Original Article|Articles in Press

Evaluation of changes in endolymphatic hydrops volume after medical treatments for Meniere's disease using 3D magnetic resonance imaging

Published:February 27, 2023DOI:



      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).


      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).


      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.


      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.


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        • Sajjadi H
        • Paparella M.
        Meniere's disease.
        Lancet. 2008; 372: 406-414
        • Yamakawa K.
        Uber die pathologische Veranderung bei einem Meniere-Kranken.
        J Otolaryngol Jpn. 1938; 44: 2310-2312
        • Hallpike CS
        • Cairns H.
        Observations on the pathology of Meniere's syndrome.
        Proc R Soc Med. 1938; 53: 625-655
        • Nakashima T
        • Naganawa S
        • Sugiura M
        • Teranishi M
        • Sone M
        • Hayashi H
        • et al.
        Visualization of endolymphatic hydrops in patients with Meniere's disease.
        Laryngoscope. 2007; 117: 415-420
        • Naganawa S
        • Yamazaki M
        • Kawai H
        • Bokura K
        • Sone M
        • Nakashima T.
        Imaging of Meniere's disease after intravenous administration of single-dose gadodiamide: utility of subtraction images with different inversion time.
        Magn Reson Med Sci. 2012; 11: 213-219
        • Ito T
        • Inui H
        • Sakamoto T
        • Miyasaka T
        • Shiozaki T
        • Matsuyama S
        • et al.
        Three-dimensional magnetic resonance imaging reveals the relationship between the control of vertigo and decreases in endolymphatic hydrops after endolymphatic sac drainage with steroids for Meniere's disease.
        Front Neurol. 2019; 10: e46
        • Ito T
        • Inui H
        • Miyasaka T
        • Shiozaki T
        • Fujita H
        • Yamanaka T
        • et al.
        Relationship between changes in hearing function and volumes of endolymphatic hydrops after endolymphatic sac drainage.
        Acta Otolaryngol. 2019; 139: 739-746
        • Adrion C
        • Fischer CS
        • Wagner J
        • Gürkov R
        • Mansmann U
        • Strupp M.
        Efficacy and safety of betahistine treatment in patients with Meniere's disease: primary results of a long term, multicentre, double blind, randomized, placebo controlled, dose defining trial (BEMED trial).
        BMJ. 2016; 352: h6816
        • Mizukoshi K
        • Watanabe I
        • Matsunaga T
        • Hinoki M
        • Komatsuzaki A
        • Takayasu S
        • et al.
        Clinical evaluation of medical treatment for Menière's disease, using a double-blind controlled study.
        Am J Otol. 1988; 9: 418-422
        • Crowson MG
        • Patki A
        • Tucci DL.
        A systematic review of diuretics in the medical management of Ménière's disease.
        Otolaryngol Head Neck Surg. 2016; 154: 824-834
        • Inada R
        • Miyamoto K
        • Tanaka N
        • Moriguchi K
        • Oryeongsan Kusunoki S.
        Goreisan) ameliorates experimental autoimmune encephalomyelitis.
        Intern Med. 2020; 59: 55-60
        • Okayasu T
        • Ohyama H
        • Kitano K
        • Mitani K
        • Kitahara T.
        Indications of kampo medicine for neurotologic disease.
        Kampo Med. 2021; 72: 1-8
        • Magnan J
        • Özgirgin ON
        • Trabalzini F
        • Lacour M
        • Escamez AL
        • Magnusson M
        • et al.
        European position statement on diagnosis, and treatment of Meniere's disease.
        J Int Adv Otol. 2018; 14: 317-321
        • Iwasaki S
        • Shojaku H
        • Murofushi T
        • Seo T
        • Kitahara T
        • Origasa H
        • et al.
        Committee for Clinical Practice Guidelines of Japan Society for Equilibrium Research. Diagnostic and therapeutic strategies for Meniere's disease of the Japan society for equilibrium research.
        Auris Nasus Larynx. 2021; 48: 15-22
        • Lopes-Escames JA
        • Carey J
        • Chung WH.
        Diagnostic criteria for Meniere's disease.
        J Vestib Res. 2015; 25: 1-7
        • Committee on hearing and equilibrium
        Committee on hearing and equilibrium guidelines for diagnosis and evaluation of therapy in Meniere's disease.
        Otolaryngol Head Neck Surg. 1995; 113: 181-185
        • Inui H
        • Sakamoto T
        • Ito T
        • Kitahara T.
        Volumetric measurements of the inner ear in patients with Meniere's disease using three-dimensional magnetic resonance imaging.
        Acta Otolaryngol. 2016; 136: 888-893
        • Okuno T
        • Sando I.
        Localization, frequency, and severity of endolymphatic hydrops and the pathology of the labyrinthine membrane in Menière's disease.
        Ann Otol Rhinol Laryngol. 1987; 96: 438-445