Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology · 2025
Does Endolymphatic Hydrops Influences Gentamicin Effects in Meniere Disease Patients Undergoing Intratympanic Treatment?
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Lorente-Piera Joan, Suárez-Vega Victor, Blanco Melissa, Liaño Gloria, Viñuela Macarena, Garaycochea Octavio, Domínguez Pablo, Manrique-Huarte Raquel, Pérez-Fernandez Nicolás
Аннотация
OBJECTIVE: To investigate whether the severity of endolymphatic hydrops (EH) influences the audiovestibular effects of intratympanic gentamicin (ITG) in patients with unilateral Ménière disease (uMD).
MATERIAL AND METHODS: Forty patients in 2 different tertiary referral centers with uMD refractory to medical treatment underwent 3T MRI 4 hours after gadolinium administration. EH severity was evaluated qualitatively and quantitatively (volumetry). Audiovestibular function was assessed with the PTA, vHIT, cVEMP, and oVEMP before and 1 month after ITG. Associations were analyzed with Kruskal-Wallis tests, Pearson/Spearman correlations, and logistic regression models.
RESULTS: After ITG, a significant vestibulo-ocular reflex gain reduction was observed in the horizontal (ΔGain: 30.72%) and posterior (ΔGain: 34.64%,) semicircular canals, while hearing showed nonsignificant minimal increase (ΔPTA: 5.88 dB). cVEMP responses were more frequently absent ( P = 0.018), and the IAAR increased significantly ( P = 0.003). The level of EH and its amount, as measured by the relative volume in the vestibule ( v ELRaff), both with perilymphatic enhancement, were all positively correlated with the amount of vestibular damage in both PSC and HSC; however, did not correlate with changes in PTA ( P = 0.266). In contrast, cochlear EH showed no predictive value for posttreatment hearing loss. Endolymphatic herniation was significantly associated with cVEMP changes ( P = 0.016).
CONCLUSION: EH does not act as a barrier to gentamicin diffusion. MRI-based EH assessment may help predict treatment outcomes and guide safer ITG strategies.
MATERIAL AND METHODS: Forty patients in 2 different tertiary referral centers with uMD refractory to medical treatment underwent 3T MRI 4 hours after gadolinium administration. EH severity was evaluated qualitatively and quantitatively (volumetry). Audiovestibular function was assessed with the PTA, vHIT, cVEMP, and oVEMP before and 1 month after ITG. Associations were analyzed with Kruskal-Wallis tests, Pearson/Spearman correlations, and logistic regression models.
RESULTS: After ITG, a significant vestibulo-ocular reflex gain reduction was observed in the horizontal (ΔGain: 30.72%) and posterior (ΔGain: 34.64%,) semicircular canals, while hearing showed nonsignificant minimal increase (ΔPTA: 5.88 dB). cVEMP responses were more frequently absent ( P = 0.018), and the IAAR increased significantly ( P = 0.003). The level of EH and its amount, as measured by the relative volume in the vestibule ( v ELRaff), both with perilymphatic enhancement, were all positively correlated with the amount of vestibular damage in both PSC and HSC; however, did not correlate with changes in PTA ( P = 0.266). In contrast, cochlear EH showed no predictive value for posttreatment hearing loss. Endolymphatic herniation was significantly associated with cVEMP changes ( P = 0.016).
CONCLUSION: EH does not act as a barrier to gentamicin diffusion. MRI-based EH assessment may help predict treatment outcomes and guide safer ITG strategies.