Evaluation of changes in endolymphatic volume after middle ear pressure therapy for intractable meniere’s disease using 3D magnetic resonance imaging

Abstract

Background

Nowadays, the endolymphatic space size can be evaluated by 3D-analysis of 3 T-MRI after intravenous injection of gadolinium enhancement.

Aims/objectives

In the present study, to elucidate the relationships between vertigo and endolymphatic hydrops (EH) volume after middle ear pressure therapy (MEPT), we investigated changes in EH volume after MEPT for intractable Meniere’s disease (MD) by means of the inner ear MRI (ieMRI) in relation to clinical results.

Materials and methods

We enrolled 202 successive definite MD cases with intractable vertiginous symptoms from 2015 to 2020, assigning Group-I of MEPT, and Group-II of endolymphatic sac drainage (ELSD). Ninety patients completed the planned 2-year-follow-up, which included assessment of vertigo frequency and changes in EH volume using ieMRI (Group-I/MEPT: n = 40; Group-II/ELSD: n = 50).

Results

Two years after surgery, vertigo was completely controlled in 77.5% of patients in Group-I and 90.0% in Group-II. Hearing improved by >10 dB in 7.5% of patients in Group-I and 24.0% in Group-II. ELS ratios were significantly reduced after treatments of Group-I and Group-II only in the vestibule.

Conclusions

The obtained results indicate that MEPT as well as ELSD could be a good treatment option for patients with intractable MD.

Chinese Abstract

背景：现今, 内淋巴空间大小可以通过静脉注射钆增强后 3 T-MRI 的 3D 分析来评估。

目的：在本研究中, 为了阐明中耳压力治疗 (MEPT) 后眩晕与内淋巴积水 (EH) 体积之间的关系, 我们通过比较内耳 MRI (ieMRI) 与临床结果, 调查了针对难治性梅尼埃病 (MD) 进行的MEPT 后的 EH 体积变化。

材料和方法：我们招募了2015 年至 2020 年期间, 202 名连续确诊的具顽固性眩晕症状的 MD 病例, 分为I 组 MEPT和II 组内淋巴囊引流(ELSD)。 90 名患者完成了所计划的 2 年随访, 包括使用 ieMRI对眩晕频率和 EH 体积变化进行评估(Group-I/MEPT：n = 40；Group-II/ELSD：n = 50)。

结果：手术后两年, I 组 77.5% 的患者眩晕得到完全控制, II组为 90.0%。 I 组 7.5% 的患者和 II组24.0% 的患者听力改善 >10 dB。 I 组和 II 组仅前厅治疗后, ELS 比率显著降低。

结论：所获结果表明 , MEPT 和 ELSD 可能是难治性 MD 患者治疗的良好选择。

Keywords:

• Meniere’s disease
• endolymphatic hydrops
• middle ear pressure therapy
• endolymphatic sac drainage surgery
• inner ear MRI

Acknowledgements

We wish to thank Dr. Masashi Choubi, a registered statistician (certificate number: 622017) for helpful advice on statistical analyses. We also thank Editage Group (www.editage.com) for editing a draft of this manuscript.

Author contributions

Tadashi Kitahara and Hiroaki Irino: study design, data interpretation, and writing. Masaharu Sakagami: data collection and analysis. Hiroshi Inui: data interpretation.

Conflicts of interest

The present study does not include any conflicts of interest.

Additional information

Funding

This study was supported in part by JSPS KAKENHI Grant (2023-2025), AMED under Grant Number 18dk0310092h000a and Health and Labour Sciences Research Grant for Research on Rare and Intractable Diseases (H29-Nanchito (Nan)-Ippan-031) from the Ministry of Health, Labour and Welfare of Japan.