Abstract
Objective
The caloric test (C-test) and video head impulse test (vHIT) are known to occasionally
show contradictory results in patients with Meniere's disease (MD). The reasons underlying
this discrepancy between the two tests are currently unclear. We aimed to reveal the
mechanisms responsible for this discrepancy by performing volumetric evaluation of
the endolymphatic space (ELS) by using endoluminal contrast-enhanced inner ear MRI
(ieMRI).
Methods
We enrolled 136 patients (174 ears) who visited the vertigo/dizziness center of our
university and underwent the C-test and vHIT between February 2018 and February 2020.
Inner ear MRI was also performed to determine the presence of endolymphatic hydrops
(EH). The percentage of patients diagnosed with each vestibular disease was as follows:
MD, 23.0%; benign paroxysmal positional vertigo (BPPV), 17.8%; bilateral vestibular
disorder (BVD), 9.2%; sudden deafness with vertigo (SD), 8.0%; peripheral dizziness
(PD), 7.5%; unilateral vestibular disorder (UVD), 6.9%; vestibular neuritis (VN),
6.3%; delayed endolymphatic hydrops (DEH), 3.4%; central dizziness (CD), 2.9%; Hunt
syndrome (Hunt), 1.2%; and other disorders (OD), 13.8%.
Results
Among the ears in the present study, 46.0% (80/174) showed a discrepancy in the results
of the C-test and vHIT, and the disease-related distribution of patients showing this
discrepancy was as follows; MD, 38.8% (27/80; p = 0.0019); BVD, 13.8% (11/80); UVD, 12.5% (10/80); SD, 7.5% (6/80); BPPV, 6.3% (5/80);
PD, 6.3% (5/80); VN, 3.8% (3/80); DEH, 3.8% (3/80); CD, 2.5% (2/80); Hunt, 0.0% (0/80);
and OD, 10.0% (8/80). In all cases, the discrepancy presented as a positive C-test
result and negative vHIT result. The ELS ratio was measured for the whole inner ear,
cochlea, vestibule, and semicircular canal, and the relationships between the rates
and the presence of discrepancy was examined. Inner ear ELS ratio was 17.9% ± 10.8%
in patients with the discrepancy and 15.2% ± 8.8% in those without the discrepancy
(p = 0.036). Cochlear ELS ratio was 14.9% ± 11.3% in patients with the discrepancy and
11.9% ± 10.3% in those without the discrepancy (p = 0.0012). Vestibular ELS ratio was 22.3% ± 16.2% in patients with the discrepancy
and 17.2% ± 12.7% in those without the discrepancy (p = 0.032). Semicircular canal ELS ratio was 18.0% ± 11.0% in patients with the discrepancy
and 16.5% ± 9.6% in those without the discrepancy (p = 0.442).
Conclusion
The volume of the ELS may affect the discrepancy of results between the C-test and
vHIT.
Keywords
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References
- Hearing organ of a patient who showed Meniere's symptoms.J Otolaryngol Soc Jpn. 1938; 44: 2310-2312
- Observations on the pathology of Ménière's syndrome: (Section of Otology).Proc R Soc Med. 1938; 31: 1317-1336
- Electrocochleography for Ménière's disease: is it reliable?.Braz J Otorhinolaryngol. 2014; 80: 527-532
- [Endolymphatic hydrops detected with inner ear gd contrast-enhanced MRI; comparison between administration routes or with ECochG or glycerol test].Nihon Jibiinkoka Gakkai Kaiho. 2013; 116: 960-968
- Imaging of endolymphatic and perilymphatic fluid after intravenous administration of single-dose gadodiamide.Magn Reson Med Sci. 2012; 11: 145-150
- Imaging of Ménière's disease after intravenous administration of single-dose gadodiamide: utility of multiplication of MR cisternography and HYDROPS image.Magn Reson Med Sci. 2013; 12: 63-68
- What does the dissociation between the results of video head impulse versus caloric testing reveal about the vestibular dysfunction in Ménière's disease?.Acta Otolaryngol. 2015; 135: 859-865
- Vertical head impulse and caloric are complementary but react opposite to Meniere's disease hydrops.Laryngoscope. 2019; 129: 1660-1666
- Video head impulse test and caloric test in definite Ménière's disease.Eur Arch Otorhinolaryngol. 2020; 277: 679-686
- Diagnostic criteria for Menière's disease.J Vestib Res. 2015; 25: 1-7
- Overview of the international classification of vestibular disorders.Neurol Clin. 2015; 33 (vii): 541-550
- Low-dose intratympanic gentamicin treatment of Meniere's disease.Eur Arch Otorhinolaryngol. 1994; 251 (-S4): S12
- Clinical significance of vertical component of caloric response including its second phase in vertiginous patients.Acta Otolaryngol. 2007; 127: 1142-1149
- The video head impulse test (vHIT) of semicircular canal function - age-dependent normative values of VOR gain in healthy subjects.Front Neurol. 2015; 6: 154
- Volumetric measurements of the inner ear in patients with Meniere's disease using three-dimensional magnetic resonance imaging.Acta Otolaryngol. 2016; 136: 888-893
- Endolymphatic space size in patients with Meniere's disease and healthy controls.Acta Otolaryngol. 2016; 136: 879-882
- Endolymphatic volume in patients with meniere's disease and healthy controls: three-dimensional analysis with magnetic resonance imaging.Laryngoscope Investig Otolaryngol. 2019; 4: 653-658
- Comparison of the video head impulse test results with caloric test in patients with Meniere's disease and other vestibular disorders.Acta Otolaryngol. 2020; 140: 728-735
- A Micro-CT and synchrotron imaging study of the human endolymphatic duct with special reference to endolymph outflow and Meniere's disease.Sci Rep. 2020; 10: 8295
- Temporal bone studies of the human peripheral vestibular system. Aminoglycoside ototoxicity.Ann Otol Rhinol Laryngol Suppl. 2000; 181: 20-25
- Histopathological and ultrastructural analysis of vestibular endorgans in Meniere's disease reveals basement membrane pathology.BMC Ear Nose Throat Disord. 2009; 9: 4
- Comparing results from vestibular caloric stimulation and vHIT from a specialised outpatient clinic.Int Tinnitus J. 2019; 23: 1-5
- Comparison of video head impulse test and caloric reflex test in advanced unilateral definite Menière's disease.Eur Ann Otorhinolaryngol Head Neck Dis. 2018; 135: 167-169
Article info
Publication history
Published online: November 26, 2022
Accepted:
November 11,
2022
Received:
June 8,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.
