MRI Detection of Endolymphatic Hydrops in Meniere's Disease

Discussion in 'Research News' started by Frédéric, Jan 14, 2020.

    1. Frédéric

      Frédéric Member Podcast Patron Benefactor Advocate

      Location:
      Marseille, France
      Tinnitus Since:
      11/19/2012
      Cause of Tinnitus:
      acoustic trauma
      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
       
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    2. Dana
      Busy

      Dana Member Benefactor

      Location:
      Bucharest, Romania
      Tinnitus Since:
      09/2008
      Cause of Tinnitus:
      Multi-factorial
      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?
       
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    3. GregCA
      Jaded

      GregCA Member Benefactor Hall of Fame

      Tinnitus Since:
      03/2016
      Cause of Tinnitus:
      Otosclerosis
      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.
       
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    4. AUTHOR
      AUTHOR
      Frédéric

      Frédéric Member Podcast Patron Benefactor Advocate

      Location:
      Marseille, France
      Tinnitus Since:
      11/19/2012
      Cause of Tinnitus:
      acoustic trauma
      @Dana
      Good question, I think @GregCA is right. I don't see another explanation.
       
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    5. Dana
      Busy

      Dana Member Benefactor

      Location:
      Bucharest, Romania
      Tinnitus Since:
      09/2008
      Cause of Tinnitus:
      Multi-factorial
      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.
       
    6. FGG
      No Mood

      FGG Member Podcast Patron Benefactor Hall of Fame Advocate

      Tinnitus Since:
      01/2019
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      Multi-factorial
      Would it change anything treatment wise for you? Have you had an electrocochleogram?
       
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    7. Candy

      Candy Member Benefactor Advocate

      Tinnitus Since:
      06/2016
      Cause of Tinnitus:
      Unidentified
      What other endolymphatic hydrops symptoms do you have, @Dana?
       
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    8. Pre55ure

      Pre55ure Member

      Location:
      California
      Tinnitus Since:
      May 2019
      Cause of Tinnitus:
      Cochlear migraines
      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.
       
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    9. Dana
      Busy

      Dana Member Benefactor

      Location:
      Bucharest, Romania
      Tinnitus Since:
      09/2008
      Cause of Tinnitus:
      Multi-factorial
      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?
       
    10. Dana
      Busy

      Dana Member Benefactor

      Location:
      Bucharest, Romania
      Tinnitus Since:
      09/2008
      Cause of Tinnitus:
      Multi-factorial
      @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.
       
    11. Pre55ure

      Pre55ure Member

      Location:
      California
      Tinnitus Since:
      May 2019
      Cause of Tinnitus:
      Cochlear migraines
      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.
       
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    12. FGG
      No Mood

      FGG Member Podcast Patron Benefactor Hall of Fame Advocate

      Tinnitus Since:
      01/2019
      Cause of Tinnitus:
      Multi-factorial
      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.
       
    13. AUTHOR
      AUTHOR
      Frédéric

      Frédéric Member Podcast Patron Benefactor Advocate

      Location:
      Marseille, France
      Tinnitus Since:
      11/19/2012
      Cause of Tinnitus:
      acoustic trauma
      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
       
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    14. Juan

      Juan Member

      Tinnitus Since:
      08/2014
      Cause of Tinnitus:
      Several causes
      It can be due to surgery. Myringotomy. DTTs (ear tubes).
       
    15. Juan

      Juan Member

      Tinnitus Since:
      08/2014
      Cause of Tinnitus:
      Several causes
      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.
       

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