Fukushima Munehisa, Kadowaki Seiichi, Nakatani Saho, Waki Sadanori, Matsumoto Ken, Okamoto Hidehiko
Department of Otolaryngology, Adachi Medical Center, Tokyo Women's Medical University, 4-33-1 Kohoku, Adachi-Ku, Tokyo, 123-8558, Japan.
Department of Otolaryngology and Head and Neck Surgery, Kansai Rosai Hospital, Hyogo, Japan.
Eur Arch Otorhinolaryngol. 2024 Apr;281(4):1701-1708. doi: 10.1007/s00405-023-08272-7. Epub 2023 Oct 7.
When a dizzy patient with episodic vertigo has an abnormal caloric and a normal video head impulse test (vHIT), this caloric-vHIT dissociation provides vital information for a diagnosis of Ménière's disease (MD). Endolymphatic hydrops (EH), a histological marker of MD, is hypothesized to be involved in the caloric-vHIT dissociation in MD through hydropic duct distension of the horizontal semicircular canal (SC). This study was designed to determine the impact of EH on the function of horizontal SC during caloric stimulation.
Caloric test and vHIT were used to evaluate the function of horizontal SC every six months, annual magnetic resonance imaging (MRI) was used to evaluate the degree of EH size in the vestibule, and monthly vertigo and hearing evaluation was done for 12 months. EH shrinkage was defined as the size change of vestibular EH from significant to none.
Among 133 MD patients evaluated for eligibility, 67 patients with caloric-vHIT dissociation entered the study. Fifteen participants had EH shrinkage (G-I), while 52 participants had no remarkable EH change (G-II). Average values (IQR) of the maximum slow phase velocity in G-I and G-II were 29.6 (13.0-34.0) and 25.9 (17.3-31.3), respectively, at baseline, 26.1 (9.0-38.0) and 23.6 (18.0-28.3) at 12 months. Two-factor repeated-measures ANOVA showed no significant differences between the groups (P = 0.486). The values of vestibulo-ocular reflex gain of the horizontal SC in G-I and G-II remained above 0.8 during the study period.
EH detected by MRI shows limited correlation with caloric stimulation results.
当发作性眩晕的头晕患者冷热试验异常而视频头脉冲试验（vHIT）正常时，这种冷热试验 - vHIT分离为梅尼埃病（MD）的诊断提供了重要信息。内淋巴积水（EH）是MD的组织学标志物，据推测其通过水平半规管（SC）的积水性导管扩张参与MD的冷热试验 - vHIT分离。本研究旨在确定EH在冷热刺激期间对水平SC功能的影响。
每六个月使用冷热试验和vHIT评估水平SC的功能，每年使用磁共振成像（MRI）评估前庭中EH大小的程度，并在12个月内每月进行眩晕和听力评估。EH缩小定义为前庭EH大小从显著变为无。
在133名接受资格评估的MD患者中，67名冷热试验 - vHIT分离的患者进入研究。15名参与者出现EH缩小（G - I组），而52名参与者的EH无明显变化（G - II组）。G - I组和G - II组在基线时最大慢相速度的平均值（四分位间距）分别为29.6（13.0 - 34.0）和25.9（17.3 - 31.3），12个月时分别为26.1（9.0 - 38.0）和23.6（18.0 - 28.3）。双因素重复测量方差分析显示两组之间无显著差异（P = 0.486）。在研究期间，G - I组和G - II组水平SC的前庭眼反射增益值保持在0.8以上。
MRI检测到的EH与冷热刺激结果的相关性有限。
