梅尼埃病内淋巴积水影像学测定

目的采用经咽鼓管鼓室内导入造影剂钆喷酸葡胺稀释液、内耳三维快速液体衰减反转恢复磁共振扫描（three dimensional fluid attenuated inversion recovery magnetic resonance imaging,3D-FLAIR MRI）,探讨梅尼埃病内淋巴液截面积的测定方法。方法 5例梅尼埃病患者和10名健康受试者经咽鼓管鼓室内导入钆喷酸葡胺稀释液、24h后行内耳3D-FLAIR MRI。耳蜗部采用斜矢位蜗轴截取平面,测量耳蜗底转内淋巴间隙和总淋巴间隙面积;前庭部采用冠状位前庭长轴垂直截取平面,测量前庭部内淋巴间隙（椭圆囊和球囊的面积之和）和总淋巴间隙。结果 5例梅尼埃病患者单侧患耳和10名健康受试者受试耳的内耳3D-FLAIR MRI显示内耳的耳蜗、前庭和（或）半规管的外淋巴间隙广泛可见造影剂钆增强区影,可以区分内、外淋巴间隙的边界和清晰显像内淋巴间隙的情况。5例梅尼埃病患者的耳蜗和前庭部的内淋巴间隙评定值分别为0.36±0.08和0.40±0.12;全组梅尼埃病患者（5例）和健康受试者（10名）之间耳蜗的内淋巴间隙评定值比较有统计学差异（P〈0.05）。结论经咽鼓管鼓室内导入造影剂钆、内耳3D-FLAIR MRI,采用客观统一的内淋巴间隙核磁采集和测定方法可以评定梅尼埃病内淋巴积水的情况。     

梅尼埃病的内淋巴积水显像

目的 采用无创性技术经咽鼓管鼓室内导入造影剂钆,进行内耳三维快速液体衰减反转恢复磁共振扫描(three dimensional fluid attenuated inversion recovery magnetic resonance imaging,3D-FLAIR MBI),探讨梅尼埃病内淋巴间隙的显像.方法 7例梅尼埃病患者患侧经咽鼓管鼓室内导入钆喷酸葡胺稀释液,24 h后进行内耳3D-FLAIR MRI.全部患者于造影剂导入前、导人后24 h及3个月时分别进行纯音测听和鼓室声导抗检查.结果 5例患者内耳3D-FLAIR MRI显示造影剂钆广泛分布于患侧耳蜗、前庭和(或)半规管的外淋巴,可以区分内、外淋巴间隙的边界,清晰显像内淋巴情况;2例患者患侧包围内淋巴的外淋巴间隙缩小或消失(即不显影),提示内淋巴积水的存在.5例患侧中耳鼓室腔内未见造影剂钆增强;2例患侧部分中耳乳突腔内可见造影剂钆增强,而内耳未见明显增强.所有患者造影剂给药前和给药后24 h纯音测听平均听阈无明显变化;给药前、给药后24 h及3个月时鼓室声导抗结果无明显变化.结论 经咽鼓管鼓室内导入造影剂钆进行内耳3D-FLAIR MRI扫描,可以了解梅尼埃病患者内淋巴间隙情况.     

经鼓室钆注射内耳成像磁共振检查在梅尼埃病中的应用

目的 对梅尼埃病(Meniere's disease)患者采用经鼓膜穿刺鼓室内注入对比剂钆、内耳三维快速液体衰减反转恢复磁共振(three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging,3D-FLAIR MRI)扫描,将影像学显示的膜迷路积水情况与临床听力及前庭功能检查结果进行比较,探讨经鼓室钆注射内耳成像磁共振在梅尼埃病诊断中的应用价值.方法 32例经临床确诊的单侧梅尼埃病患者,双侧耳均经鼓膜穿刺鼓室内注入对比剂钆喷酸葡胺稀释液,24 h后行3D-FLAIR MRI和三维平衡快速梯度回波磁共振扫描,观察双侧耳蜗、前庭和半规管外淋巴间隙的增强显影,对耳蜗底转鼓阶和前庭阶分别进行评分,并对前庭外淋巴间隙显影范围进行测量.患者常规行纯音测听、冷热试验、前庭诱发肌源性电位(vestibular evoked myogenic potential,VEMP)和耳蜗电图检查.将患侧耳蜗底转前庭阶评分及前庭外淋巴间隙显影范围分别按纯音测听、冷热试验、VEMP、耳蜗电图的检查结果分组进行比较,采用SPSS17.0统计软件进行数据分析.结果 全部患者内耳3D-FLAIR MRI均显示对比剂钆广泛分布于耳蜗、前庭和半规管的外淋巴间隙,可清晰对比显示内淋巴间隙.患侧耳蜗底转前庭阶评分值与健侧比较,差异具有统计学意义(Z=4.309,P＜0.05);患侧与健侧前庭外淋巴间隙显影范围(-x±s)分别为(6.04±2.89)mm2和(8.28±3.04) mm2,二者比较差异具有统计学意义(t =3.322,P ＜0.05).VEMP异常组患者与VEMP正常组比较,患侧前庭显影范围明显缩小,差异具有统计学意义(F=11.96,P＜0.05).耳蜗电图异常组患者与正常组比较,耳蜗底转前庭阶评分明显偏低,差异具有统计学意义(Z=3.17,P＜0.05).患侧耳蜗前庭阶评分及前庭显影范围与患者听力水平及冷热试验结果无明显相关.结论 经鼓室钆注射内耳3 D-FLAIRMRI可以区分内、外淋巴间隙的边界,显示膜迷路积水情况,可为梅尼埃病的诊断提供影像学参考.VEMP和耳蜗电图检查结果可能与前庭和耳蜗积水程度有一定相关性.     

三维液体衰减反转恢复序列磁共振成像在内耳疾病中的应用研究

 目的探讨三维液体衰减反转恢复序列磁共振成像(3D FLAIR MRI)在内耳疾病诊断中的应用。方法选择我院52例内耳疾病患者作为研究对象,将其分为研究组（梅尼埃病患耳组、可疑梅尼埃病患耳组和突发性聋患耳组）和对照组（健侧耳组）,对受试者进行耳蜗电图及内耳3D FLAIR MRI扫描等相关检查,观察各组内耳3D FLAIR MRI内淋巴显像与耳蜗电图关系。结果3D FLAIR MRI扫描可观察到梅尼埃病组、可疑梅尼埃病组、突聋组内淋巴积水程度患侧比健侧耳组严重,但梅尼埃病、可疑梅尼埃病及突发性聋的内淋巴积水程度差异无统计学意义。内淋巴积水诊断的阳性率3D FLAIR MRI扫描高于耳蜗电图,尤其在可疑梅尼埃病的诊断中3D FLAIR MRI 检查比耳蜗电图更具有优势,但尚不能认为3D FLAIR MRI扫描可以取代耳蜗电图检查。结论三维液体衰减反转恢复序列磁共振成像在内耳疾病诊断中的应用效果显著,可以用于梅尼埃病、可疑梅尼埃病及突聋的辅助诊断,能有效提高内耳内淋巴积水的检出率。     

梅尼埃病患者前庭内淋巴积水程度与其症状和听觉及前庭功能的相关性分析

目的探讨梅尼埃病患者前庭内淋巴积水程度与其症状、听觉及前庭功能的相关性。方法以34例单侧梅尼埃病患者为研究对象,分别行双侧鼓室内注入稀释8倍的钆喷酸葡胺注射液,24小时后在3T场强下行内耳3DFLAIR序列磁共振成像(three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging,3DFLAIR MRI),评估内淋巴积水程度,并与患者年龄、病程、疾病分级、眩晕发作频率、前庭诱发肌源性电位(VEMP)结果、耳蜗电图结果、冷热试验结果、纯音听阈进行相关性分析。结果 34例患者鼓室注入钆剂后,除5例出现短暂眩晕外,其余患者均未诉不适,未见鼓膜穿孔、感染等并发症。3DFLAIR MRI显示34例患耳前庭外淋巴间隙均清晰显影,可清晰对比显示前庭内淋巴积水征象,其中轻度积水8例,中度积水11例,重度积水15例。34例患者平均听阈为9~90dB HL,平均为43.56dB HL;冷热试验异常21例,正常13例,诊断率为61.76%;VEMP正常17例,异常7例,未引出10例,诊断率为50%;耳蜗电图异常22例,正常12例,诊断率为64.71%。患者前庭内淋巴积水程度与病程、眩晕发作频率、耳蜗电图结果、冷热试验结果无显著相关性(P>0.05),与患者年龄、纯音听阈、疾病分级、VEMP结果有显著相关性(P<0.01),对应的相关系数分别为0.494、0.568、0.590、0.495。结论梅尼埃病患者前庭内淋巴积水程度与其年龄、疾病分级,纯音听阈及VEMP结果显著相关,与病程、眩晕发作频率、耳蜗电图、冷热试验结果无明显相关性。     

钆增强MRI检测梅尼埃病患者内淋巴积水的技术操作与临床应用北大核心CSCD

梅尼埃病的诊断过去一直缺乏客观依据,钆增强颞骨MRI检测内淋巴积水技术的应用使得在临床上确诊梅尼埃病成为可能。本文描述了钆增强MRI检测梅尼埃病内淋巴积水的研究背景与相关基础、临床操作方法、存在问题与解决方案、以及该技术的应用对梅尼埃病临床研究的影响,还介绍了其他内耳疾病的内淋巴积水检测情况。钆对比剂投放的方法包括鼓室注射法和静脉注射法,前者药物从鼓室经过卵圆窗的镫骨环韧带和圆窗膜、以及从血液经中轴的Schwalbe耳蜗血管球等通道进入内耳外淋巴腔隙。图像采集一般采用基于3T磁共振成像仪的三维液体衰减反转恢复(3D-FLAIR)脉冲序列,图像重建采用实部数据或幅度重建算法。经鼓室注射投放钆效果较好,临床适用人群广泛,但对操作要求较高;静脉注射钆对比剂的操作方便,但是内耳增强效果总体欠佳,且有潜在的肾脏毒副作用,肾脏功能不良者无法接受该检查。内淋巴积水程度的评估方法包括半定量的各个分区面积或体积比值法和形态学判定法,其中半定量法存在较大误差,形态学判定法使用较为简便,但是,前提条件是要排除潜在的技术性问题导致的假阳性。近期报道的新的形态学判定法有较大改进,其临床应用效果有待进一步验证。钆增强MRI检测内淋巴积水的研究工作促进了国内外梅尼埃病的临床诊疗水平的提高。     

梅尼埃病内淋巴积水MRI影像诊断评价及影响因素分析

目的针对拟诊为梅尼埃病的患者,以MRI检测内淋巴积水为方法,探讨在梅尼埃病诊断中以此方法确诊为内淋巴积水的可行性,并评估临床诊断价值,分析影响判定结果的相关因素。方法选择2013.6月-2014.11月间住院病人梅尼埃病43例做为研究对象,经鼓室注射钆喷酸葡胺造影剂24小时后进行内耳MRI检查,MRI扫描序列为T1加权三维自旋回波序列(3D-FSE-T1WI),所得图像以前庭和耳蜗底转各自内淋巴面积占内外淋巴面积之和的比率大于1/3为阳性,应用三分法进行定性判定,进行计数并统计。结果在43例梅尼埃病中,35例(81.40%)在前庭发现内淋巴积水,4例(9.30%)未发现积水,另外4例(9.30%)不能确定;在耳蜗,36例(83.72%)发现内淋巴积水,3例(6.98%)未发现积水,另外4例(9.30%)不能确定。结论鼓室内注射顺磁性造影剂后内耳MRI检查可发现内淋巴积水,是临床确定内淋巴积水有效和可行的方法。其主要影响因素包括造影剂进入内耳受阻扩散不良、鼓室给药技术、MRI检测技术及主观判定因素。     

梅尼埃病患者MRI造影所见内淋巴积水程度的临床相关性研究

目的分析梅尼埃病患者MRI造影所见内淋巴积水程度与疾病分级、纯音听阈、前庭诱发肌源性电位(VEMP)的相关性。方法以本单位2014年6月~2016年6月诊治的176例梅尼埃病患者为研究对象,均鼓室内注射稀释8倍的钆喷酸葡胺对比剂,在24h后进行内耳3D-FLATR MRI影像学检查,计算患者的内淋巴积水程度,并与梅尼埃疾病分级、纯音听阈、前庭诱发肌电位(VEMP)等指标进行相关性分析。结果 (1)内淋巴积水程度:176例梅尼埃病患者均获得良好的MRI影像,有171例患者的R值33.3%,阳性率为97.16%,其中显示中度积水63例(36.84%)、重度积水108例(63.16%)。(2)纯音听阈与疾病分级:患者听阈在10~88d BHL之间,平均听阈(42.8±13.59)d BHL;其中1级17例(9.66%),2级35例(19.89%),3级58例(32.95%),4级66例(37.50%)。(3)VEMP测试:VEMP测试正常者84例(47.73%),异常者37例(21.02%),未引出55例(31.25%)。(4)Spearman相关性分析,内淋巴积水程度与疾病分级、纯音听阈、VEMP分别相关(r=0.5218、0.5673、0.3904,P0.05)。结论MRI造影所见内淋巴积水程度与纯音听阈、疾病分级、VEMP等显著相关,提示该检查方法可以为梅尼埃病的临床诊断提供客观依据。     

1.5T MRI经静脉钆造影在内耳膜迷路积水诊断中的临床应用[论著]

目的　探讨1.5T MRI经静脉3D-Flair内耳钆造影在内耳膜迷路积水诊断中的临床应用价值。方法　收集2018年5月至2020年11月鄂尔多斯市东胜区人民医院耳鼻咽喉科门诊就诊的17例（17耳）梅尼埃病和16例（16耳）前庭性偏头痛患者。其中梅尼埃病组（实验组）男11例（11耳）,女6例（6耳）,年龄28~69岁,中位年龄56岁,病程1~17年;前庭性偏头痛组（对照组）16例（16耳）, 男3例（3耳）,女13例（13耳）,年龄31~67岁,中位年龄48.5岁,病程6个月~3年。两组病例均先行1.5T MRI内耳水成像和3D-Flair序列扫描（层厚1 mm）,第1次扫描后即行静脉注射钆剂,剂量为0.4 ml/kg,通过肘静脉以3.0 ml/min的速度注射入体内,注射钆剂后4.5 h行第2次3D-Flair序列扫描。由2名有经验的核磁室医师依据内耳膜迷路MRI评分法观察比较内耳半规管、前庭、耳蜗各 转水成像及钆造影前后3D-Flair图像,并进行评分判断是否存在内耳膜迷路积水。结果　33例患者均获得满意的MRI图像,其中17例梅尼埃病患者中16例患耳提示膜迷路积水,积水显示率为94.11%;16例前庭性偏头痛患者中1例症状耳提示膜迷路积水,积水显示率为6.25%。实验组和对照组比较,实验组积水率高于对照组,两者比较差异有统计学意义（χ2=25.48,P <0.05）。结论  1.5T MRI经静脉双倍剂量内耳3D-Flair钆造影在内耳膜迷路积水诊断中具有一定的临床应用价值。     

内耳内淋巴积水磁共振影像评估中国专家共识(2020)北大核心CSCD

内耳内淋巴积水的磁共振(magnetie resonance,MR)影像评估技术是指临床上运用MR及钆对比剂(gadolinium-based contrast agent)对内耳内、外淋巴间隙进行成像得到内淋巴造影图像并评估内耳内淋巴积水的影像学诊断技术,即通过不同方法将钆对比剂引入内耳外淋巴来改变外淋巴液的弛豫时间,通过设置合适的MR序列扫描参数(重复时间与反转时间),提高外淋巴信号强度,形成内、外淋巴的信号差异,得以在MR图像上突出显示内淋巴,并通过面积、容积测量和/或目测评分系统,衡量内、外淋巴间隙的空间构成比,评估内淋巴积水的情况。该技术在以内淋巴积水为主要病理特征的一系列内耳病的诊断和疗效评估中具有重要作用,其代表性疾病为梅尼埃病,也可见于突发性聋、大前庭导水管综合征等疾病。国内习惯称之“内耳MR钆造影”。     

Imaging of the endolymphatic space in patients with Ménière’s disease

Objective

To examine endolymphatic hydrops (EH) using magnetic resonance imaging (MRI) in patients with definite Ménière’s disease (MD) and those with nonotological diseases.

Comparison of noninvasive evaluation of endolymphatic space in healthy volunteers in different age groups using magnetic resonance imaging

Conclusions: Noninvasive standard evaluation of normal endolymphatic space and endolymphatic hydrops using magnetic resonance imaging (MRI) in various age groups is reported for the first time. Objective: To compare the standard evaluation of endolymphatic space in healthy volunteers in the cochlea and the vestibule among different age groups by applying noninvasive intratympanic gadolinium (Gd) perfusion through the eustachian tube and three-dimensional fluid-attenuated inversion recovery MRI (3D-FLAIR MRI). Methods: This was a prospective study. 3D-FLAIR MRI was performed with a 3 T unit 24 h after intratympanic administration of Gd through the eustachian tube in 60 healthy volunteers aged 20–55 years. Pure-tone test and tympanometry were performed 24 h before and 1 week after Gd administration. Results: There was no significant difference in the ratios of the area of the endolymphatic space to that of the fluid space in the cochlea and the vestibule between males and females, or among 20–30-, 31–44-, and 45–55-year-old healthy volunteers. In 20–55-year-old healthy volunteers, the normal value of the endolymphatic space in the cochlea ranged between 7% and 27%, and that in the vestibule was between 17% and 39%. No significant changes in pure-tone test or tympanometry were noted.     

Endolymphatic hydrops in patients with unilateral and bilateral Meniere’s disease

Conclusion: All definite Meniere’s disease (MD) had endolymphatic hydrops (EH) at least in the cochlea or the vestibule. Symptoms of MD may appear after formation of EH. It is assumed that the probability of immediate progression to bilateral MD from unilateral MD is very low in patients without EH on the non-affected side.

Objective: To evaluate the EH on both sides in patients with unilateral and bilateral MD, and to investigate factors with progression to bilateral MD including the degree of EH, hearing level, and the duration of MD.

Patients and methods: The study included 29 patients with unilateral definite MD and 12 patients with bilateral definite MD. The endolymphatic space size was visualized by using 3-Tesla magnetic resonance imaging.

Results: All patients with unilateral and bilateral MD had significant or mild EH at least in the cochlea or the vestibule on the affected side. On the non-affected side, EH was not observed at all in eight patients, but asymptomatic EH was observed in the cochlea in 14 patients and in the vestibule in 16 patients. There was no relationship between the EH on the non-affected side and the duration of MD.     

Vestibular aqueduct in Menière's disease and non-Menière's disease with endolymphatic hydrops: a computer aided volumetric study.

The volume of the vestibular aqueduct was studied by a computer-aided volumetric method in 9 temporal bones with endolymphatic hydrops from individuals with Menière's disease (MD), 7 temporal bones with endolymphatic hydrops from individuals without a history of Meniere's disease (non-MD hydrops), and 10 normal temporal bones (controls) to investigate the cause of endolymphatic hydrops in both MD and non-MD hydrops. A hypoplastic vestibular aqueduct was found significantly more often in the MD group than in either the non-MD hydrops group (chi 2-test, chi 2 = 4.063, p less than 0.05) or the control group (chi 2-test, chi 2 = 6.363, p less than 0.05). The difference in volume between the non-MD hydrops group and the control group was not significant. It is speculated that a small vestibular aqueduct (presumably containing a small endolymphatic sac) might be a predisposing factor in Menière's disease. In contrast, in non-MD hydrops, there seems to be no correlation of endolymphatic hydrops with a hypoplastic vestibular aqueduct and endolymphatic sac.     

Magnetic resonance imaging evaluation of endolymphatic hydrops andpost-operative findings in cases with otosclerosis

Conclusions: The presence of endolymphatic hydrops (EH) in the vestibule on magnetic resonance imaging (MRI) might be a high-risk factor for complications in cases that are candidates for stapes surgery.

Objective: Pre-operative detection of EH could be valuable in cases that are candidates for stapes surgery to prevent unpredictable complications following surgery. Pre-operative MRI findings and post-operative findings following stapes surgery were compared to evaluate the efficacy of such MRI evaluation for the management of cases with otosclerosis.

Subjects and methods: Sixteen cases who underwent pre-operative evaluation by 3T MRI performed 4?h after intravenous injection of gadolinium and stapes surgery for otosclerosis were recruited. Imaging data concerning the degree of EH in the vestibule and cochlea were compared with post-operative clinical findings for all cases.

Results: Mild EH in the cochlea or the vestibule was observed in eight ears and one ear, respectively, whereas one ear showed significant EH both in the cochlea and the vestibule. The post-operative course was uneventful in 12 of 14 cases with no EH in the vestibule, and the other two cases had a short period of dizziness, but two cases with EH in the vestibule had a long period of dizziness.     

两种内淋巴积水动物模型中水通道蛋白1的表达

目的了解水通道蛋白1（aquaporin 1，AQP1）在手术及醛固酮引起的内淋巴积水豚鼠耳蜗及内淋巴囊中的表达情况。方法30只健康豚鼠随机分为手术组、醛固酮注射组和对照组，每组10只。通过手术阻塞内淋巴囊和腹腔注射醛固酮的方法制造出两种内淋巴积水动物模型，采用免疫组化染色及蛋白质印迹法检测豚鼠耳蜗及内淋巴囊中AQP1的表达，通过图像处理软件进行半定量分析。结果手术组出现中、重度内淋巴积水，以顶回最为明显，自顶回向底回减轻；醛固酮注射组出现轻、中度积水，积水多位于底回。两组积水动物模型中AQP1表达的部位与对照组相同，手术组耳蜗与对照组相比AQP1表达差异无统计学意义（t=0．718，P〉0．05）；醛固酮组耳蜗AQP1表达低于对照组（t=6．609，P〈0．01）；对照组与醛固酮组内淋巴囊AQP1表达差异无统计学意义（t=0．998，P〉0．05）。醛固酮组耳蜗外侧壁组织中AQP1蛋白定量低于对照组（t=13．626，P〈0．01）。结论AQP1在手术引起的内淋巴积水中表达没有改变，在醛固酮引起的内淋巴积水中表达下降。AQP1在豚鼠内耳中的表达可能受离子浓度的调节。     

突发性聋患者内耳三维液体衰减反转恢复成像在预后评估中的价值

目的 探讨突发性聋患者内耳在三维液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)成像上的表现及其与疗效间关系.方法 23例突发性聋患者行三维FLAIR成像,观察内耳在FLAIR上的表现,并测定入院和治疗后的平均听阈,分析内耳信号与治疗结果之间关系.结果23例患者中8例患侧耳蜗在FLAIR上呈高信号,15例患侧及全部健侧耳蜗无信号.就诊时患侧耳蜗无信号组患者平均((x)±s,下同)听阈(听力级,下同)为(80±24) dB,耳蜗高信号组平均听阈为(92±18)dB,差异无统计学意义(t=1.245,P＞0.05);治疗后两组的平均听阈分别为(60±28)dB和(90±21)dB,有效率分别为60.0％和12.5％,差异均有统计学意义(P值均＜0.05).7例伴有眩晕患者中5例患侧半规管在FLAIR上呈高信号,此5例均治疗无效.结论三维FLAIR可显示突发性聋患者内耳淋巴液改变,呈高信号时疗效及预后差.     

Responses of the endolymphatic sac to perilymphatic injections and withdrawals: evidence for the presence of a one-way valve

Although the endolymphatic sac (ES) is thought to be a primary site for endolymph volume regulation, we have limited knowledge of how it responds to volume and pressure changes. In a prior publication, we demonstrated changes of K(+), Na(+) and endolymphatic sac potential (ESP) resulting from volume injections into, and withdrawals from, scala media of the cochlea. In the present study, we compared the influence of injections into and withdrawals from scala tympani of the cochlea on the endolymphatic sac. It is assumed that similar pressure changes are induced in endolymph and perilymph of both the cochlear and vestibular compartments of the ear. Pressure changes induced by the perilymphatic injections and withdrawals did not induce similar K(+) changes in the ES. The majority of perilymph withdrawals caused K(+) and ESP reductions in the sac, but few injections caused any measurable changes in the sac. Pressure measurements from the ES demonstrated that transmission of labyrinthine pressures to the lumen was directionally sensitive, with negative pressure transmitted more effectively than positive. In other experiments, application of infrasonic stimulation to the ear canal resulted in K(+) increase in the ES. These physiological measurements suggest that the endolymphatic duct may be closed by sustained positive pressure in the vestibule but open during pressure fluctuations. Study of the anatomy where the endolymphatic duct enters the vestibule suggests that the membranous sinus of the endolymphatic duct could act as a mechanical valve, limiting the flow of endolymph from the saccule to the endolymphatic sac when pressure is applied. This structure could therefore play an important role in endolymph volume regulation.     

Localization, frequency, and severity of endolymphatic hydrops and the pathology of the labyrinthine membrane in Menière's disease

The localization, frequency, and severity of endolymphatic hydrops in 22 temporal bones of 16 individuals with Meniere's disease were studied histopathologically. Endolymphatic hydrops was more often observed in the pars inferior (22/22) than in the pars superior (13/22) of the temporal bone, and severe hydrops was observed most frequently in the saccule, followed by the cochlea, the utricle, and the three semicircular canals. In the cochlea, the most severe hydrops was observed in the apical turn, followed by the hook portion, the middle turn, and the basal turn. Clinically interesting observations regarding endolymphatic hydrops included bulging into the perilymphatic space of the vestibule. In 17 of 22 bones the saccular membrane bulged into the vestibule laterally and was attached to the footplate of the stapes. In two of 22 bones, Reissner's membrane in the hook portion of the basal turn of the cochlea bulged superiorly into the vestibule, occupying most of the perilymphatic space of the vestibule.     

Gadolinium-enhanced MRI reveals dynamic development of endolymphatic hydrops in Ménière's disease

IntroductionMeniere's disease is associated with impaired hearing, tinnitus, vertigo, and aural fullness. Many anatomical studies have suggested idiopathic endolymphatic hydrops as the pathological basis of Meniere's disease, which now can be visualized by using gadolinium -enhanced magnetic resonance imaging of the inner ear.ObjectiveTo investigate the development of endolymphatic hydrops in Meniere's disease by monitoring the vestibules and cochleae of affected patients.MethodsInner ears of 178 patients with definite unilateral Meniere's disease diagnosis were visualized by 3-dimensional fluid-attenuated inversion recovery and three-dimensional real inversion recovery magnetic resonance imaging following bilateral gadolinium intratympanic injection. The scans were used to evaluate the presence and degree of endolymphatic hydrops in the vestibules and cochlear structures, including the cochlear apical turn, the cochlear middle turn, and the cochlear basal turn. The correlation of endolymphatic hydrops occurrence between the various parts of the inner ear was determined.ResultsSymptomatic endolymphatic hydrops was detected on the affected side in all patients, whereas asymptomatic endolymphatic hydrops was detected on the unaffected contra-lateral side in 32 patients (18.0%). On the affected side, the cochlear apical turn and the cochlear middle turn demonstrated significantly higher rates of endolymphatic hydrops than the cochlear basal turn and the vestibule. The severity of endolymphatic hydrops gradually decreased from the cochlear apical turn to the cochlear basal turn. On the contra lateral side, the incidence and degree of the detected asymptomatic endolymphatic hydrops were significantly greater in the cochleae than in the vestibules (p < 0.05), with no significant difference detected between the cochlear turns.ConclusionProgression of endolymphatic hydrops appears to be directional, initiated in the cochlea. The order of endolymphatic hydrops severity gradually decreases from the cochlear apical turn to the cochlear basal turn and then to the vestibule. Endolymphatic hydrops in the vestibule is associated with symptomatic Meniere's disease.