ABSTRACT
Objective
To elucidate the relationship between vertigo and EH volume after medical treatment,
we investigated changes in endolymphatic hydrops (EH) volume using inner ear magnetic
resonance imaging (ieMRI) in relation to clinical results for vertigo and hearing
after administration of the anti-vertiginous medications betahistine, adenosine triphosphate
(ATP), isosorbide (ISO), and saireito (SAI) for Meniere's disease (MD).
Methods
We retrospectively enrolled 202 consecutive patients diagnosed with unilateral MD
from 2015 to 2021 and assigned them to four groups: Group I (G-I), symptomatic oral
medication with betahistine only (CONT); Group II (G-II), inner ear vasoactive oral
medication (ATP); Group III (G-III), osmotic diuretic oral medication (ISO); and Group
IV (G-IV), kampo oral medication (SAI). In total, 172 patients completed the planned
one-year-follow-up, which included the assessment of vertigo frequency, hearing improvement,
and changes in EH using ieMRI (G-I, n=40; G-II, n=42; G-III, n=44; G-IV, n=46). We
constructed 3D MRI images semi-automatically and fused the 3D images of the total
fluid space (TFS) of the inner ear and endolymphatic space (ELS). After fusing the
images, we calculated the volume ratios of the TFS and ELS (ELS ratios).
Results
One year after treatment, vertigo was controlled with zero episodes per month in 57.5%
(23/40) of patients in G-I, 78.6% (33/42) in G-II, 81.8% (36/44) in G-III, and 82.6%
(38/46) in G-IV (statistical significance: G-I<G-II=G-III=G-IV). Hearing improved
by > 10 dB in 5.0% (2/40) of patients in G-I, 16.7% (7/42) in G-II, 18.2% (8/44) in
G-III, and 21.7% (10/46) in G-IV (statistical significance: G-I=G-II=G-III=G-IV).
ELS ratios were significantly reduced after treatment only in the vestibule for G-II,
G-III, and G-IV when compared with G-I. Especially among patients with complete control
of vertigo after treatment, ELS ratios were significantly reduced after treatment
in the vestibule and total inner ear for G-II; in the cochlea, vestibule, and total
inner ear for G-III; and in the cochlea, vestibule, and total inner ear for G-IV compared
with G-I. However, there were no significant findings in the relationship between
hearing results and changes in ELS ratios.
Conclusion
These results indicate that daily administration of anti-vertiginous medications including
ATP, ISO, and SAI could be an effective treatment option for patients with MD at an
early stage before it becomes intractable. Treatments to reduce EH might offer better
control of vertigo rather than improve hearing.
Keywords
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Article info
Publication history
Published online: February 27, 2023
Accepted:
February 17,
2023
Received:
December 27,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.
