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Updated: Sep 27, 2026
Surgical Induction of Endolymphatic Hydrops by Obliteration of the Endolymphatic Duct
Published on: January 23, 2010
Unilateral endolymphatic hydrops: what about the contralateral ear?
F Salvinelli1, M Trivelli, F Greco
1Campus Biomedico University, Department of Otolaryngology, V. Emilio Longoni, 69, 00155 Roma, Italy.
Insights
Early recognition of Meniere
Area of Science:
- Otolaryngology
- Neurology
- Diagnostic Imaging
Background:
- Early diagnosis of Meniere's disease (MD) in the contralateral ear is crucial but controversial.
- Unilateral MD can progress to bilateral disease over time.
Purpose of the Study:
- To evaluate diagnostic criteria for incipient bilateral Meniere's disease.
- To assess the utility of MRI and glycerol tests in diagnosing contralateral MD.
Main Methods:
- Forty-nine patients with unilateral MD were assessed.
- Methods included audiometry, stapedial reflex, glycerol test, Auditory Brainstem Response (ABR), and MRI in 14 patients.
Main Results:
- 27 patients (55%) showed hearing changes in the contralateral ear; only 7 met criteria for bilateral MD.
- Contralateral ear involvement averaged 7 years after initial diagnosis.
- Glycerol test was positive in only 4 unilateral MD cases; MRI visualization of endolymphatic structures was limited.
Conclusions:
- MRI should be part of the MD diagnostic protocol, with future improvements aiding inner ear structure visualization.
- Glycerol test has limited utility.
- A conservative surgical approach for unilateral MD is advised due to the risk of bilateral progression.
Introduction:
The early recognition of incipient Meniere's disease (MD) in the asymptomatic ear of a patient with known unilateral disease has profound implications for patient management and follow-up, but the criteria for a right and precocious diagnosis is still controversial.
Materials And Methods:
We evaluated forty-nine patients with MD, selected according to Committee on Hearing and Equilibrium guidelines. All patients underwent laminar tonal audiometry, stapedial reflex study, Glycerol dehydration test, Auditory Brainstem Response (ABR) vestibular examination. MRI was performed in 14 patients.
Results:
A raised hearing threshold in the contralateral ear was found in 27 patients, but only 7 (14.3%) fulfilled the requirements to be considered affected by bilateral MD. The average delay of occurrence in the contralateral ear was 7 years (from 5 to 12 years). The glycerol test was positive only in 4 patients with unilateral MD and moderate hearing loss. It was not positive in any case of bilateral MD. The membranous endolymphatic duct and sac is not well visualised with MRI on the affected side in the majority of patients.
Conclusion:
A MRI study must be included in the diagnostic protocol for MD and with improvements in this imaging modality will possibly allow detection of variations in the size of inner ear structures. Glycerol dehydration test was useful only in selected cases. A full assessment of incipient disease in the asymptomatic ear in unilateral Meniere's disease should be undertaken. A conservative approach in surgical treatment of unilateral MD is recommended because of the possibility of evolution of a bilateral form, which can occur even 10 years after the onset of the disease.
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