Recurrent vertigo can continue after severe unilateral or bilateral hearing loss. This is a condition similar to Ménière’s disease, the diagnosis of which can be difficult. In this study intratympanic injection of gadolinium-diethylenetriamine penta-acetic acid dimeglumine was done in 25 patients and followed by inner ear 3-D fluid-attenuated inversion recovery MRI 24 hours later. The distribution of Gadolinium in the labyrinth was quantitatively scored in the regions of cochlear base, middle and apex, vestibule and the three semi-circular canals. The presence of endolymphatic hydrops was evaluated with an established formula and the diagnosis was thought confirmed if the score of the function reached an accepted numerical value. The authors claim that this method diagnosed 84% (21/25 patients) of endolymphatic hydrops and thus has a higher sensitivity rate. No complications resulted with this technique. At the same time the authors performed pure tone audiometry, electrocochleography, bithermal caloric testing and VEMP potential testing. They found this MRI method to be the most sensitive. Electrocochleography is not useful in cases of severe hearing loss. Bithermal caloric testing has 72% sensitivity but is not a normal physiological vestibular stimulus and often evokes a vestibule-autonomic reflex. VEMP is limited in that it evaluates only the saccular function. The authors claim that accurate identification of the clinical type of delayed endolymphatic hydrops helps determine surgical strategy for treating these patients. If there is delayed endolymphatic hydrops in one ear and hearing loss in the other, endolymphatic sac surgery in the affected ear can maintain hearing and eliminate dizzy spells. Despite limited numbers the study does seem promising in the management of vertigo where symptoms persist years after hearing loss.

Diagnostic value of 3 dimensional magnetic resonance imaging of inner ear after intratympanic gadolinium Injection, and clinical application of magnetic resonance imaging scoring system in patients with delayed endolymphatic hydrops.
Gu X, Fang ZM, Liu Y, et al.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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