title: Magnetic resonance imaging of intratympanic gadolinium helps differentiate vestibular migraine from Ménière disease.
abstract: To study the differential diagnosis of vestibular migraine (VM) and Ménière disease (MD) by using magnetic resonance imaging (MRI) of intratympanic gadolinium.
  
  
  
  Prospective cohort study.
  
  
  
  Definite MD patients (n = 30) and definite or probable VM patients (n = 30) were included, and the two groups were age and sex matched. Three-dimensional real inversion recovery (3D-real-IR) MRI was performed 24 hours after bilateral intratympanic gadolinium to assess the presence and degree of endolymphatic hydrops (EH). Response rates, amplitudes, latency, and response threshold of cervical and ocular vestibular evoked myogenic potentials (c/oVEMPs) were tested by using air-conducted sound. Pure tone audiometry was used to evaluate the level of hearing loss.
  
  
  
  Different degrees of EH were observed in the cochlea and vestibule in the affected ears of MD patients, but only suspicious cochlear hydrops and no vestibular hydrops was noted in the VM patients. The correlation between the degree of EH and low-frequency hearing loss was statistically significant. Only the response threshold for c/oVEMP differentiated the MD-affected side from VM. The latency and amplitude for c/oVEMP showed no significant difference between groups.
  
  
  
  Characteristic pathological changes of MD include EH in the inner ear, and 3D-real-IR MRI helps differentiate VM from MD. VM and MD behaved similarly in vestibular dysfunction and their transduction pathway, but MD appeared to be more severe than VM. An association in their pathophysiology may play a part in these responses.
  
  
  
  4 Laryngoscope, 127:2382-2388, 2017.
authors.affiliation: Department of Otology and Skull Base Surgery, Hearing Research Key Laboratory of the Health Ministry of China, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors.forename: Wenfang
authors.initials: W
authors.lastname: Sun
authors.affiliation: Department of Otology and Skull Base Surgery, Hearing Research Key Laboratory of the Health Ministry of China, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Guo
authors.affiliation: Department of Otology and Skull Base Surgery, Hearing Research Key Laboratory of the Health Ministry of China, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors.forename: Tongli
authors.initials: T
authors.lastname: Ren
authors.affiliation: Department of Otology and Skull Base Surgery, Hearing Research Key Laboratory of the Health Ministry of China, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors.forename: Wuqing
authors.initials: W
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D001301:Audiometry, Pure-Tone; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D042601:Lymphatic Vessels; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008575:Meniere Disease / Q000175:diagnosis* / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D014722:Vestibule, Labyrinth / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Ménière disease; Vestibular migraine; intratympanic gadolinium; magnetic resonance imaging; vestibular evoked myogenic potential