Inner ear MRI enhancement based on 3D‐real IR sequence in patients with Meniere's disease after intravenous gadolinium injection: comparison of different doses used and exploration of a appropriate dose

Objective: Intravenous contrast agent enhanced, high-resolution magnetic resonance imaging of the inner ear (iMRI) confirmed that patients with Menière's disease (MD) and vestibular migraine (VM) could present with endolymphatic hydrops (EH). The present study aimed to investigate EH characteristics and their interrelation to neurotologic testing in patients with VM, MD, or VM with concurrent MD (VM-MD).Methods: Sixty–two patients (45 females, aged 23–81 years) with definite or probable VM (n = 25, 19 definite), MD (n = 29, 17 definite), or showing characteristics of both diseases (n = 8) were included in this study. Diagnostic workup included neurotologic assessments including video-oculography (VOG) during caloric stimulation and head-impulse test (HIT), ocular and cervical vestibular evoked myogenic potentials (o/cVEMP), pure tone audiometry (PTA), as well as iMRI. EH's degree was assessed visually and via volumetric quantification using a probabilistic atlas-based segmentation of the bony labyrinth and volumetric local thresholding (VOLT).Results: Although a relevant number of VM patients reported varying auditory symptoms (13 of 25, 52.0%), EH in VM was only observed twice. In contrast, EH in VM-MD was prevalent (2/8, 25%) and in MD frequent [23/29, 79.3%; χ2(2) = 29.1, p < 0.001, φ = 0.7]. Location and laterality of EH and neurophysiological testing classifications were highly associated (Fisher exact test, p < 0.005). In MD, visual semi-quantitative grading and volumetric quantification correlated highly to each other (rS = 0.8, p < 0.005, two-sided) and to side differences in VOG during caloric irrigation (vestibular EH ipsilateral: rS = 0.6, p < 0.05, two-sided). In VM, correlations were less pronounced. VM-MD assumed an intermediate position between VM and MD.Conclusion: Cochlear and vestibular hydrops can occur in MD and VM patients with auditory symptoms; this suggests inner ear damage irrespective of the diagnosis of MD or VM. The EH grades often correlated with auditory symptoms such as hearing impairment and tinnitus. Further research is required to uncover whether migraine is one causative factor of EH or whether EH in VM patients with auditory symptoms suggests an additional pathology due to MD.

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Simultaneous Presentation of Benign Paroxysmal Positional Vertigo and Meniere’s Disease – Case Report

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.600 ◽

2019 ◽

Vol 7 (21) ◽

pp. 3626-3629

Author(s):

Marina Davcheva-Chakar ◽

Gabriela Kopacheva-Barsova ◽

Nikola Nikolovski

Keyword(s):

Inner Ear ◽

Benign Paroxysmal Positional Vertigo ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Positional Vertigo ◽

Ménière's Disease ◽

Paroxysmal Positional Vertigo

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is one of the most common clinical entities, which develops spontaneously in most of the cases, but it can be secondary as a result of different conditions such as head injuries, viral neurolabyrinthitis, Meniere’s disease and vertebrobasilar ischemia. The aim of presenting this case is to point out to the need of taking a precise clinical history and performing Dix-Hallpike manoeuvre in all patients who complain about vertigo regardless of the previously diagnosed primary disease of the inner ear. CASE PRESENTATION: A 63-year-old female patient presented with the classical triad of symptoms for Meniere’s disease (fluctuating sensorineural hearing loss in the right ear, tinnitus and fullness in the same ear and rotary vertigo), two years later complained of brief episodes of vertigo linked to changes in head position relative to gravity. Dix-Hallpike manoeuvre showed a classical response in the head-hanging right position. Benign paroxysmal positional vertigo (BPPV) in the same ear was diagnosed in this patient. After treatment with Epley’s canal repositioning manoeuvre for a few days, the symptoms of positional vertigo resolved. CONCLUSION: The authors recommend complete audiological and otoneurological evaluation in all patients with vertigo for timely recognition/diagnosis of any inner ear associated pathology.

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Possible functional roles of Na+, K+-ATPase in the inner ear and their relevance to Ménière's disease

American Journal of Otolaryngology ◽

10.1016/s0196-0709(82)80010-0 ◽

1982 ◽

Vol 3 (5) ◽

pp. 353-360 ◽

Cited By ~ 22

Author(s):

Muriel D. Ross ◽

Stephen A. Ernst ◽

Thomas P. Kerr

Keyword(s):

Inner Ear ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Functional Roles ◽

Ménière's Disease

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Intratympanic Steroid Treatment of Inner Ear Disease and Tinnitus (Preliminary Report)

Ear Nose & Throat Journal ◽

10.1177/014556139607500806 ◽

1996 ◽

Vol 75 (8) ◽

pp. 468-488 ◽

Cited By ~ 127

Author(s):

Herbert Silverstein ◽

Daniel Choo ◽

Seth I. Rosenberg ◽

Jeffery Kuhn ◽

Michael Seidman ◽

...

Keyword(s):

Inner Ear ◽

Round Window ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Round Window Membrane ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Inner Ear Disease ◽

Ménière's Disease

Intratympanic instillation of Depo-Medrol® (80 mg/cc), dexamethasone ophthalmic solution (1 mg/cc), or dexamethasone intravenous (4 mg/cc) solution produces improvement of cochlear function in certain patients with Meniere's disease, autoimmune inner ear disease and sudden sensorineural deafness. Tinnitus improved in 47%, most often in patients with Meniere's disease (9 of 15; 60%). The SRT improvement of greater than 10 dB or SD greater than 15% was documented in 41% (average improvement in SRT: 15 dB; SD: 24%). Patients with tinnitus and bilateral sensorineural hearing loss (i.e., presbycusis) did not benefit from the treatment. Prior to treatment with intratympanic medication, laser-assisted tympanostomy with middle ear exploration, using otoendoscopy to determine the status of the round window niche and remove mucosal folds, helps in making the round window membrane accessible to local application of drops. Placing Gelfoam into the round window niche under direct vision, and using a Venturi Bobbin tube in the tympanic membrane, appears to be a satisfactory method for delivering medication to the inner ear fluids. The medication can be injected by the physician through the tube into the middle ear, or the patient can perform self-treatment at home, placing medication in the external auditory canal. A double-blind, cross-over study in patients with Meniere's disease is now in progress with Institutional Review Board (IRB) approval, which will be reported at a later date. This preliminary study has shown that intratympanic steroids may affect the symptoms of hearing loss and tinnitus in patients with various inner ear problems. Patients with Meniere's disease appear to respond in the highest percentage of cases. Hopefully, additional research will suggest the appropriate drugs which can be used to treat inner ear disease. Direct application of the drug to the round window membrane may increase the concentration in the inner ear fluids, thus avoiding the systemic effects.

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Menière's Disease and Disorders of the Carbohydrate Metabolism Involving the Inner Ear

International Archives of Otorhinolaryngology ◽

10.1055/s-0038-1673698 ◽

2019 ◽

Vol 23 (02) ◽

pp. 218-220

Author(s):

Pedro L. Mangabeira Albernaz

Keyword(s):

Inner Ear ◽

Carbohydrate Metabolism ◽

Endolymphatic Hydrops ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Delayed Endolymphatic Hydrops ◽

Ménière's Disease

Introduction Menière’s disease was described in 1861, but there are still uncertainties regarding its pathophysiology and treatment. Endolymphatic hydrops is recognized as a fundamental pathological characteristic of the disease, as a result of an inadequate absorption of the endolymph. A milder type of endolymphatic hydrops results from an altered chemical composition of the endolymph, due to disorders of the carbohydrate metabolism. Objective To describe the association of both types of hydrops in patients with Menière disease. Methods This was a retrospective study of 98 patients with Menière’s disease, 62 of whom also presented disorders of the carbohydrate metabolism, and 5 patients with delayed endolymphatic hydrops, 2 of whom also presented disorders of the carbohydrate metabolism. Results The follow-up of these patients showed that the correction of the metabolic disorders may help in the clinical treatment of Menière’s disease and of delayed endolymphatic hydrops, but this does not happen in the more severe types of the diseases. Conclusion Patients with Menière’s disease may present simultaneous disorders of the carbohydrate metabolism, affecting the inner ear. The correction of these disorders helps the clinical treatment but does not preclude the progression of the more severe cases of Menière disease.

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