Tanaka Toshitake, Ushio Munetaka, Terada Hitoshi, Takanami Taro, Kan Seikei, Masuda Hiroaki, Ochi Kotaro, Ikeda Hitomi, Yoshino Ryosuke, Ohta Yasushi
Otolaryngology, Toho University Sakura Medical Center, Sakura, JPN.
Radiology, Toho University Sakura Medical Center, Sakura, JPN.
Cureus. 2023 Dec 31;15(12):e51384. doi: 10.7759/cureus.51384. eCollection 2023 Dec.
Objective This study aimed to investigate the correlation between enhanced inner ear magnetic resonance imaging (MRI) findings and vestibular and cochlear function test results in patients with definite Meniere's disease and confirmed endolymphatic hydrops. Methods Among 70 consecutive patients diagnosed with definite Meniere's disease, 49 underwent contrast-enhanced 3-T inner ear MRI. The patients also underwent pure-tone audiometry, glycerol, caloric, and vestibular-evoked myogenic potential (VEMP) tests. Correlations between the pure-tone audiometry, glycerol test, caloric test, VEMP test, and MRI findings were evaluated using the chi-square test or Fisher's exact test, Student's t-test, one-way ANOVA, and Bonferroni's post-hoc test. Results Contrast-enhanced inner ear MRI revealed that 33 of 49 patients (67.3%) had endolymphatic hydrops. Among them, 19 patients had bilateral endolymphatic hydrops, and 14 had unilateral hydrops. The mean hearing threshold was higher in patients with endolymphatic hydrops than those without (p< 0.001). The proportion of patients with positive glycerol test results was higher among those with endolymphatic hydrops than in those without (p= 0.01). The rate of abnormal caloric response in patients with and without endolymphatic hydrops was not significantly different (p= 0.09). Furthermore, the rate of abnormal VEMP response in patients with and without endolymphatic hydrops was not significantly different (p= 0.70). On the affected side, in the caloric test, the ratio of the presence of vestibular and cochlear hydrops was similar (p= 1.00). On the affected side, in the VEMP test, the ratio of the presence of vestibular and cochlear hydrops was also similar (p= 0.80). The consistency of the caloric test in detecting cochlear hydrops was higher than that of the VEMP test (p= 0.04). The consistency of the caloric test in detecting vestibular hydrops tended to be higher (but not significantly) than that of the VEMP test (p= 0.11). Conclusion The cochlea and vestibule on the clinically affected side were more likely to have endolymphatic hydrops revealed by contrast-enhanced 3-T inner ear MRI than on the unaffected side. The sum of the three low frequencies (125, 250, and 500 Hz) of the pure-tone audiometry was higher in patients with endolymphatic hydrops than in those without endolymphatic hydrops. The caloric test was more consistent in detecting endolymphatic hydrops, especially cochlear hydrops, than the VEMP test in patients with definite Meniere's disease. The results of this study may contribute to the future diagnosis of Meniere's disease and improve the understanding of endolymphatic hydrops.
目的 本研究旨在探讨确诊梅尼埃病并证实存在内淋巴积水患者的内耳增强磁共振成像（MRI）结果与前庭及耳蜗功能测试结果之间的相关性。方法 在连续70例确诊梅尼埃病的患者中，49例接受了3T内耳对比增强MRI检查。患者还接受了纯音听力测定、甘油试验、冷热试验及前庭诱发肌源性电位（VEMP）测试。采用卡方检验或Fisher精确检验、Student t检验、单因素方差分析及Bonferroni事后检验评估纯音听力测定、甘油试验、冷热试验、VEMP测试结果与MRI表现之间的相关性。结果 内耳对比增强MRI显示，49例患者中有33例（67.3%）存在内淋巴积水。其中，19例患者为双侧内淋巴积水，14例为单侧积水。内淋巴积水患者的平均听力阈值高于无积水患者（p<0.001）。内淋巴积水患者甘油试验阳性结果的比例高于无积水患者（p=0.01）。有或无内淋巴积水患者的冷热反应异常率无显著差异（p=0.09）。此外，有或无内淋巴积水患者的VEMP反应异常率无显著差异（p=0.70）。在患侧，冷热试验中前庭和耳蜗积水的出现比例相似（p=1.00）。在患侧，VEMP测试中前庭和耳蜗积水的出现比例也相似（p=0.80）。冷热试验检测耳蜗积水的一致性高于VEMP测试（p=0.04）。冷热试验检测前庭积水的一致性倾向于高于VEMP测试（但无显著差异）（p=0.11）。结论 与未患侧相比，临床患侧的耳蜗和前庭通过3T内耳对比增强MRI更易显示内淋巴积水。内淋巴积水患者纯音听力测定中三个低频（125、250和500Hz）之和高于无内淋巴积水患者。在确诊梅尼埃病的患者中，冷热试验在检测内淋巴积水，尤其是耳蜗积水方面比VEMP测试更具一致性。本研究结果可能有助于梅尼埃病的未来诊断，并增进对内淋巴积水的理解。
