title: Assessment of endolymphatic hydrops and otolith function in patients with Ménière's disease.
abstract: Ménière's disease is associated with hydrops of the inner ear endolymphatic space, and histopathologically, the cochlea and vestibule are usually involved. We used gadolinium-enhanced magnetic resonance imaging and measured cervical and ocular vestibular evoked myogenic potentials and the gain in the utricular induced linear vestibulo-ocular reflex to test the hypothesis that vestibular hydrops in Ménière's disease patients is associated with otolith organ dysfunction. We evaluated 21 patients diagnosed with unilateral definitive Ménière's disease using gadolinium magnetic resonance imaging to detect endolymphatic hydrops in the cochlea and vestibule. Cervical and ocular vestibular evoked myogenic potentials and the gain in utricular induced linear vestibulo-ocular reflex during eccentric rotation were measured to assess otolith organ function. For eccentric rotation, patients were rotated while displaced from the axis of rotation, while linear acceleration stimulated the utricle and induced the vestibulo-ocular reflex. Magnetic resonance imaging revealed vestibular hydrops in 14 of 20 patients (70%). Among the 14 patients, ten (71%) had abnormal cervical and three (21%) had abnormal ocular vestibular evoked myogenic potentials. Four patients (4/21, 19%) had abnormal linear vestibulo-ocular reflexes, three of whom also had abnormal ocular vestibular evoked myogenic potentials. Overall, 16 of 17 patients had normal linear vestibulo-ocular reflexes and normal ocular vestibular evoked myogenic potentials. Vestibular endolymphatic hydrops in Ménière's disease patients caused otolith organ dysfunction, mainly in the saccule. The number of Ménière's disease patients with abnormal ocular vestibular evoked myogenic potentials was low (19%), and they also had abnormal utricular induced linear vestibulo-ocular reflexes.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Okumura
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. timai@ent.med.osaka-u.ac.jp.
authors.forename: Takao
authors.identifier: http://orcid.org/0000-0002-1686-6787
authors.initials: T
authors.lastname: Imai
authors.affiliation: Department of Otolaryngology, Suita Municipal Hospital, Osaka, Japan.
authors.forename: Yasumitsu
authors.initials: Y
authors.lastname: Takimoto
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Tokushima University Graduate School of Medicine, Tokushima, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Takeda
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Nara Medical University School of Medicine, Nara, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kitahara
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan.
authors.forename: Atsuhiko
authors.initials: A
authors.lastname: Uno
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Kamakura
authors.affiliation: Department of Otorhinolaryngology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Osaki
authors.affiliation: Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Inohara
mesh_terms: D000328:Adult; D000368:Aged; D003051:Cochlea / Q000000981:diagnostic imaging*; D003287:Contrast Media; D018159:Endolymphatic Hydrops / Q000503:physiopathology*; D005260:Female; D005682:Gadolinium; D006571:Heterocyclic Compounds; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008575:Meniere Disease / Q000503:physiopathology*; D008875:Middle Aged; D009942:Organometallic Compounds; D012027:Reflex, Vestibulo-Ocular / Q000502:physiology*; D012399:Rotation; D058585:Vestibular Evoked Myogenic Potentials / Q000502:physiology*; D014722:Vestibule, Labyrinth / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium
keywords: Eccentric rotation test; Gd-enhanced MRI; Meniere’s disease; Otolith function; VEMP