Is Vestibular Meniere's Disease Associated With Endolymphatic Hydrops?
Is Vestibular Meniere's Disease Associated With Endolymphatic Hydrops?
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DOI：
10.3389/fsurg.2020.601692
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发表时间：
2020
影响因子：
1.8
通讯作者：
Horii A
中科院分区：
文献类型：
--
作者：
Morita Y;Takahashi K;Ohshima S;Yagi C;Kitazawa M;Yamagishi T;Izumi S;Horii A
背景：前庭梅尼埃病（美国眼科和耳鼻喉科学会，1972 年）也称为可能的梅尼埃病（美国耳鼻喉头颈外科学会，1995 年）或前庭型非典型梅尼埃病（V-AMD）（日本平衡研究学会，2017 年），其特征是阵发性眩晕，但不伴有听力损失。虽然被命名为梅尼埃病 (MD)，但这种疾病可能不仅仅由内淋巴积水 (EH) 引起。目的：与明确的梅尼埃病相比，评估 EH 在前庭梅尼埃病中的作用。方法：纳入 30 例单侧明确 MD 患者和 16 例前庭梅尼埃病患者。那些符合明确或可能前庭偏头痛标准的人被排除在外。所有患者均接受前庭评估，包括静脉注射钆后4小时内耳MRI、双热热量测试、转椅测试前庭眼反射定向优势、颈前庭和眼前庭诱发肌源性电位、踏步测试、头晕障碍量表（DHI）和医院焦虑抑郁量表（HADS）。所有上述测试以及眩晕发作的频率/持续时间在前庭梅尼埃病和 MD 之间进行了比较。结果：即使在单侧 MD 中，超过一半的患者不仅在患侧而且在健侧也出现了耳蜗和前庭内淋巴积液（c-、v-EH）。前庭梅尼埃病v-EH阳性率(68.8%)与MD(80%)一样高。前庭梅尼埃病中，前庭双侧EH的数量（56.3%）高于耳蜗（25.0%）。前庭梅尼埃病和 MD 之间的前庭测试和 DHI 没有差异；然而，前庭梅尼埃病患者眩晕发作的频率较低 (p = 0.001)。 MD组的HADS总分显着高于前庭梅尼埃病组。结论：MD是一种双侧内耳受累的全身性疾病。 V-EH 是前庭梅尼埃病的主要病理生理学，在前庭梅尼埃病（MD 的一种较温和亚型）的发展中，V-EH 会先于 c-EH。 MRI 可用于区分 MD 和由不同病理引起的其他眩晕发作，从而为 EH 提供证据。
Background: Vestibular Meniere's disease (American Academy of Ophthalmology and Otolaryngology, 1972) also known as possible Meniere's disease (American Academy of Otolaryngology Head and Neck Surgery, 1995) or vestibular type of atypical Meniere's disease (V-AMD) (Japan Society for Equilibrium Research, 2017) is characterized by an episodic vertigo without hearing loss. Though named as Meniere's disease (MD), this entity may not be caused solely by endolymphatic hydrops (EH). Objective: To estimate the role of EH in vestibular Meniere's disease in comparison with definite Meniere's disease. Methods: Thirty patients with unilateral definite MD and 16 patients with vestibular Meniere's disease were included. Those who met the criteria for definite or probable vestibular migraine were excluded. All patients underwent vestibular assessments including inner ear MRI 4 h after intravenous gadolinium injection, bithermal caloric testing, directional preponderance of vestibulo-ocular reflex in rotatory chair test, cervical- and ocular-vestibular evoked myogenic potential, stepping test, dizziness handicap inventory (DHI), and hospital anxiety and depression scale (HADS). All above tests and frequency/duration of vertigo spells were compared between vestibular Meniere's disease and MD. Results: Even in unilateral MD, cochlear and vestibular endolymphatic hydrops (c-, v-EH) were demonstrated not only in the affected side but also in the healthy side in more than half of patients. Positive rate of v-EH in vestibular Meniere's disease (68.8%) was as high as that of MD (80%). In vestibular Meniere's disease, the number of bilateral EH was higher in the vestibule (56.3%) than that in the cochlea (25.0%). There were no differences in vestibular tests and DHI between vestibular Meniere's disease and MD; however, the frequency of vertigo spells was lower in vestibular Meniere's disease (p = 0.001). The total HADS score in the MD group was significantly higher than that in the vestibular Meniere's disease group. Conclusions: MD is a systemic disease with bilateral involvement of inner ears. V-EH is a major pathophysiology of vestibular Meniere's disease, which would precede c-EH in the development of vestibular Meniere's disease, a milder subtype of MD. MRI is useful for differentiating MD from other vertigo attacks caused by different pathologies in bringing EH into evidence.
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