Department of Otolaryngology, Karl Landsteiner University Hospital Krems, Krems an der Donau, Austria.
Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Otol Neurotol. 2023 Sep 1;44(8):e588-e595. doi: 10.1097/MAO.0000000000003960. Epub 2023 Jul 18.
Our aim in this study was to characterize the morphology of the endolymphatic compartment on histopathology in individuals with Ménière's disease (MD) and to determine why hydrops of the saccule is more pronounced than that of other compartments of the inner ear in MD.
Temporal bones from 9 patients with idiopathic MD and from 10 individuals without MD/endolymphatic hydrops were examined. The inner ear fluid compartments in normal ears, and ears with MD were three-dimensionally reconstructed and their volume was calculated. The thickness of the membranes of the labyrinth was measured, and both ruptures of the membranes and patency of the utriculoendolymphatic (UEV; Bast's) valve were assessed.
In ears with MD, the saccule and the cochlear duct were most frequently hydropic; the utricle was involved approximately half as frequently. In ears without MD, the Reissner's membrane and the membranous wall of the saccule were thinner than that of the utricle and of the lateral semicircular canal ( p < 0.01). The lateral semicircular canal did not show signs of hydrops. In all ears with MD in which the utricle exceeded the average volume of normals (6 of 12), the UEV was open or there was a rupture in the utricle.
Increases in endolymphatic pressure may cause a primary swelling of the apical cochlear duct and saccule, both of which have relatively thin membranes. Hydrops in the utricle may occur less frequently because of a thicker wall, because of a functioning UEV, and when the saccule has already occupied most of the vestibular perilymphatic space.
本研究旨在对梅尼埃病（MD）患者的组织病理学内淋巴间隙形态进行分析，并确定为什么 MD 患者的椭圆囊积水比内耳其他部位更明显。
检查了 9 例特发性 MD 患者和 10 例非 MD/内淋巴积水患者的颞骨。正常耳和 MD 耳的内耳液间隙进行了三维重建，并计算其体积。测量了迷路膜的厚度，并评估了膜破裂和前庭内淋巴管（Bast 氏）瓣通畅情况。
在 MD 耳中，椭圆囊和耳蜗管最常积水；而前庭受累的频率约为一半。在非 MD 耳中，Reissner 膜和椭圆囊膜的厚度均小于前庭和外侧半规管（p < 0.01）。外侧半规管没有积水的迹象。在所有 MD 患者中，当前庭超过正常平均体积（12 例中有 6 例）时，UEV 是开放的，或者前庭有破裂。
内淋巴压力的增加可能导致顶部耳蜗管和相对较薄的椭圆囊的原发性肿胀。由于壁较厚、UEV 功能正常以及椭圆囊已经占据了大部分前庭外淋巴间隙，因此前庭积水的发生频率可能较低。
