MRI Detection of Endolymphatic Hydrops in Meniere's Disease

[Frédéric]

MRI detection of endolymphatic hydrops in Meniere's disease in 8 minutes using m3D-real IR and a 20-channel coil after targeted gadolinium delivery

Abstract
Background
Endolymphatic hydrops (EH) become visible in vertigo patients, particularly in those with Meniere's disease (MD), in vivo using gadolinium-enhanced MRI. However, the image quality is not satisfying after intravenous injection of gadolinium chelate (GdC), and occasional failure in GdC uptake has been noticed after traditional intratympanic injection. In the present report, targeted delivery of GdC and using a cost-effective MRI system to obtain high quality images of EH in only 8 min will be introduced.

Methods
39 MD patients were recruited in the study. First, 0.1 ml of 20-fold diluted gadolinium-diethylenetriamine acid (Gd-DTPA) was delivered onto the posterior upper part of the tympanic medial wall using a soft-tipped micro-irrigation catheter through an artificially perforated tympanic membrane. Inner ear MRI was performed 24 h after Gd-DTPA administration using a 3T MR machine and a 20-channel head/neck coil with a modified 8 min sequence of 3D-real inversion recovery (m3D-real IR). The parameters were as follows: TR 16000 ms, TE 663 ms, inversion time 2700 ms, flip angle 180°, slices per slab 60.

Results
Efficient inner ear uptake of Gd-DTPA was detected 24 h after delivery and it created excellent contrast in the inner ear of all cases. High quality images demonstrating EH in the vestibule and cochlea were obtained.

Conclusion
Targeted delivery of minimum Gd-DTPA (0.1 ml, 20-fold dilution) onto the posterior upper portion of the tympanic medial wall and MRI with m3D-real IR in a 3T machine and 20-channel head/neck coil are clinically practical to obtain high quality images displaying EH.

Full article: https://www.sciencedirect.com/science/article/pii/S2095881119301040

 

[Dana]

I was just talking with vermillion about how I have postponed for so long a recommended MRI with contrast substance because I am afraid that my tinnitus may aggravate, from that obnoxious loud sound on one side, and from injecting a substance that may/must enter in/near ear to see things but which may increase pressure, making things worse.

The substance of contrast will not be injected onto the posterior upper portion of the tympanic medial wall, but in the arm, I think. I am not even sure.

What do you understand from "artificially perforated tympanic membrane", @Frédéric, eardrum perforated not "naturally", like by an infection, for example, or an accident, as a second example?

 

[GregCA]

What do you understand from "artificially perforated tympanic membrane", @Frédéric, eardrum perforated not "naturally", like by an infection, for example, or an accident, as a second example?

It means that someone (most likely a doctor, since this is in the context of a study) deliberately perforated a patient's ear drum in order to be able to insert a catheter to deliver the contrast agent.

 

[Frédéric]

@Dana
Good question, I think @GregCA is right. I don't see another explanation.

 

[Dana]

What do you think, fellow sufferers, shall I risk perforation of the eardrum? (I think I found a hospital in my country that does this).

I am soo afraid, but I would like an image of my problem.

 

[FGG]

What do you think, fellow sufferers, shall I risk perforation of the eardrum? (I think I found a hospital in my country that does this).

I am soo afraid, but I would like an image of my problem.

Would it change anything treatment wise for you? Have you had an electrocochleogram?

 

[Candy]

What other endolymphatic hydrops symptoms do you have, @Dana?

 

[Pre55ure]

What do you think, fellow sufferers, shall I risk perforation of the eardrum? (I think I found a hospital in my country that does this).

I am soo afraid, but I would like an image of my problem.

You can get an MRI done to look for E Hydrops without having the eardrum perforated. It does take longer than the 8 minutes in the linked study though. I had one done last year. The contrast agent is injected in the arm, and the MRI took about 30 minutes.

 

[Dana]

How can I thank you, @Pre55ure?
Thank you thank you thank you thank you... (scroll)

And you get a good image of the ear?

Yours was done in pontocerebellar angle, to see the ear, or in regular angle?

What was your result, if I may ask?

 

[Dana]

@FGG

Thank you for caring and circumventing the essential question.

Well, it would, because if hydrops was confirmed I would be more serious about the treatment in case of hydrops: diet.

What scares me is that aural fullness, I am afraid something may burst one day.
With hydrops I must avoid salt, sugar, coffee, strong tea, eat and drink equally spaced throughout the day, something that I have NOT done, I have no discipline, this tinnitus made me a complete mess.

I use Rivotril by Roche to bring it down, and it does, but I think this drug shaves tinnitus approximately the same regardless of the etiology.

Have I had an electrocochleogram?
I had a battery of tests in the first year at an ear clinic, I can only assume that one of them was electrocochleogram, I must go again to the same clinic and ask.
I know, weird answer, I do not know. They were done when I was SUCH a mess, in the first year of tinnitus I was not on this planet, that big of a blow it was for me.

I will go again to that clinic, in another attempt to investigate the cause.
Thank you.

 

[Pre55ure]

And you get a good image of the ear?

Yours was done in pontocerebellar angle, to see the ear, or in regular angle?

What was your result, if I may ask?

I wasn't the one that looked at the results or ordered the test, but the Dr. who ordered it is a leading specialist involving inner ear disorders, so I assume that he thought it was a good image.

I did not (at the time of the MRI) have E. Hydrops. I have almost all of the symptoms of menieres disease but no vertigo (yet).
According to my Dr. I likely have vestibular migraines. New research has shown that there is a very solid connection between migraines and menieres, with some doctors now thinking that menieres should not even be a separate diagnosis, but rather a list of common symptoms from vestibular migraines. I am actually switching from the Hydrops diet to a migraine avoidance diet at my doctors urging. So far I haven't had much luck stopping my episodes with the hydrops diet, so I figure this is worth a try.

Best of luck to you.

 

[FGG]

@FGG

Thank you for caring and circumventing the essential question.

Well, it would, because if hydrops was confirmed I would be more serious about the treatment in case of hydrops: diet.

What scares me is that aural fullness, I am afraid something may burst one day.
With hydrops I must avoid salt, sugar, coffee, strong tea, eat and drink equally spaced throughout the day, something that I have NOT done, I have no discipline, this tinnitus made me a complete mess.

I use Rivotril by Roche to bring it down, and it does, but I think this drug shaves tinnitus approximately the same regardless of the etiology.

Have I had an electrocochleogram?
I had a battery of tests in the first year at an ear clinic, I can only assume that one of them was electrocochleogram, I must go again to the same clinic and ask.
I know, weird answer, I do not know. They were done when I was SUCH a mess, in the first year of tinnitus I was not on this planet, that big of a blow it was for me.

I will go again to that clinic, in another attempt to investigate the cause.
Thank you.

Any chance you could stick to the Meniere's diet for 3 months to see if it helps? Sort of like a trial treatment with something that is very, very hard (I know because I was misdiagnosed with Meniere's early on) to stick with but benign and ultimately healthy.

That diet doesn't even always benefit people with hydrops, anyway, so it would be good to know.

 

[Frédéric]

A Micro-CT and Synchrotron Imaging Study of the Human Endolymphatic Duct with Special Reference to Endolymph Outflow and Meniere's Disease

Abstract
Meniere's disease remains enigmatic, and has no treatment with sufficient evidence. The characteristic histopathological finding is endolymphatic hydrops, suggesting either an overproduction or decreased reabsorption of endolymph in the human inner ear. This study presents the first analysis of the vascular plexus around the human endolymphatic duct using micro computed tomography and coherent synchrotron radiation with phase contrast imaging. Using a software program, data were processed by volume-rendering with scalar opacity mapping to create transparent three-dimensional reconstructions. A rich vascular plexus was discovered around the endolymphatic duct that drained into collecting channels, linked to the vestibular venous outflow system. This network is believed to make up the principal route for endolymph outflow, and its associated malfunction may result in endolymphatic hydrops and Meniere's disease.

Full article: https://www.nature.com/articles/s41598-020-65110-0

 

[Juan]

What do you understand from "artificially perforated tympanic membrane", @Frédéric, eardrum perforated not "naturally", like by an infection, for example, or an accident, as a second example?

It can be due to surgery. Myringotomy. DTTs (ear tubes).

 

[Juan]

What do you think, fellow sufferers, shall I risk perforation of the eardrum? (I think I found a hospital in my country that does this).

I am soo afraid, but I would like an image of my problem.

They do that often for kids with problems with fluid or wax behind the eardrum, for it to drain. However, I found some literature that quoted DTTs (ear tubes) as a contributing factor to hyperacusis. The classical understanding about a DTT surgery was that is is very simple and can barely have any side effect, but there are articles on hyperacusis that say DTTs could have an impact.

 

[floridian2]

Any chance you could stick to the Meniere's diet for 3 months to see if it helps? Sort of like a trial treatment with something that is very, very hard (I know because I was misdiagnosed with Meniere's early on) to stick with but benign and ultimately healthy..

What is the Ménière's diet? I don't know if I have it, but I have had, since mid October 2019, three episodes of sudden, wildly spinning vertigo and extreme, violent vomiting that lasted in one case 6 hours in the Emergency Room requiring morphine to make it possible for them to get a ct scan;,in the next case 4+ hours at home where I just toughed it out fearing COVID-19 in the ER; and the most recent case under 3 hours (at least it is getting shorter?). Hearing in my left ear has decreased pretty significantly. Tinnitus in both ears is very troubling.

People on this forum have suggested Ménière's (the ENT has been useless, said "wait and see and call me if it happens again and we'll get a hearing test"). People have said that @glynis knows about Ménière's also. If there is a diet that helps Ménière's, I am willing to try it, ANYTHING to make this stop happening.

 

[FGG]

What is the Ménière's diet? I don't know if I have it, but I have had, since mid October 2019, three episodes of sudden, wildly spinning vertigo and extreme, violent vomiting that lasted in one case 6 hours in the Emergency Room requiring morphine to make it possible for them to get a ct scan;,in the next case 4+ hours at home where I just toughed it out fearing COVID-19 in the ER; and the most recent case under 3 hours (at least it is getting shorter?). Hearing in my left ear has decreased pretty significantly. Tinnitus in both ears is very troubling.

People on this forum have suggested Ménière's (the ENT has been useless, said "wait and see and call me if it happens again and we'll get a hearing test"). People have said that @glynis knows about Ménière's also. If there is a diet that helps Ménière's, I am willing to try it, ANYTHING to make this stop happening.

It's a very low sodium and low sugar diet. Much more low sodium than the cardiac diet a lot of older people are on (my mom is on one) and that's already pretty restrictive. I did about 800mg of sodium a day. This pretty much excludes all processed foods and breads. Gluten free pasta is low sodium for whatever reason so I ate a lot of that, and baked chicken with no added salt (Benson's is the only salt substitute I found that doesn't taste bad).

None of that ended up helping me but some people have seen a dramatic reduction in vertigo episodes on that diet.

I had it really bad. My worst episode was 48 hours straight of full 10/10 rotational vertigo. Mine turned out to be viral, though, so do not discount this as a possibility (I haven't had a single vertigo episode since being on antivirals a year and a half or so ago):

Recovery of Hearing in Meniere's Disease after Antiviral Treatment

And if it turns out you do have Meniere's, Otonomy has a drug (Otividex) to reduce vertigo episodes in phase 3. In fact, it's wrapping up so they could have the drug out as early as this fall.

Also, ((hug)). About the only thing worse than severe pain (or severe tinnitus even) is full blown rotational vertigo attacks.

 

[floridian2]

Thank you so much! This is such helpful information and so kind. I'll try to get the (frankly useless so far) ENT to prescribe antivirals. The full blown rotation/tumbling/flipping vomiting episodes are indeed pretty horrible.

Just trying to stay calm and positive at this point and hope it only happens in the middle of the night as so far.

Thanks again.

 

[Jrblovsky]

Thank you so much! This is such helpful information and so kind. I'll try to get the (frankly useless so far) ENT to prescribe antivirals. The full blown rotation/tumbling/flipping vomiting episodes are indeed pretty horrible.

Just trying to stay calm and positive at this point and hope it only happens in the middle of the night as so far.

Thanks again.

I have tried the Meniere's diet with no success, but I guess it depends on the person. Then again it's been over a year and I still have no idea what is actually wrong with me.