Endolymphatic hydrops is generally considered to be a marker in Ménière’s disease and frusemide is used with the purpose of reducing it and improving symptoms. With the use of MRI, the authors have used the phenomenon of non-enhancing endolymphatic structures and enhancing perilymphatic compartments following intratympanic gadolinium administration. 3D-FLAIR MRI sequences 24 hours before and one hour after intravenous administration of 20 mg frusemide were used for evaluation of these compartments in the basal, middle and apical turns of the cochlea, the vestibule and the semi-circular canals. Reduced or absent enhancement area was related to enlarged endolymphaitc sac. Of the 12 patients studied, none showed any changes after intravenously administered frusemide. Frusemide is considered to have a 50% sensitivity in Ménière’s disease by improving vestibular-evoked myogenic potential amplitude or caloric reflectivity. Unless these MRI results have a low sensitivity, the study opens to question the depletive effect of diurectics on the endolymphatic sac and authors contend that the use of diuretics in Ménière’s disease should be reconsidered. The study, however, is highly experimental and as the authors have mentioned here, endolymphatic sac distension may be an ‘epiphenomenon’ sequential to cytochemical and ultrastructural disruption of fibrocytes in spiral ligaments rather than the cause of Ménière’s disease, which continues to remain uncertain.

Does intravenous administration of frusemide reduce endolymphatic hydrops?
Fiorino F, Mattellini B, Vento M, et al.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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