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Three cases of cochleosaccular endolymphatic hydrops without vertigo revealed by furosemide-loading vestibular evoked

Toru Seo1, Michiko Node, Atsushi Miyamoto

  • 1Department of Otolaryngology, Hyogo College of Medicine, Hyogo, Japan. tseo@hyo-med.sc.jp

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology
|September 23, 2003
PubMed

Insights

This study describes three cases of cochleosaccular endolymphatic hydrops without vertigo, diagnosed using the furosemide-loading vestibular evoked myogenic potential test. Severe disequilibrium was a key symptom, suggesting saccular hydrops as the cause.

Area of Science:

  • Otolaryngology
  • Neuroscience
  • Vestibular System Research

Background:

  • Endolymphatic hydrops (ELH) is a disorder of the inner ear characterized by excess endolymph.
  • Vertigo is a common symptom of ELH, but atypical presentations are increasingly recognized.

Observation:

  • Three patients with possible cochleosaccular ELH without vertigo were identified.
  • Diagnostic criteria included a positive furosemide-loading vestibular evoked myogenic potential (VEMP) test, absence of canal paresis, and fluctuating cochlear symptoms.
  • Patients presented with symptoms like aural fullness, tinnitus, fluctuating hearing loss, and severe disequilibrium preventing them from standing.

Findings:

  • All three patients exhibited severe disequilibrium, with two experiencing short-lasting falling sensations.
  • The furosemide-loading VEMP test was positive in all cases, indicating saccular dysfunction.
  • The absence of canal paresis on caloric testing supported a diagnosis beyond semicircular canal involvement.

Implications:

  • These cases suggest that cochleosaccular ELH can manifest without vertigo, primarily with severe disequilibrium.
  • Saccular hydrops may be the underlying cause of these non-vertiginous symptoms.
  • The furosemide-loading VEMP test is a valuable tool for diagnosing ELH in patients with atypical vestibular symptoms.
Abstract

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