In vivo imaging of saccular hydrops in humans reflects sensorineural hearing loss rather than Meniere’s disease symptoms

  • Arnaud Attyé
  • Michael Eliezer
  • Maud Medici
  • Irène Tropres
  • Georges Dumas
  • Alexandre Krainik
  • Sébastien Schmerber
Head and Neck

Abstract

Objectives

A case-controlled imaging study demonstrated that saccular hydrops was specific to Meniere’s disease (MD), but only present in a subset of patients. Here, we compared patients with definite MD, vertigo and sensorineural hearing loss (SNHL) to elucidate the relationship between saccular hydrops and extent of SNHL.

Methods

In this prospective study, we performed 3D-FLAIR sequences between 4.5 and 5.5 h after contrast media injection in patients with MD (n=20), SNHL (n=20), vertigo (n=20) and 30 healthy subjects. Two radiologists independently graded saccular hydrops. ROC analysis was performed to determine the hearing loss threshold to differentiate patients with saccular hydrops.

Results

Saccular hydrops was found in 11 of 20 MD patients, 10 of 20 SNHL patients and in none of the vertigo patients and healthy subjects. In SNHL patients, 45 dB was the threshold above which there was a significant association with saccular hydrops, with sensitivity of 100 % and specificity of 90 %. In MD patients, 40 dB was the threshold above which there was a significant association with saccular hydrops, with sensitivity of 100 % and specificity of 44 %.

Conclusions

Our results indicate saccular hydrops as a feature of worse than moderate SNHL rather than MD itself.

Key Points

MRI helps clinicians to assess patients with isolated low-tone sensorineural hearing loss.

Saccular hydrops correlates with sensorineural hearing loss at levels above 40 dB.

Vertigo patients without sensorineural hearing loss do not have saccular hydrops.

Saccular hydrops is described in patients without clinical diagnosis of Meniere’s disease.

Keywords

Inner ear Meniere’s disease Magnetic resonance imaging Endolymphatic hydrops Hearing loss 

Abbreviations

ESS

Endolymphatic sac surgery

MD

Meniere’s disease

SNHL

Sensorineural hearing loss

SURI

Saccule to Utricle Ratio Inversion

Notes

Acknowledgements

The authors acknowledge the valuable assistance of Patrice Jousse and Hélène Fournié for their work in editing the MRI pictures and drawings. We also thank Dr Alison Foote (Grenoble Alps University Hospital) for critically reviewing the manuscript.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Arnaud Attyé.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Maud Medici) has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study healthy subjects have been previously reported in European Radiology (https://www.ncbi.nlm.nih.gov/pubmed/27999985).

Methodology

• prospective

• case-control study

• performed at one institution

References

  1. 1.
    Altmann F (1949) Surgical treatment of Ménière’s disease. The Laryngoscope 59:1045–1067CrossRefPubMedGoogle Scholar
  2. 2.
    Kimura RS (1982) Animal models of endolymphatic hydrops. Am J Otolaryngol 3:447–451CrossRefPubMedGoogle Scholar
  3. 3.
    Nakashima T, Naganawa S, Pyykko I, et al (2009) Grading of endolymphatic hydrops using magnetic resonance imaging. Acta Oto-Laryngol Suppl 5–8.  https://doi.org/10.1080/00016480902729827
  4. 4.
    Yoshida T, Sugimoto S, Teranishi M, et al (2017) Imaging of the endolymphatic space in patients with Ménière’s disease. Auris Nasus Larynx.  https://doi.org/10.1016/j.anl.2017.02.002
  5. 5.
    Attyé A, Dumas G, Troprès I et al (2015) Recurrent peripheral vestibulopathy: Is MRI useful for the diagnosis of endolymphatic hydrops in clinical practice? Eur Radiol 25:3043–3049CrossRefPubMedGoogle Scholar
  6. 6.
    Baráth K, Schuknecht B, Naldi AM et al (2014) Detection and grading of endolymphatic hydrops in Menière disease using MR imaging. AJNR Am J Neuroradiol 35:1387–1392CrossRefPubMedGoogle Scholar
  7. 7.
    Bykowski J, Harris JP, Miller M et al (2015) Intratympanic Contrast in the Evaluation of Menière Disease: Understanding the Limits. AJNR Am J Neuroradiol 36:1326–1332CrossRefPubMedGoogle Scholar
  8. 8.
    Eliezer M, Gillibert A, Tropres I, et al Influence of inversion time on endolymphatic hydrops evaluation in 3D-FLAIR imaging. J Neuroradiol.  https://doi.org/10.1016/j.neurad.2017.06.002
  9. 9.
    Pender DJ (2014) Endolymphatic hydrops and Ménière’s disease: a lesion meta-analysis. J Laryngol Otol 128:859–865CrossRefPubMedGoogle Scholar
  10. 10.
    Rauch SD, Merchant SN, Thedinger BA (1989) Meniere’s syndrome and endolymphatic hydrops. Double-blind temporal bone study. Ann Otol Rhinol Laryngol 98:873–883CrossRefPubMedGoogle Scholar
  11. 11.
    Attyé A, Eliezer M, Boudiaf N, et al (2016) MRI of endolymphatic hydrops in patients with Meniere’s disease: a case-controlled study with a simplified classification based on saccular morphology. Eur Radiol.  https://doi.org/10.1007/s00330-016-4701-z
  12. 12.
    Sajjadi H, Paparella MM (2008) Meniere’s disease. Lancet 372:406–414CrossRefPubMedGoogle Scholar
  13. 13.
    (1995) Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Menière’s disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg 113:181–185Google Scholar
  14. 14.
    Lopez-Escamez JA, Carey J, Chung W-H et al (2015) Diagnostic criteria for Menière’s disease. J Vestib Res Equilib Orientat 25:1–7Google Scholar
  15. 15.
    Morita N, Kariya S, Farajzadeh Deroee A et al (2009) Membranous labyrinth volumes in normal ears and Ménière disease: a three-dimensional reconstruction study. The Laryngoscope 119:2216–2220CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMedGoogle Scholar
  17. 17.
    Miller MW, Agrawal Y (2014) Intratympanic Therapies for Menière’s disease. Curr Otorhinolaryngol Rep 2:137–143CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Paparella MM (2006) Endolymphatic sac revision for recurrent intractable Meniere’s disease. Otolaryngol Clin North Am 39:713–721 viCrossRefPubMedGoogle Scholar
  19. 19.
    Sood AJ, Lambert PR, Nguyen SA, Meyer TA (2014) Endolymphatic sac surgery for Ménière’s disease: a systematic review and meta-analysis. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 35:1033–1045CrossRefGoogle Scholar
  20. 20.
    Thomsen J, Bretlau P, Tos M, Johnsen NJ (1981) Placebo effect in surgery for Ménière’s disease. A double-blind, placebo-controlled study on endolymphatic sac shunt surgery. Arch Otolaryngol Chic Ill 1960 107:271–277CrossRefGoogle Scholar
  21. 21.
    Kitahara T, Fukushima M, Uno A et al (2013) Long-term results of endolymphatic sac drainage with local steroids for intractable Meniere’s disease. Auris Nasus Larynx 40:425–430CrossRefPubMedGoogle Scholar
  22. 22.
    Durland WF, Pyle GM, Connor NP (2005) Endolymphatic sac decompression as a treatment for Meniere’s disease. The Laryngoscope 115:1454–1457CrossRefPubMedGoogle Scholar
  23. 23.
    Hu A, Parnes LS (2010) 10-year review of endolymphatic sac surgery for intractable meniere disease. J Otolaryngol - Head Neck Surg J Oto-Rhino-Laryngol Chir Cervico-Faciale 39:415–421Google Scholar
  24. 24.
    Kimura RS, Schuknecht HF (1975) Effect of fistulae on endolymphatic hydrops. Ann Otol Rhinol Laryngol 84:271–286CrossRefPubMedGoogle Scholar
  25. 25.
    Attyé A, Eliezer M, Galloux A, et al (2017) Endolymphatic hydrops imaging: differential diagnosis in patients with Meniere disease symptoms. Diagn Interv Imaging.  https://doi.org/10.1016/j.diii.2017.06.002
  26. 26.
    Gürkov R, Flatz W, Ertl-Wagner B, Krause E (2013) Endolymphatic hydrops in the horizontal semicircular canal: a morphologic correlate for canal paresis in Ménière’s disease. The Laryngoscope 123:503–506CrossRefPubMedGoogle Scholar
  27. 27.
    Pender DJ (2015) Membrane stress in the human labyrinth and Meniere disease: a model analysis. Int Arch Otorhinolaryngol 19:336–342CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    de Waele C, Tran Ba Huy P, Diard JP et al (1999) Saccular dysfunction in Ménière’s patients. A vestibular-evoked myogenic potential study. Ann N Y Acad Sci 871:392–397CrossRefPubMedGoogle Scholar
  29. 29.
    Sepahdari AR, Ishiyama G, Vorasubin N et al (2015) Delayed intravenous contrast-enhanced 3D FLAIR MRI in Meniere’s disease: correlation of quantitative measures of endolymphatic hydrops with hearing. Clin Imaging 39:26–31CrossRefPubMedGoogle Scholar
  30. 30.
    Salt AN, Plontke SK (2010) Endolymphatic hydrops: pathophysiology and experimental models. Otolaryngol Clin North Am 43:971–983CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Merchant SN, Adams JC, Nadol JB (2005) Pathophysiology of Meniere’s syndrome: are symptoms caused by endolymphatic hydrops? Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 26:74–81CrossRefGoogle Scholar
  32. 32.
    Flock A, Flock B (2003) Micro-lesions in Reissner’s membrane evoked by acute hydrops. Audiol Neurootol 8:59–69CrossRefPubMedGoogle Scholar
  33. 33.
    Samy RN, Houston L, Scott M et al (2015) Cochlear implantation in patients with Meniere’s disease. Cochlear Implants Int 16:208–212CrossRefPubMedGoogle Scholar
  34. 34.
    Mick P, Amoodi H, Arnoldner C et al (2014) Cochlear implantation in patients with advanced Ménière’s disease. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 35:1172–1178Google Scholar
  35. 35.
    McRackan TR, Gifford RH, Kahue CN et al (2014) Cochlear implantation in Ménière’s disease patients. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 35:421–425CrossRefGoogle Scholar
  36. 36.
    Gürkov R, Berman A, Dietrich O et al (2015) MR volumetric assessment of endolymphatic hydrops. Eur Radiol 25:585–595CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Neuroradiology and MRIGrenoble Alpes University Hospital – SFR RMN NeurosciencesGrenobleFrance
  2. 2.IRMaGeUniversity Grenoble AlpesGrenobleFrance
  3. 3.Neuroradiology and MR UnitCS 10217- Grenoble University HospitalGrenoble cedex 9France
  4. 4.Department of RadiologyRouen University HospitalRouenFrance
  5. 5.Unité innovation technologique, Centre d’Investigation CliniqueCHU de Grenoble, CS 10217Grenoble cedex 9France
  6. 6.IRMaGe, Inserm US 17, CNRS UMS 3552GrenobleFrance
  7. 7.Department of OtologyGrenoble Alpes University HospitalGrenobleFrance

Personalised recommendations