辅助方法，包括听觉和前庭评估，以识别ELH。新出现的鼓室内注射钆（Gd）后内耳延迟磁共振成像（MRI）已用于识别ELH。我们旨在研究单侧MD患者的听前庭和放射学检查结果的一致性。
在这项回顾性研究中，70例单侧确诊MD患者在鼓室内注射Gd后接受三维液体衰减反转恢复（3D-FLAIR）序列检查。进行了听前庭评估，包括纯音听力测定、耳蜗电图（ECochG）、甘油试验、冷热试验、颈性和眼性前庭诱发肌源性电位（VEMPs）以及视频头脉冲试验（vHIT）。研究了ELH的影像学表现与听前庭结果之间的关系。
放射学ELH的发生率高于包括甘油试验、冷热试验、VEMPs和vHIT在内的神经耳科学检查结果。在耳蜗和/或前庭，听前庭检查结果与放射学ELH之间的一致性较差或较弱（kappa值<0.4）。然而，患侧的纯音平均听阈（PTA）与耳蜗（r = 0.26795，P = 0.0249）和前庭（r = 0.2728，P = 0.0223）积水程度显著相关。此外，患侧前庭积水程度也与病程（r = 0.2592，P = 0.0303）和甘油试验结果（r = 0.3944，P = 0.0061）呈正相关。
在MD的诊断中，内耳对比增强MRI在检测ELH方面优于传统的听前庭评估，传统评估估计的不仅仅是内淋巴间隙的积水扩张。
