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Xia K, Lei P, Liu Y, Chen C, Pan H, Leng Y, Liu B. Comparison of vestibular aqueduct visualization on computed tomography and magnetic resonance imaging in patients with Ménière's disease. BMC Med Imaging 2024; 24:93. [PMID: 38649991 PMCID: PMC11034041 DOI: 10.1186/s12880-024-01275-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The vestibular aqueduct (VA) serves an essential role in homeostasis of the inner ear and pathogenesis of Ménière's disease (MD). The bony VA can be clearly depicted by high-resolution computed tomography (HRCT), whereas the optimal sequences and parameters for magnetic resonance imaging (MRI) are not yet established. We investigated VA characteristics and potential factors influencing MRI-VA visibility in unilateral MD patients. METHODS One hundred patients with unilateral MD underwent MRI with three-dimensional sampling perfection with application optimized contrasts using different flip angle evolutions (3D-SPACE) sequence and HRCT evaluation. The imaging variables included MRI-VA and CT-VA visibility, CT-VA morphology and CT-peri-VA pneumatization. RESULTS The most frequent type of MRI-VA and CT-VA visualization was invisible VA and continuous VA, respectively. The MRI-VA visibility was significantly lower than CT-VA visibility. MRI-VA visibility had a weak positive correlation with ipsilateral CT-VA visualization. For the affected side, the MRI-VA visualization was negatively correlated with the incidence of obliterated-shaped CT-VA and positively with that of tubular-shaped CT-VA. MRI-VA visualization was not affected by CT-peri-VA pneumatization. CONCLUSION In patients with MD, the VA visualization on 3D-SPACE MRI is poorer than that observed on CT and may be affected by its osseous configuration. These findings may provide a basis for further characterization of VA demonstrated by MRI and its clinical significance.
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Affiliation(s)
- Kaijun Xia
- Department of Otorhinolaryngology-Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ping Lei
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yingzhao Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Cen Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hui Pan
- Department of Otorhinolaryngology-Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yangming Leng
- Department of Otorhinolaryngology-Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Bo Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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2
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Honkura Y, Katori Y, Hirano-Kawamoto A, Kawase T, Rodríguez-Vázquez JF, Murakami G, Abe H. Characteristic findings in the human fetus vestibule: A human temporal bone study. Auris Nasus Larynx 2024; 51:147-153. [PMID: 37308374 DOI: 10.1016/j.anl.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/16/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The "collapse," a highly flexed, dented, or caved membrane between the endo- and peri-lymph of the saccule and utricle in adults, is considered as a morphological aspect of Ménière's syndrome. Likewise, when mesh-like tissues in the perilymphatic space are damaged or lost, the endothelium loses mechanical support and causes nerve irritation. However, these morphologies were not examined in fetuses. METHODS By using histological sections from 25 human fetuses (crown-rump length[CRL] 82-372 mm; approximately 12-40 weeks), morphologies of the perilymphatic-endolymphatic border membrane and the mesh-like tissue around the endothelium were examined. RESULTS The highly flexed or caved membrane between the endo- and peri-lymphatic spaces was usually seen in the growing saccule and utricle of fetuses, especially at junctions between the utricle and ampulla at midterm. Likewise, the perilymphatic space around the saccule, utricle and semicircular ducts often lost the mesh-like tissues. The residual mesh-like tissue supported the veins, especially in the semicircular canal. CONCLUSION Within a cartilaginous or bony room showing a limited growth in size but containing increased perilymph, the growing endothelium appeared to become wavy. Owing to a difference in growth rates between the utricle and semicircular duct, the dentation tended to be more frequently seen at junctions than at free margins of the utricle. The difference in site and gestational age suggested that the deformity was not "pathological" but occurred due to unbalanced growth of the border membrane. Nevertheless, the possibility that the deformed membrane in fetuses was an artifact caused by delayed fixation is not deniable.
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Affiliation(s)
- Yohei Honkura
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba, Sendai 980-8574, Japan.
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba, Sendai 980-8574, Japan
| | - Ai Hirano-Kawamoto
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba, Sendai 980-8574, Japan
| | - Tetsuaki Kawase
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba, Sendai 980-8574, Japan
| | | | - Gen Murakami
- Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan
| | - Hiroshi Abe
- Emeritus professor of Akita University School of Medicine, Akita, Japan
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3
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de Pont LMH, Houben MTPM, Verhagen TO, Verbist BM, van Buchem MA, Bommeljé CC, Blom HM, Hammer S. Visualization and clinical relevance of the endolymphatic duct and sac in Ménière's disease. Front Neurol 2023; 14:1239422. [PMID: 37719762 PMCID: PMC10501721 DOI: 10.3389/fneur.2023.1239422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/31/2023] [Indexed: 09/19/2023] Open
Abstract
Background Ménière's disease (MD) is a chronic inner ear disorder with a multifactorial etiology. Decreased visualization of the endolymphatic duct (ED) and sac (ES) is thought to be associated with MD, although controversy exists about whether this finding is specific to MD. Recent literature has revealed that two distinct ES pathologies, developmental hypoplasia and epithelial degeneration, can be distinguished in MD using the angular trajectory of the vestibular aqueduct (ATVA) or ED-ES system as a radiographic surrogate marker. It has been suggested that these two subtypes are associated with distinct phenotypical features. However, the clinical differences between the ATVA subtypes require further validation. Research objective The objective of this study is to investigate whether (1) non-visualization of the ED-ES system is a discriminative radiological feature for MD in a cohort of vertigo-associated pathologies (VAPs) and whether (2) different angular trajectories of the ED-ES system in MD are associated with distinguishable clinical features. Setting The study was conducted in the Vertigo Referral Center (Haga Teaching Hospital, The Hague, the Netherlands). Methods We retrospectively assessed 301 patients (187 definite MD and 114 other VAPs) that underwent 4h-delayed 3D FLAIR MRI. We evaluated (1) the visibility of the ED-ES system between MD and other VAP patients and (2) measured the angular trajectory of the ED-ES system. MD patients were stratified based on the angular measurements into αexit ≤ 120° (MD-120), αexit 120°-140° (MD-intermediate), or αexit ≥ 140° (MD-140). Correlations between ATVA subgroups and clinical parameters were evaluated. Results Non-visualization of the ED-ES system was more common in definite MD patients compared with other VAPs (P < 0.001). Among definite MD patients, the MD-140 subtype demonstrated a longer history of vertigo (P = 0.006), a higher prevalence of bilateral clinical disease (P = 0.005), and a trend toward a male preponderance (p = 0.053). No significant differences were found between ATVA subgroups regarding the presence or severity of auditory symptoms, or the frequency of vertigo attacks. Conclusion Non-visualization of the ED-ES system is significantly associated with MD. Among MD patients with a visible ED-ES system, we demonstrated that the MD-140 subtype is associated with a longer disease duration, a higher prevalence of bilateral MD, and a trend toward a male preponderance.
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Affiliation(s)
- Lisa M. H. de Pont
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Maartje T. P. M. Houben
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands
- Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands
| | - Thijs O. Verhagen
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands
- Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands
| | - Berit M. Verbist
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark A. van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Claire C. Bommeljé
- Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands
| | - Henk M. Blom
- Department of Otorhinolaryngology, Haga Teaching Hospital, The Hague, Netherlands
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, Netherlands
- Department of Otorhinolaryngology, Antwerp University Hospital, Antwerp, Belgium
| | - Sebastiaan Hammer
- Department of Radiology, Haga Teaching Hospital, The Hague, Netherlands
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Bouhadjer K, Romo LV, Brennan MJ, Kozak BM, Hattingen E, Juliano AF, Curtin HD, Reinshagen KL. Retrospective Analysis of the Association of a Small Vestibular Aqueduct with Cochleovestibular Symptoms in a Large, Single-Center Cohort Undergoing CT. AJNR Am J Neuroradiol 2023; 44:70-73. [PMID: 36521965 PMCID: PMC9835903 DOI: 10.3174/ajnr.a7734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Temporal bones in some patients with Ménière disease have demonstrated small vestibular aqueducts; however, the prevalence and clinical importance of small vestibular aqueducts remain unclear in patients without Ménière disease. This study correlates the presence of a small vestibular aqueduct with cochleovestibular symptoms. MATERIALS AND METHODS Consecutive temporal bone CTs in adults from January to December 2020 were reviewed. The midpoint vestibular aqueduct size in the 45°-oblique Pöschl view was measured by 2 reviewers independently in 684 patients (1346 ears). Retrospective chart review for the clinical diagnosis of Ménière disease, the presence of cochleovestibular symptoms, and indications for CT was performed. RESULTS Fifty-two of 684 patients (7.6% of patients, 62/1346 ears) had small vestibular aqueducts. Twelve patients (15/1346 ears) had Ménière disease. Five of 12 patients with Ménière disease (5 ears) had a small vestibular aqueduct. There was a significant correlation between a small vestibular aqueduct and Ménière disease (P < .001). There was no statistical difference between the small vestibular aqueduct cohort and the cohort with normal vestibular aqueducts (0.3-0.7 mm) regarding tinnitus (P = .06), hearing loss (P = .88), vertigo (P = .26), dizziness (P = .83), and aural fullness (P = .61). CONCLUSIONS While patients with Ménière disease were proportionately more likely to have a small vestibular aqueduct than patients without Ménière disease, the small vestibular aqueduct was more frequently seen in patients without Ménière disease and had no correlation with hearing loss, vertigo, dizziness, or aural fullness. We suggest that the finding of a small vestibular aqueduct on CT could be reported by radiologists as a possible finding in Ménière disease, but it remains of uncertain, and potentially unlikely, clinical importance in the absence of symptoms of Ménière disease.
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Affiliation(s)
- K Bouhadjer
- From the Department of Radiology (K.B., L.V.R., M.J.B., A.F.J., H.D.C., K.L.R.), Massachusetts Eye and Ear, Boston, Massachusetts
| | - L V Romo
- From the Department of Radiology (K.B., L.V.R., M.J.B., A.F.J., H.D.C., K.L.R.), Massachusetts Eye and Ear, Boston, Massachusetts
| | - M J Brennan
- From the Department of Radiology (K.B., L.V.R., M.J.B., A.F.J., H.D.C., K.L.R.), Massachusetts Eye and Ear, Boston, Massachusetts
| | - B M Kozak
- Neuroradiology Division (B.M.K.), Massachusetts General Hospital, Boston, Massachusetts
| | - E Hattingen
- Institut für Neuroradiologie (E.H.), Universitätsmedizin der Goethe Universität Frankfurt, Frankfurt am Main, Germany
| | - A F Juliano
- From the Department of Radiology (K.B., L.V.R., M.J.B., A.F.J., H.D.C., K.L.R.), Massachusetts Eye and Ear, Boston, Massachusetts
| | - H D Curtin
- From the Department of Radiology (K.B., L.V.R., M.J.B., A.F.J., H.D.C., K.L.R.), Massachusetts Eye and Ear, Boston, Massachusetts
| | - K L Reinshagen
- From the Department of Radiology (K.B., L.V.R., M.J.B., A.F.J., H.D.C., K.L.R.), Massachusetts Eye and Ear, Boston, Massachusetts
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5
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Jung D, Nagururu N, Hui F, Pearl MS, Carey JP, Ward BK. 2D Measurements of the Angle of the Vestibular Aqueduct Using CT Imaging. Brain Sci 2022; 13:brainsci13010047. [PMID: 36672029 PMCID: PMC9856657 DOI: 10.3390/brainsci13010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022] Open
Abstract
Recently, Bächinger et al. developed a software that measures the angle between the vestibular aqueduct proximal to the vestibule and the distal vestibular aqueduct on computed tomography (CT) scans and found differences in the vestibular aqueduct angle between the hypoplastic and degenerative categories of Meniere’s disease (MD). Hypoplastic radiological findings were associated with the development of bilateral MD and hypoplastic changes were not found outside of fetal temporal bones and individuals with MD. The purpose of this study is to examine how the software developed by Bächinger et al. performs when applied to a large dataset of adult patients with varied otologic diagnoses. Adult patients who underwent high resolution flat panel CT scans without intravenous contrast (n = 301) were retrospectively reviewed. Measurements of the angle of the vestibular aqueduct were made using the previously developed software tool. The tool could be applied to measure the vestibular aqueduct angle in most CT scans of the temporal bones (n = 572 ears, 95%). While the majority of ears fell within the normal range of <120 degrees (n = 462, 80%), fourteen ears (2.3%) in 13 patients were found to have vestibular aqueduct angles that meet criteria for hypoplastic MD (>140 degrees). Only one of the 13 patients had a diagnosis of MD and not in the ear in the hypoplastic category. An inconsistent pattern of other otologic diagnoses were found among the 13 individuals meeting criteria for hypoplastic MD. Although prior reports indicate the software has prognostic value in individuals with MD, these results suggest that the software may have lower positive predictive value when applied to a large population of individuals with varied otologic diagnoses.
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Affiliation(s)
- Diane Jung
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Nimesh Nagururu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ferdinand Hui
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Monica S. Pearl
- Department of Radiology, Children’s National Hospital, Washington, DC 20010, USA
| | - John P. Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Bryan K. Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Correspondence:
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6
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Leng Y, Lei P, Chen C, Liu Y, Xia K, Liu B. Non-contrast MRI of Inner Ear Detected Differences of Endolymphatic Drainage System Between Vestibular Migraine and Unilateral Ménière's Disease. Front Neurol 2022; 13:814518. [PMID: 35572933 PMCID: PMC9099065 DOI: 10.3389/fneur.2022.814518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/30/2022] [Indexed: 12/12/2022] Open
Abstract
Objective We aimed to evaluate the diagnostic performance of some anatomical variables with regard to endolymphatic sac (ES) and duct (ED), measured by non-contrast three-dimensional sampling perfection with application-optimized contrasts using different flip angle evolutions (3D-SPACE) magnetic resonance imaging (MRI), in differentiating vestibular migraine (VM) from unilateral Ménière's disease (MD). Methods In this study, 81 patients with VM, 97 patients with unilateral MD, and 50 control subjects were enrolled. The MRI-visualized parameters, such as the distance between the vertical part of the posterior semicircular canal and the posterior fossa (MRI-PP distance) and visibility of vestibular aqueduct (MRI-VA), were measured bilaterally. The diagnostic value of the MRI-PP distance and MRI-VA visibility for differentiating VM from unilateral MD was examined. Results (1) Compared with the VM patients, patients with unilateral MD exhibited shorter MRI-PP distance and poorer MRI-VA visibility. No differences in the MRI-PP distance and MRI-VA visibility were detected between patients with VM and control subjects. (2) No significant interaural difference in the MRI-PP distance and MRI-VA visibility was observed in patients with VM and those with unilateral MD, respectively. (3) Area under the curve (AUC) showed a low diagnostic value for the MRI-PP distance and MRI-VA visibility, respectively, in differentiating between the VM and unilateral MD. Conclusions Based on non-enhanced MRI-visualized measurement, anatomical variables with regard to the endolymphatic drainage system differed significantly between the patients with VM and those with unilateral MD. Further investigations are needed to improve the diagnostic value of these indices in differentiating VM from unilateral MD.
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Affiliation(s)
- Yangming Leng
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Lei
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Ping Lei
| | - Cen Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingzhao Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaijun Xia
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Bo Liu
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7
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Reynard P, Idriss S, Ltaief-Boudrigua A, Bertholon P, Pirvan A, Truy E, Thai-Van H, Ionescu EC. Proposal for a Unitary Anatomo-Clinical and Radiological Classification of Third Mobile Window Abnormalities. Front Neurol 2022; 12:792545. [PMID: 35087471 PMCID: PMC8786803 DOI: 10.3389/fneur.2021.792545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction: An increased number of otic capsule dehiscence (OCD) variants relying on the third window pathomechanism have been reported lately. Therefore, a characterization of the anatomical structures involved and an accurate radiological description of the third window (TW) interface location have become essential for improving the diagnosis and appropriate therapeutic modalities. The purpose of this article is to propose a classification based on clinical, anatomical, and radiological data of third mobile window abnormalities (TMWA) and to discuss the alleged pathomechanism in lesser-known clinical variants. Materials and Methods: The imaging records of 259 patients who underwent, over the last 6 years, a high-resolution CT (HRCT) of the petrosal bone for conductive hearing loss were analyzed retrospectively. Patients with degenerative, traumatic, or chronic infectious petrosal bone pathology were excluded. As cases with a clinical presentation similar to those of a TW syndrome have recently been described in the literature but without these being confirmed radiologically, we thought it necessary to be integrated in a separated branch of this classification as “CT - TMWA.” The same goes for certain intralabyrinthine pathologies also recently reported in the literature, which mimic to some extent the symptoms of a TW pathology. Therefore, we suggest to call them intralabyrinthine TW-like abnormalities. Results: Temporal bone HRCT and, in some cases, 3T MRI of 97 patients presenting symptomatic or pauci-symptomatic, single or multiple, unilateral or bilateral OCD were used to develop this classification. According to the topography and anatomical structures involved at the site of the interface of the TW, a third-type classification of OCD is proposed. Conclusions: A classification reuniting all types of TMWA as the one proposed in this article would allow for a better systematization and understanding of this complex pathology and possibly paves the way for innovative therapeutic approaches. To encompass all clinical and radiological variants of TMWA reported in the literature so far, TMWAs have been conventionally divided into two major subgroups: Extralabyrinthine (or “true” OCD with three subtypes) and Intralabyrinthine (in which an additional mobile window-like mechanism is highly suspected) or TMWA-like subtype. Along these subgroups, clinical forms of OCD with multiple localization (multiple OCD) and those that, despite the fact that they have obvious characteristics of OCD have a negative CT scan (or CT – TMWA), were also included.
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Affiliation(s)
- Pierre Reynard
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France.,Department of Physiology, Claude Bernard Lyon 1 University, Lyon, France.,Paris Hearing Institute, Institut Pasteur, Inserm U1120, Paris, France
| | - Samar Idriss
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France.,Department of Otolaryngology - Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
| | | | - Pierre Bertholon
- Department of Otorhinolaryngology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Andreea Pirvan
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France
| | - Eric Truy
- Department of Physiology, Claude Bernard Lyon 1 University, Lyon, France.,Department of Otorhinolaryngology, Lyon University Hospital, Lyon, France
| | - Hung Thai-Van
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France.,Department of Physiology, Claude Bernard Lyon 1 University, Lyon, France.,Paris Hearing Institute, Institut Pasteur, Inserm U1120, Paris, France
| | - Eugen C Ionescu
- Department of Audiology and Neurotology, Lyon University Hospital, Lyon, France.,Department of Physiology, Claude Bernard Lyon 1 University, Lyon, France.,Paris Hearing Institute, Institut Pasteur, Inserm U1120, Paris, France
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8
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Lei P, Leng Y, Li J, Zhou R, Liu B. Anatomical variation of inner ear may be a predisposing factor for unilateral Ménière's disease rather than for ipsilateral delayed endolymphatic hydrops. Eur Radiol 2022; 32:3553-3564. [PMID: 34978581 PMCID: PMC9038801 DOI: 10.1007/s00330-021-08430-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 01/18/2023]
Abstract
Objective Radiological anatomical variations, measured by magnetic resonance imaging (MRI), were evaluated in patients with ipsilateral delayed endolymphatic hydrops (DEH) and unilateral Ménière’s disease (MD). The role of anatomical variations in different subtypes of hydropic ear disease was investigated. Methods Twenty-eight patients with ipsilateral DEH, 76 patients with unilateral MD, and 59 control subjects were enrolled. The radiological indices included the distance between the vertical part of the posterior semicircular canal and the posterior fossa (MRI-PP distance) and the visibility of vestibular aqueduct (MRI-VA). These variations among patients with DEH, MD, and control subjects were compared. The correlation between radiological anatomical variations and clinical features or audio-vestibular findings was also examined. Results (1) MRI-PP distance in the affected side of unilateral MD was shorter than that in ipsilateral DEH (Z = − 2.481, p = 0.013) and control subjects (Z = − 2.983, p = 0.003), while the difference of MRI-PP distance between the affected side of ipsilateral DEH and control subjects was not statistically significant (Z = − 0.859, p = 0.391). (2) There was no significant interaural difference of MRI-PP distance in patients with unilateral MD (Z = − 0.041, p = 0.968) and ipsilateral DEH (t = − 0.107, p = 0.915) respectively. (3) No significant interaural difference of MRI-VA visibility was observed in patients with unilateral MD (χ2 = 0.742, p = 0.389) and ipsilateral DEH (χ2 = 0.327, p = 0.567) respectively. (4) No correlation was found between these anatomical variables and clinical features or audio-vestibular findings in patients with unilateral MD and ipsilateral DEH respectively (p > 0.05). Conclusions Anatomical variations of inner ear may be a predisposing factor in the pathogenesis of unilateral MD rather than ipsilateral DEH. Key Points • Patients with ipsilateral delayed endolymphatic hydrops showed normal distance between the vertical part of the posterior semicircular canal and the posterior fossa. • Compared to patients with ipsilateral delayed endolymphatic hydrops and control subjects, patients with unilateral Ménière’s disease exhibited shorter distance between the vertical part of the posterior semicircular canal and the posterior fossa. • Anatomical variations of inner ear may be a predisposing factor in the pathogenesis of unilateral Ménière’s disease rather than ipsilateral delayed endolymphatic hydrops. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08430-7.
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Affiliation(s)
- Ping Lei
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yangming Leng
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Jing Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Renhong Zhou
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bo Liu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Effects of intratympanic gentamicin and intratympanic glucocorticoids in Ménière's disease: a network meta-analysis. J Neurol 2022; 269:72-86. [PMID: 33387016 DOI: 10.1007/s00415-020-10320-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/08/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Intratympanic therapies, usually including glucocorticoid and gentamicin, are becoming worldwide used in clinical practice of Ménière's disease today. However, clinical efficacy and safety of these two therapies are still in controversial. DATA SOURCES Electronic searches in PubMed, CENTRAL, Web of Science, EMBASE, CINAHL, ClinicalTrials.gov and the European Union Clinical Trials Register were conducted from inception until September 2020. REVIEW METHODS The pre-specified protocol of this systematic review and meta-analysis has been registered and published in November 2018 (PROSPERO Identifier: CRD42018114389). All randomized controlled trials of intratympanic gentamicin or glucocorticoids for Ménière's disease, compared with each other or placebo, were considered for this review. RESULTS Ten studies with 455 patients met the inclusion criteria. Pooled results indicated significant advantage of intratympanic gentamicin and glucocorticoids over placebo treatments in vertigo control (gentamicin vs placebo: risk rate, RR, 2.56; 95% CI 1.18-5.54; glucocorticoids vs placebo: RR, 3.02; 95% CI 1.36-6.73). There was no significant difference between gentamicin and glucocorticoids in vertigo control (gentamicin vs placebo: RR, 1.18; 95% CI 0.97-1.45). Intratympanic glucocorticoids showed better hearing protective results than gentamicin (change of pure tone audiometric, PTA, mean difference, MD, - 6.48 dB; 95% CI - 11.84 to - 1.13 dB; change of speech discrimination scale, SDS, MD 7.69%; 95% CI 0.83-14.55%). CONCLUSIONS Intratympanic gentamicin and glucocorticoids are two effective approaches to control vertigo symptoms for Ménière's disease. Glucocorticoids showed a potentially better hearing protective role over gentamicin.
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Hornibrook J, Mudry A, Curthoys I, Smith CM. Ductus Reuniens and Its Possible Role in Menière's Disease. Otol Neurotol 2021; 42:1585-1593. [PMID: 34766952 DOI: 10.1097/mao.0000000000003352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE After 160 years the true underlying cause of Meniere's disease remains enigmatic. The aim of our study is to discuss the possible implication of an obstruction of the ductus reuniens as a cause in Menière's disease. METHODOLOGY We first conducted an historical study of the description of the ductus reuniens. We then reviewed the literature regarding ductus reuniens obstruction in animal experiments, human post-mortem studies and living ear imaging. We completed its description by modern microCT imaging. Limited knowledge on the fate of dislodged saccular otoconia is summarized. The possible implications for Meniere's attacks are discussed. RESULTS Victor Hensen was the first to describe the ductus reuniens in 1863. He described its length and width and predicted that saccular otoconia might enter the ductus and the cochlea. On microCT the narrowest width of the human ductus reuniens was 0.14 mm. The literature reports cochlear endolymphatic hydrops occurring after animal experimental obstruction of the duct. Human postmortem studies have confirmed saccular otoconial clumps entering the ductus and the cochlea. A postmortem study has shown sites of endolymphatic obstruction, and imaging speculates on blockages in ears with Meniere's disease. Dislodged utricular otoconia can be in clumps of otolithic membranes. CONCLUSION Blockages of the ductus reuniens and at other endolymphatic system sites appear to be a feature in Meniere's disease ears. The blockages have been postulated to be saccular otoconia either causing or aggravating hydrops. This could be consistent with observed nystagmus reversals during attacks as the endolymphatic sac attempts to clear the hydrops and the otoconia.
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Affiliation(s)
- Jeremy Hornibrook
- Department of Otolaryngology - Head Neck Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Albert Mudry
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, School of Medicine, Stanford, California, USA
| | - Ian Curthoys
- Vestibular Research Laboratory, School of Psychology, University of Sydney, New South Wales, Australia
| | - Christopher M Smith
- Department of Anthropology, The Graduate Center, City University of New York, New York, New York, USA
- Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- New York Consortium in Evolutionary Primatology, New York, New York, USA
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Barrette LX, Xu K, Suresh N, Harris J, Chorath KT, Moreira AG, Rajasekaran K. A systematic quality appraisal of clinical practice guidelines for Ménière's disease using the AGREE II instrument. Eur Arch Otorhinolaryngol 2021; 279:3439-3447. [PMID: 34657983 DOI: 10.1007/s00405-021-07099-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/16/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To systematically appraise clinical practice guidelines for the diagnosis and treatment of Ménière's disease using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. MATERIALS AND METHODS A systematic literature search was performed to identify guidelines pertaining to the diagnosis and treatment of Ménière's disease. Data were abstracted from guidelines that met inclusion criteria and appraised by four independent reviewers in the six domains of quality defined by the AGREE II. Domain scores reflecting quality in each domain were calculated. Intraclass correlation coefficients (ICC) were calculated across domains to qualify interrater reliability. RESULTS Six guidelines were found to meet inclusion criteria after a systematic literature search. Of the six clinical practice guidelines appraised using the AGREE II, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline received the highest average score, with a mean of 90.7% spanning six quality domains. The guideline with the lowest average score across all domains was the European Position Statement on diagnosis and treatment of Ménière's disease, receiving an average score across domains of 34.6%. Overall quality scores of clinical practice guidelines for Ménière's disease had a standard deviation of 21.3%. Two guidelines met the quality threshold of > 60% in at least five domains, qualifying as 'high': AAO-HNS and National Institute for Health and Care Excellence. Average ICC across all six domains was 0.87, suggesting near total agreement between reviewers. CONCLUSION Ménière's disease remains a challenging entity to diagnose and treat; few existing clinical guidelines meet the standards of quality established by the AGREE II appraisal instrument.
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Affiliation(s)
| | - Katherine Xu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Neeraj Suresh
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob Harris
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin T Chorath
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - Alvaro G Moreira
- Department of Pediatrics, University of Texas Health Science Center-San Antonio, San Antonio, TX, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Ishiyama G. Selected Otologic Disorders Causing Dizziness. ACTA ACUST UNITED AC 2021; 27:468-490. [PMID: 34351115 DOI: 10.1212/con.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article details updated clinical presentations and current treatment paradigms of the common otologic disorders that may present to the neurologist for vertigo, including Ménière disease, superior semicircular canal dehiscence syndrome, perilymphatic fistula, barotrauma, cholesteatoma, Ramsay Hunt syndrome, enlarged vestibular aqueduct syndrome, and autoimmune inner ear disease including Cogan syndrome. RECENT FINDINGS The recent data on modern imaging techniques with three-dimensional delayed IV contrast in Ménière disease, findings on the clinical and testing parameters to diagnose semicircular canal dehiscence and barotrauma, and clinical findings in Ramsay Hunt syndrome, cholesteatoma, and enlarged vestibular aqueduct syndrome are discussed in the article. The most recent findings on the treatment and evaluation of autoimmune inner ear disease and Cogan syndrome are also covered. SUMMARY This article discusses the common clinical otologic entities in patients who may present to the neurologist for vertigo, and it can be used as a guide in the diagnosis of these conditions with the use of auditory, vestibular, and imaging results.
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Hu J, Peng A, Deng K, Huang C, Wang Q, Pan X, Liu W, Zhang Z, Jiang W, Chen Y. Value of CT and three-dimensional reconstruction revealing specific radiological signs for screening causative high jugular bulb in patients with Meniere's disease. BMC Med Imaging 2020; 20:103. [PMID: 32867723 PMCID: PMC7460768 DOI: 10.1186/s12880-020-00504-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
Background The aim of the present study was to investigate the pathological features of vestibular aqueduct (VA) related high jugular bulb (HJB) and explore the possible cause-consequence relation between HJB and endolymphatic hydrops (EH), and the potential specific radiological signs for screening causative HJB in Meniere’s disease (MD). Methods High-resolution computed tomography (HRCT) and three-dimensional reconstruction (3DRC) were used to detect the anatomical variables associated with VA and jugular bulb (JB) in hydropic and non-hydropic ears. The presence or absence of EH in the inner ear was determined by gadopentetate dimeglumine-enhanced magnetic resonance imaging. The presence of different types of HJB, the anatomical variables of the VA and JB and the three types of anatomical relationship between the VA and HJB were compared between the hydropic and non-hydropic ears using the χ2 or Fisher’s exact tests. P < 0.05 was considered to indicate a statistically significant difference. Results JB was classified as: Type 1, no bulb; type 2, below the inferior margin of the posterior semicircular canal (PSCC); type 3, between the inferior margin of the PSCC and the inferior margin of the internal auditory canal (IAC); type 4, above the inferior margin of the IAC. There were no significant differences in the presence of types 1, 2 and 3 JB between two groups. The presence of type 4 JB, average height of the JB and prevalence of the non-visualization of the VA in CT scans showed significant differences between two groups. The morphological pattern between the JB and VA revealing by 3DRC was classified as: Type I, the JB was not in contact with the VA; type II, the JB was in contact with the VA, but the latter was intact without obstruction; type III, the VA was obliterated by HJB encroachment. There were no significant differences in the presence of type I and II between two groups. Type III was identified in 5 hydropic ears but no non-hydropic ears, with a significant difference observed between the two groups. Conclusion The present results showed that JB height and non-visualization of the VA on Pöschl’s plane could render patients susceptible to the development of EH. A jugular bulb reaching above the inferior margin of the IAC (type 4 JB) could obstruct VA, resulting in EH in a few isolated patients with MD. VA obliteration revealed by 3DRC, as a specific radiological sign, may have the potential for screening causative HJB in MD.
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Affiliation(s)
- Junjiao Hu
- Department of Radiology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Anquan Peng
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Kai Deng
- Department of Radiology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Chao Huang
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Qin Wang
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xueying Pan
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Wei Liu
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Zhiwen Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Wenqi Jiang
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Yichao Chen
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
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Kakigi A, Egami N, Uehara N, Fujita T, Nibu KI, Yamashita S, Yamasoba T. Live imaging and functional changes of the inner ear in an animal model of Meniere's disease. Sci Rep 2020; 10:12271. [PMID: 32704101 PMCID: PMC7378199 DOI: 10.1038/s41598-020-68352-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/23/2020] [Indexed: 11/20/2022] Open
Abstract
The symptoms of Meniere's disease (MD) are generally considered to be related to endolymphatic hydrops (EH). There are many recent reports supporting the possibility that vasopressin (VP) is closely linked to the formation of EH in Meniere's disease. Based on this, we developed a clinically relevant animal model of Meniere's disease in which a VP type 2 receptor agonist was administered after electrocauterization of the endolymphatic sac. We report live imaging of the internal structure, and functional changes of the inner ear after electrocauterization of the endolymphatic sac and administration of a VP type 2 receptor agonist. In this model, the development of EH was visualized in vivo using optical coherence tomography, there was no rupture of Reissner's membrane, and low-tone hearing loss and vertiginous attacks were observed. This study suggested that acute attacks are caused by the abrupt development of EH. This is the first report of live imaging of the development of EH induced by the administration of a VP type 2 receptor agonist.
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Affiliation(s)
- Akinobu Kakigi
- Department of Otolaryngology-Head and Neck Surgery, Kobe University, Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Naoya Egami
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Natsumi Uehara
- Department of Otolaryngology-Head and Neck Surgery, Kobe University, Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takeshi Fujita
- Department of Otolaryngology-Head and Neck Surgery, Kobe University, Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University, Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shinji Yamashita
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, 153-8904, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
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Daneshi A, Hosseinzadeh F, Mohebbi S, Mohseni M, Mohammadi SS, Asghari A. New marsupialization technique in endolymphatic sac surgery. Laryngoscope Investig Otolaryngol 2020; 5:546-551. [PMID: 32596499 PMCID: PMC7314464 DOI: 10.1002/lio2.403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/26/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim of the present study was to describe and evaluate the results of a new technique in endolymphatic sac decompression surgery. METHODS Forty-three patients with intractable unilateral Meniere's disease were selected. Endolymphatic sac was identified after simple mastoidectomy, and its lateral layer was incised, using a sickle knife. Outer layer of the sac was turned around and placed under the anterior bony border. RESULTS Mean duration of the follow-up was 24 months. Mean tinnitus handicap index, pure tone average (PTA) on thresholds at 500, 1000, 2000, and 4000 Hz, mean speech reception threshold, mean speech discrimination score, hearing stage, and mean vertigo score before and after surgery were evaluated. CONCLUSION The new marsupialization technique with anterior bony border is a safe and effective way to improve tinnitus, vertigo, and ear fullness among these patients. According to PTA and hearing stage, this surgery can control progressive hearing loss. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Ahmad Daneshi
- ENT and Head & Neck Research Center The Five Senses Institute, Iran University of Medical SciencesTehranIran
| | - Farideh Hosseinzadeh
- ENT and Head & Neck Research Center The Five Senses Institute, Iran University of Medical SciencesTehranIran
| | - Saleh Mohebbi
- Skull Base Research CenterThe Five Senses Institute, Iran University of Medical SciencesTehranIran
| | - Mohammad Mohseni
- ENT and Head & Neck Research Center The Five Senses Institute, Iran University of Medical SciencesTehranIran
| | | | - Alimohamad Asghari
- Skull Base Research CenterThe Five Senses Institute, Iran University of Medical SciencesTehranIran
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Vestibular Aqueduct Morphology Correlates With Endolymphatic Sac Pathologies in Menière's Disease-A Correlative Histology and Computed Tomography Study. Otol Neurotol 2020; 40:e548-e555. [PMID: 31083097 PMCID: PMC6554006 DOI: 10.1097/mao.0000000000002198] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Hypothesis: The vestibular aqueduct (VA) in Menière's disease (MD) exhibits different angular trajectories depending on the presenting endolymphatic sac (ES) pathology, i.e., 1) ES hypoplasia or 2) ES degeneration. Background: Hypoplasia or degeneration of the ES was consistently found in inner ears affected by MD. The two etiologically distinct ES pathologies presumably represent two disease “endotypes,” which may be associated with different clinical traits (“phenotypes”) of MD. Recognizing these endotypes in the clinical setting requires a diagnostic tool. Methods: 1) Defining the angular trajectory of the VA (ATVA) in the axial plane. 2) Measuring age-dependent normative data for the ATVA in postmortem temporal bone histology material from normal adults and fetuses. 3) Validating ATVA measurements from normative CT imaging data. 4) Correlating the ATVA with different ES pathologies in histological materials and CT imaging data from MD patients. Results: 1) The ATVA differed significantly between normal adults and MD cases with ES degeneration, as well as between fetuses and MD cases with ES hypoplasia; 2) a strong correlation between ATVA measurements in histological sections and CT imaging data was found; 3) a correlation between the ATVA, in particular its axial trajectory in the opercular region (angle αexit), with degenerative (αexit < 120°) and hypoplastic ES pathology (αexit > 140°) was demonstrated. Conclusion: We established the ATVA as a radiographic surrogate marker for ES pathologies. CT-imaging-based determination of the ATVA enables endotyping of MD patients according to ES pathology. Future studies will apply this method to investigate whether ES endotypes distinguish clinically meaningful subgroups of MD patients.
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Kim SH, Nam GS, Choi JY. Pathophysiologic Findings in the Human Endolymphatic Sac in Endolymphatic Hydrops: Functional and Molecular Evidence. Ann Otol Rhinol Laryngol 2019; 128:76S-83S. [PMID: 31092029 DOI: 10.1177/0003489419837993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The endolymphatic sac (ES) is a cystic structure situated on the posterior fossa dura and is connected to the luminal space of the vestibular organ through the endolymphatic duct, which branches into the utricular and saccular ducts. Unlike the cochlea and vestibule, the ES does not contain sensory epithelium in its luminal space, and a single layer of epithelial cells line the luminal surface area. The ES in the inner ear is thought to play a role in the regulation of inner ear homeostasis, fluid volume, and immune reaction. If these functions of the ES are disrupted, dysfunction of the inner ear may develop. The most well-known pathology arising from dysfunction of the ES is endolymphatic hydrops, characterized by an enlarged endolymphatic space due to the accumulation of excessive endolymphatic fluid. Although, molecular identities and functional evidence for the roles were identified in animal studies, basic studies of the human ES are relatively uncommon compared with those using animal tissues, because of limited opportunity to harvest the human ES. METHODS In this study, molecular and functional evidence for the role of the human ES in the development of endolymphatic hydrops are reviewed. RESULTS AND CONCLUSIONS Although evidence is insufficient, studies using the human ES have mostly produced findings similar to those of animal studies. This review may provide a basis for planning further studies to investigate the pathophysiology of disorders with the finding of endolymphatic hydrops.
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Affiliation(s)
- Sung Huhn Kim
- 1 Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.,2 The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gi-Sung Nam
- 1 Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Young Choi
- 1 Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Republic of Korea.,2 The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Volume-rendered computed tomography images of the surgical field for endolymphatic sac surgery. Eur Arch Otorhinolaryngol 2019; 276:1617-1624. [PMID: 30929055 DOI: 10.1007/s00405-019-05399-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Identification of the endolymphatic sac has failed occasionally. Postoperative complications have also rarely been reported. Given a safer and more reliable surgery, preoperative anatomical assessments are valuable, however, the vestibular aqueduct has seldom been seen with multi-planar reconstruction (MPR) computed tomography (CT) images yet. Our study aimed to determine the significance and utility of volume-rendered (VR) CT images of the surgical field for identifying the vestibular aqueduct, compared with MPR CT images. SUBJECTS AND METHODS 14 patients with Meniere's disease who underwent endolymphatic sac surgery between 2008 and 2011. Location and size of the vestibular aqueduct were assessed using VR and MPR CT images, independently. RESULTS Accuracy of identifying the location differed significantly between VR and MPR CT images (rate of total correct evaluations: 100% by VR CT images vs 75% by MPR CT images, p = 0.02). Size was correctly identified in cases with a small endolymphatic sac using VR CT images (rate of total correct evaluations for size of the vestibular aqueduct: 100% by VR CT vs 57% by MPR CT, p = 0.046). VR CT images also demonstrated clearly the relationship between the endolymphatic sac and high jugular bulb. In two cases, the endolymphatic sac was identified by VR images, not by MPR images. CONCLUSION Accurate information about the location and size of vestibular aqueduct can allow sac surgeons to identify a tiny endolymphatic sac more easily and certainly, and also aids surgical trainees to learn sac surgery safely.
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Knoll RM, Ishai R, Trakimas DR, Chen JX, Nadol JB, Rauch SD, Remenschneider AK, Jung DH, Kozin ED. Peripheral Vestibular System Histopathologic Changes following Head Injury without Temporal Bone Fracture. Otolaryngol Head Neck Surg 2018; 160:122-130. [DOI: 10.1177/0194599818795695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective Vestibular symptoms such as dizziness and vertigo are common after head injury and may be due to trauma to the peripheral vestibular system. The pathophysiology of peripheral vestibular symptoms following head injury without temporal bone (TB) fracture, however, is not well understood. Herein, we investigate the histopathology of the peripheral vestibular system of patients who sustained head injury without a TB fracture. Study Design Otopathology study. Setting Otopathology laboratory. Subjects and Methods TB of subjects with a history of head injury without TB fractures were included and evaluated by light microscopy. Specimens were assessed for qualitative and quantitative characteristics, such as number of Scarpa’s ganglion cells in the superior and inferior vestibular nerves, vestibular hair cell and/or dendrite degeneration in vestibular end organs, presence of vestibular hydrops, and obstruction of the endolymphatic duct. Results Five cases (n = 5 TBs) had evidence of vestibular pathology. There was a decrease of 48.6% (range, 40%-59%) in the mean count of Scarpa’s ganglion cells as compared with that of normative historical age-matched controls. Moderate to severe degeneration of the vestibular membranous labyrinth was identified in the posterior, superior, and lateral canals in several cases (50%, n = 4 TBs). The maculae utriculi and sacculi showed mild to severe degeneration in 2 cases. Additional findings include vestibular hydrops (25%, n = 2 TBs) and blockage of the endolymphatic duct (n = 1 TB). Conclusions Otopathologic analysis of patients with a history of head injury without TB fracture demonstrated peripheral vestibular otopathology. Future studies are necessary to determine if otopathology findings are directly attributable to head injury.
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Affiliation(s)
- Renata M. Knoll
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Reuven Ishai
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Danielle R. Trakimas
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
| | - Jenny X. Chen
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph B. Nadol
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Steven D. Rauch
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Aaron K. Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - David H. Jung
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Elliott D. Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
- Otopathology Laboratory, Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Abstract
OBJECTIVE To determine the relationship between radiographic temporal bone anatomy of patients with Menière's disease in medically and surgically managed populations versus controls. STUDY DESIGN Retrospective chart review. SETTING Two tertiary referral centers. PATIENTS Adults older than 18 years with Menière's disease treated with endolymphatic sac decompression (ESD) or medical management (non-ESD) versus controls. INTERVENTIONS Magnetic resonance imaging and computed tomography imaging studies of the temporal bones were reviewed by blinded radiologists. MAIN OUTCOME MEASURES Radiographic temporal bone dimensions were measured in Menière's disease and control patients. Age, sex, symptoms, audiogram data, academy classification of Menière's disease, and follow-up were recorded. Statistical analysis was performed to compare outcome measures across groups and demographics. RESULTS A total of 90 imaging studies were reviewed (ESD = 22; non-ESD = 30; control = 38). ESD and non-ESD groups had similar pure-tone averages (33.9 ± 20.6 versus 41.6 ± 22.6 dB HL; p = 0.21) and frequency of definite Menière's disease (59.1% versus 53.3%; p = 0.68). There was no significant trend between groups for any measurement. One nonsignificant trend existed in mean vestibule length, increasing from the control (5.45 ± 0.54 mm), non-ESD (5.80 ± 0.97 mm), and ESD (5.94 ± 0.81 mm) group. In a combined Menière's group, mean vestibule length was significantly greater than controls (5.86 ± 0.89 versus 5.45 ± 0.54 mm; p = 0.008) and mean vestibule width significantly less (2.99 ± 0.46 versus 3.19 ± 0.39 mm; p = 0.024). CONCLUSION Medical and surgical Menière's patients were similar utilizing academy classification. There was no significant trend between medical and surgical Menière's patients versus controls for any measurement. In a combined Menière's group, the longer and narrower vestibule anatomy may suggest an anatomical basis for endolymphatic hydrops.
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Comparison of Endolymphatic Duct Dimensions and Jugular Bulb Abnormalities Between Meniere Disease and a Normal Population. J Craniofac Surg 2017; 27:e424-6. [PMID: 27300452 DOI: 10.1097/scs.0000000000002702] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The pathogenesis of Meniere disease (MD) has not been fully understood. According to the widely accepted theory, imbalances due to overproduction and/or impaired absorption of endolymph may cause endolymphatic hydrops, which is the hallmark pathological finding in MD. Some developmental temporal bone abnormalities may impair endolymph circulation and absorption, and these abnormalities could be a part of MD pathophysiology. However, structural features of the temporal bone cannot explain MD pathophysiology definitively. The authors aimed to determine the length and width of the endolymphatic duct (ED) along with jugular bulb (JB) abnormalities in MD patients and normal controls using high-resolution computed tomography, and to discuss the results supporting and opposing endolymphatic hydrops based on the data obtained. METHODS Thirty-six ears of 18 patients with unilateral MD and 34 ears of 17 normal subjects were enrolled. Jugular bulb abnormalities and ED dimensions were evaluated in 3 groups: affected and unaffected ears of MD patients, and healthy controls. The ED dimensions and JB abnormalities were evaluated with high-resolution computed tomography. RESULTS The ED was found to be significantly shorter and narrower in the affected ears of the MD patients than in the healthy control group. In addition, more JB abnormalities were detected in the affected ears of the MD patients than in the healthy control group. However, there was no difference between the affected and unaffected ears of the MD patients. CONCLUSION Structural ED abnormalities and JB abnormalities may be predisposing factors for the development of Meniere disease, but cannot fully explain MD pathophysiology.
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Juliano AF, Ting EY, Mingkwansook V, Hamberg LM, Curtin HD. Vestibular Aqueduct Measurements in the 45° Oblique (Pöschl) Plane. AJNR Am J Neuroradiol 2016; 37:1331-7. [PMID: 27012297 DOI: 10.3174/ajnr.a4735] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/18/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE The 45° oblique (Pöschl) plane allows reliable depiction of the vestibular aqueduct, with virtually its entire length often visible on 1 CT image. We measured its midpoint width in this plane, aiming to determine normal measurement values based on this plane. MATERIALS AND METHODS We retrospectively evaluated temporal bone CT studies of 96 pediatric patients without sensorineural hearing loss. Midvestibular aqueduct widths were measured in the 45° oblique plane by 2 independent readers by visual assessment (subjective technique). The vestibular aqueducts in 4 human cadaver specimens were also measured in this plane. In addition, there was a specimen that had undergone CT scanning before sectioning, and measurements made on that CT scan and on the histologic section were compared. Measurements from the 96 patients' CT images were then repeated by using findings derived from the radiologic-histologic comparison (objective technique). RESULTS All vestibular aqueducts were clearly identifiable on 45° oblique-plane CT images. The mean for subjective measurement was 0.526 ± 0.08 mm (range, 0.337-0.947 mm). The 97.5th percentile value was 0.702 mm. The mean for objective measurement was 0.537 ± 0.077 mm (range, 0.331-0.922 mm). The 97.5th percentile value was 0.717 mm. CONCLUSIONS Measurements of the vestibular aqueduct can be performed reliably and accurately in the 45° oblique plane. The mean midpoint width was 0.5 mm, with a range of 0.3-0.9 mm. These may be considered normal measurement values for the vestibular aqueduct midpoint width when measured in the 45° oblique plane.
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Affiliation(s)
- A F Juliano
- From the Department of Radiology (A.F.J., H.D.C.), Massachusetts Eye and Ear Infirmary
| | - E Y Ting
- Department of Diagnostic Imaging (E.Y.T.), National University Health System, Singapore
| | - V Mingkwansook
- Department of Radiology (V.M.), Thammasat University Hospital, Pathumthani, Thailand
| | - L M Hamberg
- Department of Radiology (L.M.H.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - H D Curtin
- From the Department of Radiology (A.F.J., H.D.C.), Massachusetts Eye and Ear Infirmary
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Morphological and functional changes in a new animal model of Ménière's disease. J Transl Med 2013; 93:1001-11. [PMID: 23877650 DOI: 10.1038/labinvest.2013.91] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/20/2013] [Accepted: 06/22/2013] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to clarify the underlying mechanism of vertiginous attacks in Ménière's disease (MD) while obtaining insight into water homeostasis in the inner ear using a new animal model. We conducted both histopathological and functional assessment of the vestibular system in the guinea-pig. In the first experiment, all animals were maintained 1 or 4 weeks after electrocauterization of the endolymphatic sac of the left ear and were given either saline or desmopressin (vasopressin type 2 receptor agonist). The temporal bones from both ears were harvested and the extent of endolymphatic hydrops was quantitatively assessed. In the second experiment, either 1 or 4 weeks after surgery, animals were assessed for balance disorders and nystagmus after the administration of saline or desmopressin. In the first experiment, the proportion of endolymphatic space in the cochlea and the saccule was significantly greater in ears that survived for 4 weeks after surgery and were given desmopressin compared with other groups. In the second experiment, all animals that underwent surgery and were given desmopressin showed spontaneous nystagmus and balance disorder, whereas all animals that had surgery but without desmopressin administration were asymptomatic. Our animal model induced severe endolymphatic hydrops in the cochlea and the saccule, and showed episodes of balance disorder along with spontaneous nystagmus. These findings suggest that administration of desmopressin can exacerbate endolymphatic hydrops because of acute V2 (vasopressin type 2 receptor)-mediated effects, and, when combined with endolymphathic sac dysfunction, can cause temporary vestibular abnormalities that are similar to the vertiginous attacks in patients with MD.
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Miyashita T, Toyama Y, Inamoto R, Mori N. Evaluation of the vestibular aqueduct in Ménière's disease using multiplanar reconstruction images of CT. Auris Nasus Larynx 2012; 39:567-71. [DOI: 10.1016/j.anl.2011.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 10/31/2011] [Accepted: 01/13/2012] [Indexed: 10/28/2022]
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Sun GH, Leung R, Samy RN, McAfee JS, Hearst MJ, Savage CR, Choo DI, Pensak ML. Analysis of hearing preservation after endolymphatic mastoid sac surgery for Meniere's disease. Laryngoscope 2010; 120:591-7. [DOI: 10.1002/lary.20787] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Computed Tomography Investigation of the Vestibular Aqueduct in Meniere's Disease. Acta Otolaryngol 2009. [DOI: 10.3109/00016488709121928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Galey FR, Durko T, Linthicum FH. Morphometric Analysis of the Human Endolymphatic Sac: Section 2. Evaluation of Epithelial Organization of Sacs from Four Meniere's Disease Cases. Acta Otolaryngol 2009. [DOI: 10.3109/00016488809098978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Galey FR, Praterelli M. Morphometric Analysis of the Human Endolymphatic Sac: Section 4. Distribution of Canaliculi in Sacs from Four Normal-hearing Cases and Four Meniere's Disease Cases. Acta Otolaryngol 2009. [DOI: 10.3109/00016488809098980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ciuman RR. Communication routes between intracranial spaces and inner ear: function, pathophysiologic importance and relations with inner ear diseases. Am J Otolaryngol 2009; 30:193-202. [PMID: 19410125 DOI: 10.1016/j.amjoto.2008.04.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 03/09/2008] [Accepted: 04/07/2008] [Indexed: 01/29/2023]
Abstract
OBJECTIVE There exist 3 communication routes between the intracranial space and the inner ear, the vestibular aqueduct, the cochlear aqueduct, and the internal auditory canal. They possess a key role in inner ear pressure regulation and fluid homeostasis and are related to inner ear diseases. REVIEW METHODS Relevant literature was reviewed, and the current knowledge of the anatomy, physiologic importance, and relations to inner ear diseases were described. Pathologic communication routes such as semicircular canal dehiscence syndrome were highlighted as well. CONCLUSION Abnormalities in all 3 communication routes may predispose or be the cause of distinct inner ear pathologic condition and involved in other cochlear and vestibular syndromes, in which their role is not completely clear. The increasing knowledge of the underlying mechanisms encourages promising approaches for possible intervention in the future.
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Abstract
Meniere's disease is a chronic illness that affects a substantial number of patients every year worldwide. The disease is characterised by intermittent episodes of vertigo lasting from minutes to hours, with fluctuating sensorineural hearing loss, tinnitus, and aural pressure. Although there is currently no cure, more than 85% of patients with Meniere's disease are helped by either changes in lifestyle and medical treatment, or minimally invasive surgical procedures such as intratympanic steroid therapy, intratympanic gentamicin therapy, and endolymphatic sac surgery. Vestibular neurectomy has a very high rate of vertigo control and is available for patients with good hearing who have failed all other treatments. Labyrinthectomy is undertaken as a last resort and is best reserved for patients with unilateral disease and deafness.
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Affiliation(s)
- Hamed Sajjadi
- Department of Otolaryngology Head and Neck Surgery, Stanford University Medical Center, San Jose, CA 95124, USA.
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Alvarenga EHDL, Cruz OLM, Yamashita HK, Lima EJD, Alvarenga AM, Bisinoto SMB. Sistematização do estudo anatômico do aqueduto vestibular por tomografia computadorizada de alta resolução em pacientes com doenças de Ménière unilateral. Radiol Bras 2006. [DOI: 10.1590/s0100-39842006000500009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Sistematizar a avaliação do aqueduto vestibular por tomografia computadorizada de alta resolução (TCAR) em pacientes com doença de Ménière unilateral e comparar com um grupo-controle. MATERIAIS E MÉTODOS: Selecionamos 20 pacientes com doença de Ménière unilateral, segundo critérios da Academia Americana de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço, e um grupo-controle composto por dez indivíduos com avaliação auditiva normal, totalizando 60 orelhas, distribuídas igualmente em três grupos: grupo I - doença de Ménière, orelha comprometida; grupo II - doença de Ménière, orelha não-comprometida; grupo III - controle. Submetemos os pacientes à TCAR de ossos temporais. O estudo das imagens foi feito de modo cego, procurando avaliar a visibilidade da porção descendente do aqueduto vestibular. Os dados obtidos foram correlacionados com os respectivos grupos. RESULTADOS: A visualização do aqueduto vestibular foi de 95% no grupo I, 90% no grupo II e 100% no grupo III. CONCLUSÃO: É possível sistematizar a avaliação por TCAR do aqueduto vestibular, com aquisição axial, usando a mesma técnica radiológica, conhecimento anatômico e seguimento seqüencial das estruturas da orelha interna. Com esta sistematização houve alta taxa de visualização do aqueduto vestibular, sem diferença estatisticamente significante entre os grupos.
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Krombach GA, van den Boom M, Di Martino E, Schmitz-Rode T, Westhofen M, Prescher A, Günther RW, Wildberger JE. Computed tomography of the inner ear: size of anatomical structures in the normal temporal bone and in the temporal bone of patients with Menière's disease. Eur Radiol 2005; 15:1505-13. [PMID: 15824909 DOI: 10.1007/s00330-005-2750-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2004] [Revised: 02/25/2005] [Accepted: 03/15/2005] [Indexed: 10/25/2022]
Abstract
The purpose of the study was to obtain reference values for the sizes of anatomical structures of the inner ear on computed tomography (CT) images and to compare these values with those obtained from patients with Menière's disease. CT images of the temporal bone of 67 patients without inner ear pathology and 53 patients with Menière's disease have been evaluated. CT was performed in the sequential mode (1-mm slice thickness, 120 kV, 125 mA). Anatomical structures, such as the length and the width of the cochlea and of the vestibule, the height of the basal turn, the length and the width of the cochlear, the vestibular and the singular aqueduct and the internal auditory meatus and the diameter of the semicircular canals, were measured, using a dedicated postprocessing workstation. Reference values from the control group could be obtained. In the patients with Menière's disease, the length and the width of the vestibular aqueduct were smaller, compared with the values from the control group. The values obtained from the control group can serve as reference values for adult patients. The different sizes of anatomical structures of the control group and of patients suffering from Menière's disease suggest that functional impairment might be related to subtle morphological changes.
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Affiliation(s)
- Gabriele A Krombach
- Department of Diagnostic Radiology, University Hospital, University of Technology (RWTH) Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
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Kobayashi M, Tsunoda A, Akita K, Yamada I. Estimation of the endolymphatic sac and vestibular aqueduct using magnetic resonance imaging. Laryngoscope 2003; 113:1015-21. [PMID: 12782814 DOI: 10.1097/00005537-200306000-00018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of magnetic resonance imaging for assessment of the endolymphatic sac and vestibular aqueduct. STUDY DESIGN Imaging and histological study of the cadaver. METHODS Five cadavers were studied by a 1.5-T magnetic resonance imaging system with a 3-inch-diameter surface coil. Magnetic resonance imaging scans were obtained with proton density-weighted and T2-weighted fast spin-echo sequences. Histological sections were made with an epoxy resin-embedding method and were compared with magnetic resonance imaging scans. RESULTS The visibility of the endolymphatic sac on both sequences corresponded well to the presence of the endolymphatic sac on histological sections. On the histological sections, the width of the external aperture of vestibular aqueduct (endolymphatic sac including surrounding connective tissue) was 0.96 +/- 0.18 mm (mean +/- SD) and the width of lumen of endolymphatic sac at the same point was 0.47 +/- 0.17 mm. The width of the endolymphatic sac was 1.02 +/- 0.19 mm on proton density-weighted images and was 0.81 +/- 0.15 mm on T2-weighted images. The widths of endolymphatic sac measured on proton density-weighted image and those of vestibular aqueduct on histological section did not show statistically significant differences (P >.05). On the other hand, the endolymphatic sac as measured on T2-weighted image tended to be smaller than the vestibular aqueduct (P <.05) and tended to be larger than the lumen of the endolymphatic sac (P <.0005). CONCLUSION Both sequences can precisely depict the endolymphatic sac; however, the proton density-weighted image is a more appropriate indicator of the actual anatomical configuration of the endolymphatic sac with surrounding connective tissue and vestibular aqueduct.
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Affiliation(s)
- Mari Kobayashi
- Department of Otolaryngology, School of Medicine, Tokyo Medical and Dental University, Japan
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Paparella MM, Djalilian HR. Etiology, pathophysiology of symptoms, and pathogenesis of Meniere's disease. Otolaryngol Clin North Am 2002; 35:529-45, vi. [PMID: 12486838 DOI: 10.1016/s0030-6665(02)00019-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endolymphatic hydrops is the pathologic feature associated with Meniere's disease. The development of endolymphatic hydrops appears to arise from multifactorial inheritance with alteration of endolymphatic homeostasis. Various factors associated with the phenomenon of hydrops include functional or anatomic obstruction of endolymphatic flow, malabsorption of endolymph, genetic anomalies, vasodilation, allergy, viral infection, and autoimmunity.
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Affiliation(s)
- Michael M Paparella
- Minnesota Ear, Head, and Neck Clinic, Suite 200, 701 25th Avenue South, Minneapolis, MN 55454, USA.
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da Costa SS, de Sousa LCA, Piza MRDT. Meniere's disease: overview, epidemiology, and natural history. Otolaryngol Clin North Am 2002; 35:455-95. [PMID: 12486835 DOI: 10.1016/s0030-6665(02)00028-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Meniere's disease is a disease of the inner ear characterized by a triad of symptoms: vestibular symptoms, auditory symptoms, and pressure. The pathologic correlate of Meniere's disease is endolymphatic hydrops and the etiopathogenesis involves a deficiency in the absorption of endolymph. The pathophysiology of the symptoms is still disputed: membranous ruptures, pressure and mechanical displacement of the end organs, or obstruction followed by an abrupt clearance of the endolymphatic duct. The course of the disease may be progressive or nonprogressive and, in addition to the typical presentation of Meniere's disease, two variations of the disorder have been identified: cochlear Meniere's disease, and vestibular Meniere's disease. It can be further broken into two subsets: Meniere's syndrome, with a known and well-established cause, and Meniere's disease, in which the cause seems to be idiopathic. It is likely that there are racial (genetic) as well as environmental factors that influence differences in incidence among countries and among various sections of countries. The disease is much more common in adults, with an average age of onset in the fourth decade, the symptoms beginning usually between ages 20 and 60 years. Meniere's disease is (grossly) equally common in each sex, and right and left ears are affected with fairly equal frequency. The diagnosis of Meniere's disease is by exclusion, and a careful history is the most important guide to a correct diagnosis. Its medical treatment is largely empiric. Surgery can be considered when, even after medical therapy, the disease progresses and the symptoms become intractable. Surgery may be either conservative or destructive. Bilaterality must be considered when deciding the best surgical option for a patient with Meniere's disease. It is the authors' opinion that endolymphatic sac surgery is an extension of conservative treatment.
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Affiliation(s)
- Sady Selaimen da Costa
- Department of Otolaryngology Head & Neck Surgery, School of Medicine, Universidade Federal do Rio Grande do Sul, Brazil.
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Mancini F, Catalani M, Carru M, Monti B. History of Meniere's disease and its clinical presentation. Otolaryngol Clin North Am 2002; 35:565-80. [PMID: 12486840 DOI: 10.1016/s0030-6665(02)00017-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The term Meniere's disease is used to define either the classic triad of vestibular and cochlear symptoms and aural pressure from known or unknown causes or its clinical variants, vestibular and cochlear Meniere's disease. Some variants evolve after years into typical forms, whereas others do not. Some symptoms (positional vertigo) have been long underestimated in previous reports. The more we study our patients and correlate clinical findings and the natural history with pathologic studies on temporal bones and laboratory research, the more we will understand Meniere's disease and its causes. Some causes have already been identified as most probable. Extrinsic factors (inflammation, trauma, otosclerosis, autoimmunity, endocrine disorders, and such) interact with congenital (genetic) and developmental intrinsic factors (primary or secondary, acquired) into a multifactorial inheritance that is, to date, the best explanation for the basis of Meniere's disease. Endolymphatic hydrops is widely accepted as the pathologic substrate, but not all hydrops seems to be progressive or becomes clinically manifest. Endolymphatic hydrops is the result of a dysfunction in the mechanism of production/absorption of endolymph, which is mainly due to defective absorptive activity of the endolymphatic duct and sac. Hyperproduction of endolymph cannot be excluded in some cases. Ruptures of the labyrinthine membranes do not satisfactorily substantiate the multiform duration, recurrence, and repetitiveness of attacks of Meniere's disease, nor do they explain the entire complex of symptoms. It seems reasonable to explain symptoms of Meniere's disease on the basis of mechanical factors (as observed in temporal bone studies) associated with biologic and biochemical factors.
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Affiliation(s)
- Fernando Mancini
- Department of Otolaryngology, Ospedale Koelliker, Corso G. Ferraris, 251, 10134 Torino, Italy.
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Abstract
Histopathologic study of the human temporal bone entails microscopic examination and analysis of a series of histologic sections. This is currently the most effective method for observing the pathologic conditions of MD by examining the entire inner ear. Complete temporal bone histopathology cannot be replaced by either clinical pathologic study of small biopsy specimens obtained during surgery, or experimental animal studies that can create endolymphatic hydrops but not create MD. We believe that the histopathologic findings together with clinical information on MD is valuable in enhancing our understanding of the pathophysiology of the inner ear in MD. For example, a hypoplastic VA and ES in MD seem to indicate that there may be congenital predisposing factors in the development of MD. The exact pathologic findings characteristic of MD remains unclear, however. Many of the temporal bone specimens were obtained years after patients were diagnosed with MD and those specimens were involved with moderate postmortem changes. For these reasons, further collection of temporal bone specimens with fewer postmortem changes, obtained within a shorter premortem time period between occurrence of the disease and the time of the patients' death, and from patients with a well-characterized clinical history of MD, is imperative. Contemporary temporal bone studies now include in situ hybridization histochemistry or polymerase chain reaction (PCR) analysis for protein, enzymes, or viral antigens that can be directed at specimens from patients with MD [54,55]. It is hoped that in the near future such advanced research studies with human temporal bone histology sections will support and enhance the significant contribution of temporal bone histopathology to clinical otology.
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Affiliation(s)
- Isamu Sando
- Elizabeth McCullough Knowles Otopathology Laboratory, Division of Otopathology, University of Pittsburgh School of Medicine, Eye and Ear Institute Building, 203 Lothrop Street, Pittsburgh, PA 15213, USA. sando+@pitt.edu
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Mateijsen DJM, Van Hengel PWJ, Krikke AP, Van Huffelen WM, Wit HP, Albers FWJ. Three-dimensional Fourier transformation constructive interference in steady state magnetic resonance imaging of the inner ear in patients with unilateral and bilateral Menière's disease. Otol Neurotol 2002; 23:208-13. [PMID: 11875351 DOI: 10.1097/00129492-200203000-00017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In this study, three-dimensional Fourier transformation constructive interference in steady state (3DFT-CISS) magnetic resonance imaging was used to quantify the distance between the vertical part of the posterior semicircular canal and the posterior fossa as a measure of the endolymphatic sac and duct in patients with Menière's disease. Differences in this distance between affected and unaffected ears, as well as differences between unilaterally and bilaterally affected patients, were studied and compared with a control group. Also, possible correlations between the measured distance and the duration and severity of symptoms, patient age, and average hearing loss were investigated in the group of patients with Menière's disease. STUDY DESIGN Retrospective clinical study. SETTING Tertiary referral center (University Hospital) as part of a large, diagnostic research project on Menière's disease. PATIENTS Of the 111 patients with Menière's disease initially included, 90 patients underwent 3DFT-CISS MRI. Eighty-six of these patients were analyzed in this MRI study. Fifty-six patients had unilateral Menière's disease, and 30 patients had bilateral Menière's disease (116 affected and 56 unaffected ears). Sixty-two ears in patients without Menière's disease were studied as controls. INTERVENTION The distance between the vertical part of the posterior semicircular canal and the posterior fossa was determined by 3DFT-CISS MRI. MAIN OUTCOME MEASURES Contiguous axial 3DFT-CISS MRI slices of 0.7 to 1.0 mm were made by a radiologist according to a strict protocol. Measurements of the distance between the vertical part of the posterior semicircular canal and the posterior fossa were taken by two professionals-a radiologist and an otolaryngologist-using a ruler and the original scan. RESULTS A significantly smaller distance (2.9 mm) between the vertical part of the posterior semicircular canal and the posterior fossa as visualized on MRI scans was found in the ears of patients with Menière's disease than in the ears of patients in the control group (3.8 mm, p < 0.001). In both uni- and bilaterally affected patients (n = 56 and n = 30, respectively), no significant difference between ears was found (p = 0.44 and p = 0.19, respectively). In bilaterally affected patients, however, this distance (3.2 mm) was significantly greater than the distance in unilaterally affected patients (2.7 mm, p = 0.004). There was no relationship between the MRI-visualized distance between the vertical part of the posterior semicircular canal and the posterior fossa and the duration of disease, average hearing loss, or severity of symptoms in uni- and bilaterally affected patients. CONCLUSION The difference in MRI-visualized distances between the vertical part of the posterior semicircular canal and the posterior fossa of uni- and bilaterally affected patients strongly suggests that unilateral and bilateral hearing loss are two different entities in patients with Menière's disease. The size of the endolymphatic sac seems not to be the only factor in the pathogenesis of Menière's disease. That the MRI-visualized distance between the vertical part of the posterior semicircular canal and the posterior fossa does not have any relationship to the duration of the disease or to patient age indicates that this distance is a congenital feature.
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Affiliation(s)
- D J M Mateijsen
- Departments of Otorhinolaryngology and Radiology, University Hospital Groningen, Groningen, The Netherlands.
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Sennaroglu L, Yilmazer C, Basaran F, Sennaroglu G, Gursel B. Relationship of vestibular aqueduct and inner ear pressure in Ménière's disease and the normal population. Laryngoscope 2001; 111:1625-30. [PMID: 11568617 DOI: 10.1097/00005537-200109000-00025] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Etiopathogenesis of Ménière's disease has not been resolved. The principal histopathologic finding in this disease is endolymphatic hydrops. The majority of radiologic and histopathologic studies demonstrated a narrow vestibular aqueduct in Ménière's disease. There is no study in the literature investigating the relationship between inner ear pressure and vestibular aqueduct dimensions. Static acoustic compliance is a noninvasive procedure that is thought to measure perilymphatic pressure at the footplate. An increase in mechanical fluid pressure in the inner ear is transmitted to the footplate of the stapes. This causes a reduction in the compliance at the drum. The aim of this study is to investigate the relationship between vestibular aqueduct dimensions and static acoustic compliance in Ménière's disease and the normal population. STUDY DESIGN Prospective study. METHODS Forty patients with Ménière's disease and 40 healthy individuals with no otolaryngologic disorders were the subjects of this study. Each group was further divided into two according to static compliance value (normal and low static compliance). In these four groups dimensions of vestibular aqueduct were determined radiologically by high-resolution computerized tomography and correlated with normal and low static acoustic compliance values (normal and high perilymphatic pressure). RESULTS The results demonstrated that vestibular aqueduct is narrower in patients with Ménière's disease than the normal population. However, there is no relationship between vestibular aqueduct dimensions and inner ear pressure obtained by static acoustic compliance measurements.
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Affiliation(s)
- L Sennaroglu
- Department of Otolaryngology Head and Neck Surgery, Hacettepe University Medical Faculty, Ankara, Turkey.
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Warmerdam TJ, Schröder FH, Wit HP, Albers FW. Perilymphatic and Endolymphatic Pressure in the Guinea Pig After Distal Dissection of the Endolymphatic Sac. Otol Neurotol 2001; 22:373-6. [PMID: 11347642 DOI: 10.1097/00129492-200105000-00017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS The study was designed to investigate whether endolymphatic pressure exceeds perilymphatic pressure in an endolymphatic hydrops model with a partially functioning endolymphatic sac. BACKGROUND Previous investigations of perilymphatic and endolymphatic pressure measurements during endolymphatic hydrops were done in a classic endolymphatic hydrops model, with a surgically blocked endolymphatic duct and sac. This model, in contrast to the clinical situation of Meniere's patients, totally lacks the functional contribution of the endolymphatic sac. METHODS In the guinea pig, a partially functioning endolymphatic sac was created via dissection of the distal portion of the sac from the sigmoid sinus. Three (n = 5) and 6 months (n = 3) later, perilymphatic and endolymphatic pressures were measured consecutively using a WPI 900A micropressure system. RESULTS It was observed that damage to the distal part of the endolymphatic sac caused endolymphatic hydrops in 58% of the cases. The hydrostatic pressure in hydropic ears did not differ from that of control ears. There was no pressure difference between the perilymphatic and endolymphatic compartments in ears with endolymphatic hydrops. The endocochlear potential in ears with hydrops was statistically significantly decreased (p < 0.002). CONCLUSION In a hydrops model developed to be more comparable to the histopathologic appearance of Meniere's disease in the inner ear, no hydrostatic pressure difference was measured between the perilymphatic and endolymphatic spaces. The only functional difference from control ears we found was a decreased endocochlear potential.
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Affiliation(s)
- T J Warmerdam
- Department of Otorhinolaryngology, University Hospital Groningen, The Netherlands
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Kobayashi M, Fukaya T, Noda M. The endolymphatic sac in patients with Ménière's disease: correlation between the MRI and the surgical findings. Acta Otolaryngol 2000; 120:955-9. [PMID: 11200591 DOI: 10.1080/00016480050218690] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The endolymphatic sac (ES) is thought to have close relations to pathogenesis of endolymphatic hydrops. Here is reported a retrospective study of 41 patients (42 ears) with Meniere's disease who underwent MRI prior to endolymphatic sac surgery. Based on proton-density weighted image (PDI) and T2-weighted image (T2), the ES including an endolymphatic duct (ED) were estimated whether it was detectable or not. Fourteen ESs were detected on both images (Group A), 14 ESs were detected only on PDI (Group B), and the remaining 14 ESs were not detected on either image (Group D). The actual shape of the sac, obtained from surgical findings, was classified into three (normoplastic, atrophic, invisible). Seventeen ears showed normoplastic ESs and 14 showed atrophic ESs. ES was not detected in 11 ears during surgery, and these findings were compared with image classification. From the study data, normoplastic ESs tend to be observed on both images whereas atrophic or invisible sacs were hardly observed on T2. This classification of ES on MRI was thought to correlate with surgical findings and this correlation was statistically significant (Spearman's rank correlation coefficient. r(s) = 0.58, p < 0.01).
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Affiliation(s)
- M Kobayashi
- Department of Otolaryngology, Kanto Medical Center Nippon Telegram and Telephone East Corporation, Tokyo, Japan
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Danckwardt-Lillieström N, Friberg U, Kinnefors A, Rask-Andersen H. Ultrastructural analysis of 20 intraosseous endolymphatic sacs from patients with cerebello-pontine angle tumours. A surgically obtained control material for histopathological studies. Auris Nasus Larynx 2000; 27:311-21. [PMID: 10996489 DOI: 10.1016/s0385-8146(00)00073-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this work was to collect a surgically obtained, freshly fixed material of the human intraosseous endolymphatic sac. This biopsy material was used to describe the normal ultrastructure as well as to serve as a control material for histopathological studies on Ménière's disease in particular. METHOD The specimens, obtained during surgery for cerebello-pontine angle tumours, were fixed by immersion and then prepared by routine methods for transmission electron microscopy. The ultrastructural analysis was focused on intraluminal content, epithelial cell layer, subepithelial space, and morphological signs of immunological activity. The ultrastructure was analysed in relation to inner ear sensory function, tumour diagnosis, and patient's age and sex. RESULTS As it was possible to obtain numerous specimens with an intact bony shell, the intraluminal substance could be analysed. Two separate epithelial cell types are described: one less abundant, often lighter and mitochondria-rich cell type; the other, often darker, epithelial cell with fever mitochondrias. Some of the latter cell types showed signs of active secretion. The subepithelial space was characterized by loose connective tissue adjacent to the epithelial lining, being more dense toward the bone. Elastic fibres were seen surrounding the entire endolymphatic sac. Macrophages in the intraluminal space and lymphocytes in the epithelial and subepithelial layers are described. No distinct morphology correlating to inner ear sensory function, tumour diagnosis, or patient's age and sex was revealed. CONCLUSIONS This study confirms previously described, extensive variations in form and structure of the human endolymphatic sac. Various factors, such as surgical trauma, previous treatment, and processing method, can affect the ultrastructure and must be taken into consideration. The specimens described in this work appear to constitute a good control material for histopathological study of the human endolymphatic sac. It is still necessary to obtain large control materials such as this, as surgical specimens from patients with Ménière's disease are uncommon.
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Affiliation(s)
- N Danckwardt-Lillieström
- Department of Oto-Rhino-Laryngology and Head & Neck Surgery, University Hospital, 751 85, Uppsala, Sweden.
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Xenellis J, Vlahos L, Papadopoulos A, Nomicos P, Papafragos K, Adamopoulos G. Role of the new imaging modalities in the investigation of Meniere's disease. Otolaryngol Head Neck Surg 2000; 123:114-9. [PMID: 10889493 DOI: 10.1067/mhn.2000.102113] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The incidence of nonvisualization of the vestibular aqueduct and the endolymphatic duct-endolymphatic sac (ED-ES) complex as well as the type of periaqueductal pneumatization were evaluated in 23 patients with definite Meniere's disease (MD) by high-resolution CT and by MRI. Fifty subjects with no previous history of any ear disease were used as a control group. High-resolution CT results disclosed that in the control group the percentage of nonvisualized vestibular aqueduct (3.4%) was statistically significantly lower than in the MD group, when either the diseased ear (27.8%) or the nondiseased ear of the same group (22.2%) was examined. In addition, no differences were observed between the diseased and nondiseased ears of the patients with MD. The periaqueductal pneumatization was also found to be statistically significantly lower in the MD group. As regards the MRI examination, the results of the analysis showed that the ED-ES complex was visualized more frequently in the ears of the control subjects (64.1%) than in the diseased ears of the patients with Meniere's disease (39.1%). This difference had a marginal statistical significance (P approximately 0.05). We discussed the results in relation to possible underlying pathophysiologic mechanisms involving the flow of endolymph toward the ES during the different stages of the disease.
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Affiliation(s)
- J Xenellis
- Department of ENT, University of Athens Medical School, Greece
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Stone JA, Chakeres DW, Schmalbrock P. HIGH-RESOLUTION MR IMAGING OF THE AUDITORY PATHWAY. Magn Reson Imaging Clin N Am 1998. [DOI: 10.1016/s1064-9689(21)00453-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mutlu C, Govsa F, Unlu HH, Senyilmaz Y. The variational anatomy of the external aperture of the human vestibular aqueduct. Surg Radiol Anat 1997; 19:303-5. [PMID: 9413077 DOI: 10.1007/bf01637598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A study was undertaken to demonstrate the variational anatomy of the external aperture of the vestibular aqueduct in 90 human temporal bones obtained from 58 cadavers. Topographic landmarks of the posterior surface of the petrous bone are useful for general orientation and include the external aperture of the vestibular aqueduct, internal auditory meatus, sigmoid sinus, subarcuate fossa, superior petrosal sinus and cochlear canaliculus. We determined the mean distances from the external aperture of vestibular aqueduct to the above structures to be 10.98, 11.21, 9.42, 10.27 and 13.90 mm, respectively. Furthermore, the length of the external aperture of the vestibular aqueduct revealed significant differences between the right and left sides. The distances between the EAVA and certain anatomical structures on the posterior surface of the temporal bone should be taken into consideration during surgery. Knowing the variability of the position of the external aperture of the vestibular aqueduct may help surgeons avoid traumatizing, and thus producing inadvertent lesions to the hearing mechanism.
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Affiliation(s)
- C Mutlu
- Department of Otolaryngology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
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Welling DB, Clarkson MW, Miles BA, Schmalbrock P, Williams PM, Chakeres DW, Oehler MC. Submillimeter magnetic resonance imaging of the temporal bone in Meniere's disease. Laryngoscope 1996; 106:1359-64. [PMID: 8914901 DOI: 10.1097/00005537-199611000-00010] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The pathoetiology of Meniere's disease remains elusive. Histopathologic and imaging studies have implicated congenital or developmental abnormality of the endolymphatic duct as a likely predisposing factor to the development of endolymphatic hydrops and clinical Meniere's disease. Recently, improved high-resolution magnetic resonance imaging (MRI) protocols have allowed better demonstration of the soft tissues of the endolymphatic duct and sac. This study is a prospective evaluation of the ability of submillimeter MRI to detect the endolymphatic duct in Meniere's disease patients and control subjects. In addition, the development of the temporal bone in the region of the endolymphatic sac and duct is evaluated by measurements of the distance from the posterior semicircular canal to the subarachnoid space and the distance from the vestibule to the subarachnoid space. Visualization of the endolymphatic duct was found to be significantly less frequent in the Meniere's disease patients (29%) than in the control subjects (91%). Temporal bone measurements in the region of the endolymphatic duct showed patients with Meniere's disease to have smaller dimensions than control subjects.
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Affiliation(s)
- D B Welling
- Department of Otolaryngology--Head and Neck Surgery, The Ohio State University, Columbus 43210, USA
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Okumura T, Takahashi H, Honjo I, Takagi A, Mitamura K. Sensorineural hearing loss in patients with large vestibular aqueduct. Laryngoscope 1995; 105:289-93; discussion 293-4. [PMID: 7877418 DOI: 10.1288/00005537-199503000-00012] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In examining 181 patients (327 ears) with sensorineural hearing loss of unknown etiology and 25 people (50 ears) with normal hearing by high-resolution computed tomography (CT), the image of the large vestibular aqueduct (VA) was defined as being a visible large aperture (> or = 4 mm), and small distance between vestibule and traceable part of the VA nearest to the vestibule (> or = 1 mm). The large VA was found in 13 patients (23 ears, 7.0%); it was relatively frequent following hypoplastic cochlea (33 ears, 10.1%) in all the inner ear anomalies detected. In patients with large VA, high-frequency hearing was affected more than low frequency, and history of sudden hearing loss was observed frequently (61% of ears with large VA), which was found to be triggered by characteristic episodes such as minor head trauma, etc. Those clinical features were observed more in those without cochlear anomaly than in those accompanying cochlear anomaly. Pathogenesis of sensorineural hearing loss and characteristic fluctuation of hearing in those patients are discussed.
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Affiliation(s)
- T Okumura
- Department of Otolaryngology, Otsu Red Cross Hospital, Nagara, Japan
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Abstract
There now exists a vast literature on Ménière's disease. In this review, we examine closely the foundations of some of the current concepts regarding various aspects of the disorder, including definitions, clinical features, natural history, pathology, pathogenesis, pathophysiology, diagnosis and treatment. We will highlight areas where the current state of knowledge is incomplete and also suggest some avenues for further research.
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Affiliation(s)
- S N Merchant
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
The etiopathogenesis of Menière's disease has remained controversial since the early 1900s. Many investigators have studied the histopathology of the inner ear in patients with this disorder. Three basic pathologic mechanisms have emerged: fibrosis of the endolymphatic sac and vestibular epithelia, altered glycoprotein metabolism, and inner ear viral infection. This article reviews the current understanding of these three basic pathologic processes.
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Affiliation(s)
- P A Wackym
- Goodhill Ear Center, University of California, Los Angeles School of Medicine 90024-1794
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