Intratympanic gadolinium magnetic resonance imaging supports the role of endolymphatic hydrops in the pathogenesis of immune-mediated inner-ear disease

J Laryngol Otol. 2018 Jun;132(6):554-559. doi: 10.1017/S0022215118000749. Epub 2018 Jun 11.

Abstract

Objective: To evaluate the presence of endolymphatic hydrops in patients with immune-mediated inner-ear disease.

Methods: The presence of endolymphatic hydrops was prospectively evaluated in 17 patients clinically diagnosed with secondary (n = 5) or primary (n = 12) immune-mediated inner-ear disease, who attended the ENT department of a tertiary care centre for evaluation or treatment over the previous year. All patients underwent magnetic resonance imaging of the temporal bone.

Results: Intratympanic gadolinium three-dimensional magnetic resonance imaging diagnosed hydrops in 11 of 12 patients with primary immune-mediated inner-ear disease (92 per cent). Of these, seven patients (64 per cent) presented only cochlear (n = 5) or predominantly cochlear (n = 2) hydrops. A positive magnetic resonance imaging result was observed in only one of five patients with secondary immune-mediated inner-ear disease (20 per cent).

Conclusion: This study confirms the presence of endolymphatic hydrops in immune-mediated inner-ear disease patients. The virtual absence of hydrops in patients with secondary immune-mediated inner-ear disease is remarkable, although firm conclusions cannot be drawn; this should be explored in a multicentre study with a larger sample of patients. A different immune reaction without development of endolymphatic hydrops should not be ruled out in secondary immune-mediated inner-ear disease patients.

Keywords: Inner; Sensorineural; Autoimmunity; Ear; Endolymphatic Hydrops; Hearing Loss; Magnetic Resonance Imaging.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Audiometry, Pure-Tone
  • Autoimmune Diseases / diagnostic imaging*
  • Autoimmune Diseases / physiopathology
  • Contrast Media
  • Endolymphatic Hydrops / diagnostic imaging*
  • Endolymphatic Hydrops / physiopathology
  • Female
  • Heterocyclic Compounds
  • Humans
  • Imaging, Three-Dimensional
  • Injection, Intratympanic
  • Labyrinth Diseases / diagnostic imaging*
  • Labyrinth Diseases / physiopathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Organometallic Compounds
  • Prospective Studies
  • Young Adult

Substances

  • Contrast Media
  • Heterocyclic Compounds
  • Organometallic Compounds
  • gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate