Objective:To explore of auditory-vestibular function and inner ear imaging features of patients with Meniere's disease（MD） at different clinical stages. Methods:The clinical data of 110 patients with unilateral MD who were admitted from January 2023 to March 2024 were collected, and all patients were staged according to the results of pure tone hearing threshold test, including 13 patients with stage Ⅰ, 18 cases with stage Ⅱ, 65 cases with stage Ⅲ, and 14 cases with stage Ⅳ. All patients were tested for vestibular function, including caloric tests, vestibular evoked myogenic potentials（VEMPs）, vHIT and sensory integration tests（SOT）. The sites of endolymphatic hydrops were evaluated by intravenous endotogidolinium-based MRI, twenty-seven patients completed electrocochleography. Results:①The disease course time of patients with different stages was different, and the disease course time of stage Ⅰ and Ⅱ was shorter than that of stage Ⅲ and Ⅳpatients（P<0.05）. ②No statistical differences were found in clinical data or vestibular function between normal and abnormal ECochG groups（P>0.05）. ③The results of caloric tests showed that the UW% values of stage Ⅲ（45.5±14.79） and stage Ⅳ （51.57±22.44） were higher than those of stageⅠ（31.2±14.9） and stage Ⅱ（33.5±13.31）, there were statistically significant differences between stage Ⅰ and stage Ⅱ with stage Ⅲ and Ⅳ groups（P<0.05）, the total abnormal rate of cVEMP was 62.72%, there was a statistically significant difference between stageⅠand stage Ⅲ with the stage Ⅳ group（P<0.05）, the total abnormal rate of oVEMP was 71.82%, the difference between stage Ⅰ and stage Ⅳ group was statistically significant（P<0.05）. The total score of SOT comprehensive balance gradually decreased with the increase of clinical stage, and there was a significant difference between the stage Ⅰ and Ⅳ groups（H=26.08, P<0.01）, and there was a statistically significant difference in the rate of vestibular dysfunction of SOT between the two groups（χ²=6.7, P<0.05）. ④Patients with vestibular and cochlear endolymphatic hydrops, and patients with simple cochlear or vestibular had significantly differences in disease course time, clinical stages, UW% value of caloric test, abnormal rate of cVEMP and oVEMP, total SOT balance score, the rate of vestibular abnormality（P<0.01）. Among them, when the vestibular and cochlear endolymphatic hydrops are at the same time, the clinical stage of the patient is mainly stage Ⅲand Ⅳ. Conclusion:Auditory-vestibular and inner ear gadolinium-contrasted MRI examinations in clinical practice provide a supplementary reference for judging vestibular function and the type of endolymphatic hydrops.
Humans ; Meniere Disease/diagnostic imaging* ; Ear, Inner/physiopathology* ; Male ; Magnetic Resonance Imaging ; Female ; Middle Aged ; Vestibule, Labyrinth/diagnostic imaging* ; Adult ; Vestibular Evoked Myogenic Potentials ; Aged ; Audiometry, Pure-Tone ; Caloric Tests ; Vestibular Function Tests

The purpose of the study was to observe changes in endolymphatic hydrops by using intratympanic injection of gadolinium and magnetic resonance imaging (MRI) before and after endolymphatic sac surgery in patients with unilateral Meniere's disease. Thirteen patients with unilateral Meniere's disease undergoing endolymphatic sac surgery were retrospectively and prospectively analyzed. Three-dimensional fluid-attenuated inversion recovery or three-dimensional real inversion recovery MRI was performed 24 h after an intratympanic injection of gadolinium to grade the presence of endolymphatic hydrops. Among the 13 patients with hydrops confirmed by preoperative MRI, vestibular hydrops had no significant change in all patients; cochlear hydrops became negative in 2 patients, and remained unchanged in the other 11 patients after surgery. Definite vertigo attacks were substantially controlled in one patient and completely controlled in 12 patients during a follow-up period of 8-34 months after surgery. The hearing levels were improved in 3 patients, remained unchanged in 7 patients, and decreased in 3 patients. In conclusion, endolymphatic sac surgery does not always alleviate endolymphatic hydrops in patients with Meniere's disease. Relief from vertigo cannot always be attributed to the remission of hydrops. A change in hearing levels cannot be explained by hydrops status alone.
Adult ; Aged ; Contrast Media ; administration & dosage ; Endolymphatic Hydrops ; diagnostic imaging ; pathology ; surgery ; Endolymphatic Sac ; diagnostic imaging ; pathology ; surgery ; Female ; Gadolinium ; administration & dosage ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Male ; Meniere Disease ; diagnostic imaging ; pathology ; surgery ; Middle Aged

Vestibular schwannoma is a rare tumor, which is easily misdiagnosed. The authors presented a case of vestibular schwannoma in a 36-year-old woman. The clinical manifestations were recurrent vertigo, hearing loss of the left ear, and tinnitus. The pure tone audiometry threshold of the left ear was 45dBHL with air conduction, and 33 dBHL with bone conduction. A CT scan of the temporal bone region didn't show any abnormal finding. A MRI scan of the head showed nodule abnormal signal in the internal of left vestibular and the narrow of perilymphaticum gap in T2W1 + T2Flair. The initial diagnosis was Meniere's disease. And the post-operation pathologic diagnosis was vestibular schwannoma.
Adult ; Audiometry, Pure-Tone ; Diagnostic Errors ; Female ; Hearing Loss ; Humans ; Magnetic Resonance Imaging ; Meniere Disease ; diagnosis ; Neuroma, Acoustic ; diagnosis ; Temporal Bone ; Tinnitus ; Tomography, X-Ray Computed ; Vertigo ; Vestibule, Labyrinth

OBJECTIVETo attempt to visualize the endolymph in patients with Meniere's disease by applying non-invasive intratympanic gadolinium through eustachian tube and three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI).

METHODSWith a 3 Tesla magnetic resonance imaging (MRI) unit, 3D-FLAIR imaging was performed 24 hours after intratympanic gadolinium through eustachian tube in two patients with medically active and intractable Meniere's disease. Pure tone test and tympanometry were performed 24 hours before and after the administration of gadolinium.

RESULTSThe gadolinium appeared in almost all parts of the perilymph inside the inner ear; moreover, the border between the perilymph and the endolymph was visible so endolymphatic space was clearly shown on 3D-FLAIR. No change in pure tone test and tympanometry was noted.

CONCLUSIONS3D-FLAIR MRI with intratympanic gadolinium through eustachian tube can clearly reveal the visualization of endolymph in patients with Meniere's disease. Intratympanic gadolinium therapy through eustachian tube is a safe and effective.

Adult ; Endolymph ; diagnostic imaging ; Female ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Male ; Meniere Disease ; diagnostic imaging ; Middle Aged ; Radiography