Ongoing Discrepancy Between Unilateral Meniere's Disease and Bilateral Endolymphatic Hydrops on Hydrops MRI

Abstract

Objective

In the era of Hydrops MRI, a clinical dilemma has emerged: while Meniere's disease (MD) is diagnosed unilaterally, Hydrops MRI demonstrates endolymphatic hydrops (EH) bilaterally. This study aims to clarify this ongoing discrepancy.

Methods

Fifty-six MD patients underwent an inner ear test battery followed by 3 T Hydrops MRI. Eight unilateral MD patients with EH on both ears were classified as Group A and subdivided into Groups A1 (symptomatic EH on the affected ear, n = 8 ears) and A2 (asymptomatic EH on the opposite unaffected ear, n = 8 ears). Another 48 unilateral MD patients with EH on one ear only were referred to Group B and were subdivided into Group B1 (present EH, n = 48 ears) and Group B2 (absent EH, n = 48 ears).

Results

Both Groups A1 and B1 showed a significantly declining sequence of abnormality rates running from audiometry, cervical, and ocular vestibular-evoked myogenic potential tests to caloric test. However, such a declining trend was not observed in Groups A2 and B2. Significant differences in the abnormality rates of audiometry were noted in Groups A1 (88%) versus A2 (0) and Groups B1 (94%) versus B2 (27%). Four (50%) out of eight ears in Group A2 progressed to MD after a mean interval of 4 ± 2 years.

Conclusion

If Hydrops MRI identifies EH in both ears of a unilateral MD patient, monitoring cochlear symptoms, hearing thresholds, and imaging findings in the opposite (unaffected) ear may help predict the progression from unilateral MD to bilateral MD.

Level of Evidence

4.