Treatment of Menière’s Disease
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Endolymphatic hydrops
The existence of vestibular Menière's disease, once considered a variant of classic Menière's disease, but without hearing loss, has been questioned because of lack of objective evidence that endolymphatic hydrops is involved with the disease process. Transtympanic electrocochleography (TT ECoG) has emerged as a useful tool for electrophysiologic monitoring of the inner ear, and is especially valuable in assessing endolymphatic hydrops. A retrospective chart review was performed to identify those patients with a diagnosis consistent with vestibular Menière's disease in order to determine the presence or absence of endolymphatic hydrops using TT ECoG. A total of 15 patients were identified. Using established norms for the summating to action potential ratio (SP:AP) with click stimulus, 73 percent demonstrated values consistent with endolymphatic hydrops. The most commonly associated symptom was aural fullness (60%), followed by tinnitus (33%), and the disease was bilateral 53 percent of the time. The similarities between this clinical entity and classic Menière's disease are noted, and theoretic considerations are made.
Endolymphatic hydrops
Electrocochleography
Endolymphatic sac
MENIERE DISEASE
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Endolymphatic hydrops
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The cardinal symptoms of Meniere’s disease are episodic vertigo, fluctuating hearing loss and tinnitus. Meniere’s disease runs a chronic course and is often associated with endolymphatic hydrops (EH) in the inner ear. The etiology of the disease is unknown. Using fluid-attenuated inversion recovery (FLAIR) or more advanced techniques with contrast-enhanced magnetic resonance imaging (MRI), we evaluated EH under several conditions in patients with symptoms attributable to Meniere’s disease or inner ear symptoms. To deliver the contrast agent, we used the intratympanic (IT) and/or the intravenous (IV) approach. Potentially higher concentrations of the contrast agent can be introduced into the perilymph via the IT approach than via the IV approach. However, use of the IT approach needs approval of the ethics committee, while use of the IV approach is more acceptable in the clinical setting. In American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, EH was observed more frequently in patients with Definite Meniere’s disease than in those with Possible Meniere’s disease. Meanwhile, EH was also observed in both the cochlea and the vestibule in patients with atypical Meniere’s disease. Of 56 ears (36 patients) of patients with cochlear Meniere’s disease, 38 showed EH in the cochlea and 44 showed EH in the vestibule. Of 56 ears (28 patients) of patients with vestibular Meniere’s disease, 29 showed EH in the cochlea and 47 showed EH in the vestibule. The vestibular Meniere’s disease group showed significant vestibular predominance in the distribution of EH. In 30 patients with tinnitus as the major complaint, EH in the cochlea was present in 14 of 25 symptomatic ears (56%). Significant EH was present in 7 of 14 ears and mild EH in the remaining 7 ears. EH was observed more frequently in patients with fluctuating tinnitus than in patients with stable tinnitus. Inner-ear contrast-enhanced MRI may be useful to identify EH in its early stages.
Endolymphatic hydrops
Vestibule
Neurotology
Perilymph
Etiology
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Endolymphatic hydrops
MENIERE DISEASE
Endolymphatic sac
Labyrinth Diseases
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Experimental hydrops caused by underabsorption of endolymphatic fluid is a model of remissional stage of Meniere's disease. In this study, another type of model, ie, hydrops caused by overproduction of endolymphatic fluid, was accomplished by applying various pressures into scala media through a micropipette via stria vascularis. This type of hydrops could be a model of attacks of Meniere's disease. By using two types of the model, effects of glycerol administration and of opening the endolymphatic sac were discussed.
Endolymphatic hydrops
MENIERE DISEASE
Cochlear duct
Endolymphatic sac
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Endolymphatic hydrops
MENIERE DISEASE
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Conclusions: The blood–labyrinth barrier is impaired in association with the hydrops grade in Ménière's disease. Objectives: To investigate the relationship between endolymphatic hydrops and the clinical characteristics of patients with Ménière's disease revealed by 3 T magnetic resonance imaging (MRI). Methods: A double dose of gadoteridol (Gd; 0.2 mmol/kg) was injected intravenously in 12 patients with Ménière's disease. We performed three-dimensional fluid attenuated inversion recovery MRI and three-dimensional real inversion recovery MRI 4 h later using a 3 T MRI unit. Ten patients had unilateral and two had bilateral Ménière's disease. Results: Fourteen ears with Ménière's disease showed intense Gd contrast on MRI compared with that in the 10 asymptomatic contralateral ears of patients with unilateral Ménière's disease (1.12 ± 0.36 vs 0.82 ± 0.15). The hydrops grade was correlated significantly with the contrast effect. The 14 ears with Ménière's disease had endolymphatic hydrops. Of the 10 contralateral ears of patients with unilateral Ménière's disease, 2 had endolymphatic hydrops in the cochlea and 6 had endolymphatic hydrops in the vestibule.
Endolymphatic hydrops
MENIERE DISEASE
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Endolymphatic hydrops
MENIERE DISEASE
Endolymphatic sac
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Presented are ten cases of patients with perilymphatic fistula and/or endolymphatic hydrops who had tinnitus as a major complaint. Tinnitus and its degree of severity often correlate closely with the state of health or hydrodynamic integrity of the inner ear, as these cases illustrate.
Endolymphatic hydrops
Labyrinth Diseases
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Endolymphatic hydrops
MENIERE DISEASE
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