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Blood-Labyrinth Barrier Permeability in Menière Disease and Idiopathic Sudden Sensorineural Hearing Loss: Findings on
M N Pakdaman1, G Ishiyama2, A Ishiyama3
1From the Departments of Radiological Sciences (M.N.P., H.J.K., W.B.P., A.R.S.).
Background And Purpose:
Menière disease and idiopathic sudden sensorineural hearing loss can have overlapping clinical presentation and may have similar pathophysiology. Prior studies using postcontrast 3D-FLAIR MR imaging suggest abnormal blood-labyrinth barrier permeability in both conditions, but the 2 diseases have not been directly compared by using the same imaging techniques. We hypothesized that delayed postcontrast 3D-FLAIR MR imaging would show differences in blood-labyrinth barrier permeability between Menière disease and idiopathic sudden sensorineural hearing loss.
Materials And Methods:
Patients with unilateral Menière disease (n = 32) and unilateral idiopathic sudden sensorineural hearing loss (n = 11) imaged with delayed postcontrast 3D-FLAIR MR imaging were retrospectively studied. Signal intensities of the medulla and perilymph of the cochlear basal turns of both ears in each patient were measured in a blinded fashion. Cochlea/medulla ratios were calculated for each ear as a surrogate for blood-labyrinth barrier permeability. The ears were segregated by clinical diagnosis.
Results:
Cochlea/medulla ratio was higher in symptomatic ears of patients with Menière disease (12.6 ± 7.4) than in patients with idiopathic sudden sensorineural hearing loss (5.7 ± 2.0) and asymptomatic ears of patients with Menière disease (8.0 ± 3.1), indicating increased blood-labyrinth barrier permeability in Menière disease ears. The differences in cochlea/medulla ratio between symptomatic and asymptomatic ears were significantly higher in Menière disease than in idiopathic sudden sensorineural hearing loss. Asymptomatic ears in patients with Menière disease showed higher cochlea/medulla ratio than symptomatic and asymptomatic ears in patients with idiopathic sudden sensorineural hearing loss.
Conclusions:
Increased cochlea/medulla ratio indicates increased blood-labyrinth barrier permeability in Menière disease compared with idiopathic sudden sensorineural hearing loss. Increased cochlea/medulla ratio in asymptomatic ears of patients with Menière disease also suggests an underlying systemic cause of Menière disease and may provide a pathophysiologic biomarker.
Insights
Delayed MRI reveals increased blood-labyrinth barrier permeability in Menière disease compared to sudden hearing loss. This finding in Menière disease ears suggests a potential systemic cause and biomarker.
Area of Science:
- Otolaryngology
- Radiology
- Neuroscience
Background:
- Menière disease and idiopathic sudden sensorineural hearing loss share overlapping clinical features and potential pathophysiology.
- Previous studies suggest blood-labyrinth barrier (BLB) abnormalities in both conditions using MRI.
- Direct comparison using identical imaging techniques is lacking.
Purpose of the Study:
- To investigate differences in BLB permeability between Menière disease and idiopathic sudden sensorineural hearing loss.
- To utilize delayed postcontrast 3D-FLAIR MR imaging for assessing BLB integrity.
- To test the hypothesis that BLB permeability differs between these two conditions.
Main Methods:
- Retrospective study of patients with unilateral Menière disease (n=32) and idiopathic sudden sensorineural hearing loss (n=11).
- Delayed postcontrast 3D-FLAIR MR imaging was performed.
- Signal intensities of cochlear basal turn perilymph and medulla were measured; cochlea/medulla ratios calculated as a surrogate for BLB permeability.
Main Results:
- Symptomatic Menière disease ears showed significantly higher cochlea/medulla ratios (12.6 ± 7.4) compared to idiopathic sudden sensorineural hearing loss ears (5.7 ± 2.0).
- Asymptomatic Menière disease ears (8.0 ± 3.1) also exhibited higher ratios than both symptomatic and asymptomatic idiopathic sudden sensorineural hearing loss ears.
- The difference in ratios between symptomatic and asymptomatic ears was greater in Menière disease, indicating increased BLB permeability.
Conclusions:
- Elevated cochlea/medulla ratios confirm increased BLB permeability in Menière disease relative to idiopathic sudden sensorineural hearing loss.
- Higher ratios in asymptomatic Menière disease ears suggest a potential underlying systemic etiology.
- The cochlea/medulla ratio may serve as a pathophysiologic biomarker for Menière disease.
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