Otolithic membrane damage in patients with endolymphatic hydrops and drop attacks.
OBJECTIVE
1. Evaluate the otolithic membrane in patients with endolymphatic hydrops (EH) and vestibular drop attacks (VDA) undergoing ablative labyrinthectomy. 2. Correlate intraoperative findings to archival temporal bone specimens of patients with EH.


METHODS
Retrospective case review.


METHODS
Tertiary referral center. SPECIMEN SOURCE: 1. Patients undergoing labyrinthectomy for incapacitating Ménière's disease (MD), delayed EH, VDA, or acoustic neuroma (AN) between 2004 and 2011. 2. Archival temporal bone specimens of patients with MD.


METHODS
Ablative labyrinthectomy.


METHODS
Examination of the utricular otolithic membrane.


RESULTS
The otolithic membrane of the utricle was evaluated intraoperatively in 28 patients undergoing labyrinthectomy. Seven (25%) had a history of VDA, 6 (21%) had delayed EH, 9 (32%) had MD, and 6 (21%) had AN. All patients with VDA showed evidence of a disrupted utricular otolithic membrane, whereas only 50% and 56% of patients with delayed EH and MD, respectively, demonstrated otolithic membrane disruption (p = 0.051). None of the patients with AN showed otolithic membrane disruption (p = 0.004). The mean thickness of the otolithic membrane in 5 archival temporal bone MD specimens was 11.45 micrometers versus 38 micrometers in normal specimens (p = 0.001).


CONCLUSIONS
The otolithic membrane is consistently damaged in patients with VDA. In addition, there is a significantly higher incidence of otolithic membrane injury in patients with MD and delayed EH compared with patients without hydrops, suggesting that the underlying pathophysiology in VDA results from injury to the otolithic membrane of the saccule and utricle, resulting in free-floating otoliths and atrophy.
Departments of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California 90095, USA.
Audrey P
AP
Calzada
Ivan A
IA
Lopez
Gail
G
Ishiyama
Akira
A
Ishiyama
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003638:Deafness / Q000150:complications; D018159:Endolymphatic Hydrops / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000473:pathology / Q000601:surgery; D008575:Meniere Disease / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery; D010037:Otolithic Membrane / Q000473:pathology* / Q000601:surgery; D013506:Otologic Surgical Procedures; D012444:Saccule and Utricle / Q000473:pathology; D013575:Syncope / Q000473:pathology* / Q000601:surgery; D013701:Temporal Bone / Q000473:pathology / Q000601:surgery; D014717:Vertigo / Q000209:etiology