Kitahara Tadashi, Sakagami Masaharu, Inui Hiroshi, Irino Hiroaki
Department of Otolaryngology- Head and Neck Surgery, Nara Medical University, Kashihara, Nara, Japan.
Inui ENT Clinic, Sakurai, Nara, Japan.
Acta Otolaryngol. 2023 Apr;143(4):289-295. doi: 10.1080/00016489.2023.2195882. Epub 2023 Apr 17.
Nowadays, the endolymphatic space size can be evaluated by 3D-analysis of 3 T-MRI after intravenous injection of gadolinium enhancement.
AIMS/OBJECTIVES: In the present study, to elucidate the relationships between vertigo and endolymphatic hydrops (EH) volume after middle ear pressure therapy (MEPT), we investigated changes in EH volume after MEPT for intractable Meniere's disease (MD) by means of the inner ear MRI (ieMRI) in relation to clinical results.
We enrolled 202 successive definite MD cases with intractable vertiginous symptoms from 2015 to 2020, assigning Group-I of MEPT, and Group-II of endolymphatic sac drainage (ELSD). Ninety patients completed the planned 2-year-follow-up, which included assessment of vertigo frequency and changes in EH volume using ieMRI (Group-I/MEPT: = 40; Group-II/ELSD: = 50).
Two years after surgery, vertigo was completely controlled in 77.5% of patients in Group-I and 90.0% in Group-II. Hearing improved by >10 dB in 7.5% of patients in Group-I and 24.0% in Group-II. ELS ratios were significantly reduced after treatments of Group-I and Group-II only in the vestibule.
The obtained results indicate that MEPT as well as ELSD could be a good treatment option for patients with intractable MD.
如今，静脉注射钆增强剂后，可通过3T磁共振成像（MRI）的三维分析来评估内淋巴间隙大小。
在本研究中，为阐明中耳压力疗法（MEPT）后眩晕与内淋巴积水（EH）体积之间的关系，我们通过内耳MRI（ieMRI）研究了MEPT治疗难治性梅尼埃病（MD）后EH体积的变化及其与临床结果的关系。
我们纳入了2015年至2020年间连续202例有难治性眩晕症状的确诊MD病例，分为MEPT治疗的I组和内淋巴囊引流（ELSD）治疗的II组。90例患者完成了计划的2年随访，包括眩晕频率评估以及使用ieMRI评估EH体积的变化（I组/MEPT：n = 40；II组/ELSD：n = 50）。
术后两年，I组77.5%的患者眩晕得到完全控制，II组为90.0%。I组7.5%的患者听力改善超过10dB，II组为24.0%。仅在I组和II组治疗后，前庭的ELS比率显著降低。
所得结果表明，MEPT以及ELSD可能是难治性MD患者的良好治疗选择。
