Vestibular Aqueduct Grading: A Risk Indicator for Progression From Low-Frequency Sensorineural Hearing Loss to Ménière Disease.

OBJECTIVE

To determine whether high-resolution MRI-assessed vestibular aqueduct (VA) morphology predicts the risk of developing Ménière disease (MD) in patients with acute low-frequency sensorineural hearing loss (ALHL).

STUDY

DESIGN

Retrospective single-center cohort study.

SETTING

Tertiary referral center, ambulatory.

PATIENTS: One hundred thirty-five adults (66 M/69 F; mean age 45.0±13.8 y) consecutively identified March 2019 to July 2025: 67 with ALHL, 44 with MD, and 24 controls. ALHL group further stratified by with (n=35) or without (n=32) EH on MRI.

INTERVENTIONS: Diagnostic: 0.6 mm T2-SPACE and 3D-real inversion-recovery MRI for VA grading (0 to 2) and EH detection.

MAIN OUTCOME MEASURES: (1) VA grade distribution among groups; (2) risk of EH associated with VA grade 2; (3) progression from ALHL to MD during follow-up.

RESULTS

VA grading differed significantly between the MD and control groups ( P <0.0001) and between ALHL and control groups ( P =0.001). ALHL without EH showed no VA differences compared with controls. ALHL with EH exhibited VA patterns resembling MD ( P =0.831) and bilateral VA asymmetry (affected vs. unaffected ears, P <0.05). Grade 2 VA conferred a 5.1-fold increased risk of EH (95% CI: 1.50-17.38). During follow-up, 10.45% of ALHL patients progressed to MD, exclusively within the EH subgroup (20% of this subgroup), with 85.7% of progressions occurring in grade 2 VA patients.

CONCLUSIONS

Grade 2 VA is strongly associated with EH and identifies ALHL patients at increased risk of progressing to MD; VA non-visualization may serve as an early imaging biomarker for risk stratification.