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Endolymphatic hydrops mimicking obstructive Eustachian tube dysfunction: preliminary experience and literature review

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Abstract

Purpose

Aural fullness is a common symptom of middle ear diseases, most importantly Eustachian tube dysfunction (ETD). Yet, aural fullness may also be caused by inner ear disorders, such as hydropic ear diseases. Here, we report our experience with endolymphatic hydrops (EH) mimicking ETD. Furthermore, we review the literature related to (i) EH as a differential diagnosis of symptoms suggesting ETD and (ii) the pathophysiology and treatment of aural fullness due to inner ear disorders.

Methods

We retrospectively included adult patients with aural fullness as chief complaint and radiographically diagnosed EH. Hearing and Eustachian tube function were assessed using audiometry, tympanometry, and tubomanometry. Primarily suspected ETD was treated by balloon dilatation of the Eustachian tube (BDET). The endolymphatic space of the inner ear was imaged using gadolinium-enhanced MRI (Gd-MRI) including a 3D-real inversion-recovery sequence after intravenous gadolinium administration.

Results

We report three affected ears of two patients (two females, age 42 and age 51) with aural fullness as chief complaint. Audiometry of main speech frequencies was normal in all affected ears. In one ear, there was a type A tympanogram and in two ears, there was a type B tympanogram. In both patients, medical treatment for ETD and BDET were unsuccessful. Gd-MRI of the inner ears revealed cochlear EH in 3/3 ears affected by aural fullness, but not in the unaffected ear.

Conclusion

EH may underlay cases with aural fullness and could in these cases explain unsuccessful treatment for ETD. As ETD is often treated by invasive procedures, distinguishing ETD from EH as the underlying cause of aural fullness is important. Our findings raise the question whether Gd-MRI to rule out EH is indicated in patients with unexplained aural fullness, in particular after unsuccessful interventional treatment for ETD.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland

    David Bächinger, Andreas H. Eckhard, Christof Röösli, Dorothe Veraguth, Alexander Huber & Adrian Dalbert

  2. University of Zurich, Zurich, Switzerland

    David Bächinger, Andreas H. Eckhard, Christof Röösli, Dorothe Veraguth, Alexander Huber & Adrian Dalbert

Authors
  1. David Bächinger
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  2. Andreas H. Eckhard
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  3. Christof Röösli
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  4. Dorothe Veraguth
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  5. Alexander Huber
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  6. Adrian Dalbert
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Correspondence to Adrian Dalbert.

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The authors declare no conflict of interest.

Ethical approval

A formal ethical approval was waived by the local Ethics Committee (Kantonale Ethikkommission, Zurich, Switzerland) in view of the retrospective nature of the study, which is based on single cases, and since all the procedures being performed were part of the routine care.

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Bächinger, D., Eckhard, A.H., Röösli, C. et al. Endolymphatic hydrops mimicking obstructive Eustachian tube dysfunction: preliminary experience and literature review. Eur Arch Otorhinolaryngol 278, 561–565 (2021). https://doi.org/10.1007/s00405-020-06139-9

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  • DOI: https://doi.org/10.1007/s00405-020-06139-9

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