UNASSIGNED: To investigate the relative sensitivity and agreement of caloric testing and video head impulse test (vHIT) across four groups of vestibular disorders.
UNASSIGNED: Caloric and vHIT results of 118 patients with either Ménière\'s disease, vestibular neuritis/labyrinthitis, vestibular migraine, or vestibular schwannoma were retrospectively analyzed. vHIT gain, gain asymmetry, and catch-up-saccades (≥100°/sec) were compared with reference limits of 91 controls.
UNASSIGNED: Abnormal caloric results and vHIT gain were recorded in 57.6 % and 33.1 % of patients, respectively. Consideration of all three measures increased vHIT sensitivity to 43.2 %, and concordance with caloric results improved from 66.1 % to 70.3 %. A significant interaction effect confirmed the relationship between tests depended on the diagnosis (p = 0.013). Vestibular migraine and vestibular neuritis/labyrinthitis produced similar results on both tests, usually normal and abnormal respectively. Vestibular schwannoma produced more caloric abnormalities than vHIT gain but not compared with catch-up-saccades and gain asymmetry; Ménière\'s disease produced more caloric abnormalities than all vHIT measures. When vHIT was normal (all measures), a 37 % canal paresis was 90 % specific for Ménière\'s disease.
UNASSIGNED: Rates of vHIT catch-up-saccades and gain asymmetry can improve sensitivity and concordance with caloric testing, but this is disease-dependent.
UNASSIGNED: vHIT outcome measures are complementary to the caloric test and each other.

OBJECTIVE: Ménière\'s disease (MD) is an idiopathic inner ear disorder characterized by recurrent episodes of episodic rotational vertigo, fluctuating hearing loss, tinnitus, and a feeling of ear stuffiness. Endolymphatic sac (ES)-related surgery is used primarily in patients with MD who have failed to respond to pharmacologic therapy. Endolymphatic duct blockage (EDB) is a new procedure for the treatment of MD, and related clinical studies are still scarce. This study aims to investigate the dynamic changes in endolymphatic hydrops (EH) and the long-term surgical outcomes in MD patients undergoing EDB, and to evaluate the impact of different types of ES on the surgical efficacy.
METHODS: A retrospective analysis was conducted on 33 patients with refractory MD who underwent EDB. Based on the morphology of their endolymphatic sacs, patients were divided into a normal-type group (n=14) and an atrophic-type group (n=19). The frequency of vertigo symptoms, hearing, vestibular function, and the dynamic changes of gadolinium-enhanced MRI of the inner ear were compared were compared before and after surgery between the 2 groups.
RESULTS: Compared with the atrophic-type group, the patients in the normal-type group had a higher rate of complete vertigo control, better cochlear and vestibular function, and a lower endolymph to vestibule volume ratio (all P<0.05). In addition, 7 patients in the normal-type group were found to have reversal of EH, while no reversal of EH was detected in the atrophic-type group after surgery.
CONCLUSIONS: The response to EDB treatment varies between normal and atrophic MD patients, suggesting that the 2 pathological types of endolymphatic sacs may have different underlying mechanisms of disease.
目的: 梅尼埃病(Ménière’s disease，MD)是一种特发性的内耳疾病，临床表现为反复的发作性旋转性眩晕、波动性听力下降、耳鸣和耳闷胀感。内淋巴囊相关的手术主要用于药物治疗无效的MD患者。内淋巴管夹闭术(endolymphatic duct blockage，EDB)是一种治疗MD的新术式，相关临床研究较少。本研究旨在探讨MD患者行EDB后内淋巴积水(endolymphatic hydrops，EH)的改变及手术远期疗效，评估不同类型内淋巴囊的手术效果。方法: 回顾性分析33例接受EDB治疗的难治性MD患者，根据患者的内淋巴囊形态分为正常形态组(n=14)和萎缩形态组(n=19)。比较2组患者在术前和术后眩晕症状的发作频率、听力、前庭功能和内耳钆增强MRI的变化。结果: 与萎缩形态组比较，正常形态组患者具有更高的眩晕完全控制率、更好的耳蜗和前庭功能以及更低的前庭内淋巴间隙体积占前庭总淋巴体积的比值(均P<0.05)。此外，正常形态组共有7例患者出现EH的逆转，而萎缩形态组术后未检测到EH的逆转。结论: 正常形态和萎缩形态内淋巴囊的MD患者对EDB治疗的反应存在差异，提示2种不同病理类型的内淋巴囊可能存在不同的发病机制。.

OBJECTIVE: To compare the calibre of the cochlear (CN), superior vestibular (SVN) and inferior vestibular (IVN) nerves on magnetic resonance imaging (MRI), both between Ménière\'s Disease (MD) ears and clinical controls, and between inner ears with and without endolymphatic hydrops (EH) on MRI.
METHODS: A retrospective case-control study evaluated patients undergoing MRI for suspected hydropic ear disease from 9/2017 to 8/2022. The CN, SVN, IVN and facial nerve (FN) diameters and cross-sectional areas (CSA) were measured on T2-weighted sequences whilst EH was evaluated on delayed post-gadolinium MRI. Absolute nerve calibre (and that relative to the FN) in unilateral definite MD ears (2015 Barany criteria) was compared to that in both asymptomatic contralateral ears and clinical control ears. Nerve calibre in ears with severe cochlear and vestibular EH was compared to ears without EH. t tests or Wilcoxon signed-rank test/Mann-Whitney U test were applied (p < 0.001).
RESULTS: 173 patients (mean age 51.3 ± 15.1, 65 men) with 84 MD (62 unilateral) and 62 clinical control ears were studied. Absolute and relative CN dimensions were decreased in both MD ears (CSA and diameter) and the contralateral asymptomatic ears (CSA) when compared to clinical controls (p < 0.001). Absolute nerve dimensions were reduced in both severe vestibular EH (CN, IVN and SVN) and severe cochlear EH (CN) (p < 0.001), however this was not evident when adjusted according to facial nerve calibre.
CONCLUSIONS: There is decreased absolute CN calibre in both symptomatic and asymptomatic MD ears as well as ears with severe cochlear and vestibular EH on MRI.

Bevezetés: A Ménière-betegség gyógyíthatatlan, de menedzselhető betegség. Alapja az endolympha terének „kitágulása”, az endolympha hydrops. Lehet egy- vagy kétoldali. A tünetek megjelenése alapján metakrón vagy szinkrón megjelenésről beszélhetünk. Hasonló tünetekkel jelentkezhet az autoimmun belsőfül-betegség. Célkitűzés: Kétoldali Ménière-betegséggel diagnosztizált betegek (7 beteg: 2 férfi és 5 nő) belső fülének feltérképezése, immunológiai statusuk felderítése, továbbá az egyéb kórképektől, főleg az autoimmun belsőfül-betegségtől való differenciálás, tapasztalatok alapján egy kivizsgálási protokoll felállítása. Módszer: Kétoldali Ménière-betegeknél rohammentes állapotban a fül-orr-gégészeti, otoneurológiai és immunológiai status, valamint az anamnézis felvétele, továbbá az angularis vestibuloocularis reflex (aVOR) nagy és kis frekvenciájú működésének felmérése. Az előbbit videofejimpulzus-teszt (vHIT), míg az utóbbit kalorizációs teszt során vizsgáltuk. Tisztahang-küszöbaudiogramot végeztünk. Mágneses rezonanciás képalkotó segítségével koponyafelvétel készült. Az immunológiai laborvizsgálat vérszérumból történt. Eredmények: A betegeknél szisztémás autoimmun betegség nem igazolódott. Minden esetben kétoldali, a mély frekvenciákat is érintő pancochlearis sensorineuralis halláscsökkenés volt látható. vHIT során két esetben a magas frekvenciájú aVOR érintettsége is igazolható volt, melyet a betegség előrehaladottságának véleményeztünk. A többi esetben ép működésű, magas frekvenciájú aVOR-t találtunk. A kalorizációs teszt során minden esetben kétoldali ívjáratparesis volt látható. Megbeszélés: A szakirodalomban számos tanulmány foglalkozik az általunk megfigyelt, a vHIT és a kalorizációs teszt közötti diszkrepanciával. Ez az aVOR receptorának, a crista ampullarisnak az anatómiájából következhet: míg a magas frekvenciájú aVOR-t a centrálisan elhelyezkedő I-es típusú szőrsejtek érzékelik, addig az alacsony frekvenciájú aVOR-t a perifériásan elhelyezkedő II-es típusú szőrsejtek. Az utóbbiak szelektív károsodását figyelték meg Ménière-betegségben és autoimmun belsőfül-betegségben is. Ugyanakkor segített a differenciálásban a betegek rendezett immunológiai statusa, az intravénás kortikoszteroidra adott gyenge válaszuk, egy esetben pedig a saccotomiát követő állapotjavulás. Következtetés: A tapasztalatok alapján egy kivizsgálási protokollt kíséreltünk meg felállítani olyan betegek esetében, akik kétoldali fültünetekkel, rohamokban jelentkező, forgó jellegű szédüléssel jelentkeznek. Javasoljuk többek között a vHIT, a kalorizációs teszt és az immunológiai kivizsgálás elvégzését is. Megfontolandónak tartjuk egy multicentrikus vizsgálat elvégzését is mindkét kórképpel kapcsolatban. Orv Hetil. 2024; 165(30): 1176–1183.

BACKGROUND: This study aimed to investigate the association of peripheral vestibular disorders with type 1 and type 2 diabetes using a population-based dataset.
METHODS: The data for this study were obtained from Taiwan\'s Longitudinal Health Insurance Database 2010. The sample consisted of 150,916 patients who were newly diagnosed with peripheral vestibular disorders as cases and 452,748 propensity-score-matching controls without peripheral vestibular disorders. We utilized multivariate logistic regression models to quantitatively evaluate the association between peripheral vestibular disorders and diabetes while considering factors such as sex, age, geographic location, monthly income, urbanization level of the patient\'s residence, coronary heart disease, hypertension, and hyperlipidemia.
RESULTS: The chi-squared test indicates that diabetes was more common in the peripheral vestibular disorder group compared to controls (20.6% vs. 15.1%, p < 0.001). Of all sampled patients, the adjusted odds ratio for diabetes was 1.597 (95% CI = 1.570~1.623) for those with peripheral vestibular disorders when compared to controls, while patients with Ménière\'s disease, benign paroxysmal positional vertigo, unilateral vestibulopathy, and other peripheral vestibular disorders had respective adjusted odds ratios of diabetes at 1.566 (95% CI = 1.498~1.638), 1.677 (95% CI = 1.603~1.755), 1.592 (95% CI = 1.504~1.685), and 1.588 (95% CI = l.555~1.621) in comparison to controls.
CONCLUSIONS: Our research has revealed an association between diabetes and an increased susceptibility to peripheral vestibular disorders.

OBJECTIVE: To compare the effectiveness of the Endolymphatic duct blockage (EDB) and intratympanic methylprednisolone(ITMP) injection to control refractory Ménière\'s disease(MD) symptoms and evaluate their impact on hearing level.
METHODS: Retrospective study in a tertiary care center.
METHODS: 36 received ITMP injection and 52 EDB. Mean outcome measures at 24 months included vertigo control, tinnitus, aural fullness and hearing level: pure-tone average (PTA), bone conduction average(BCA) and speech discrimination score(SDS).
RESULTS: At 24 months postoperatively, 90.4% of the EDB group had complete control of vertigo and 43.4% of the ITMP group (p = 0.001). There was no significant difference in tinnitus or aural fullness control (p = 0.34 and p 0.21 respectively). In each group, the drop in tinnitus and aural fullness frequency at 24 months were significant for EDB (p = 0.03; p < 0.001 respectively) and for ITMP group in tinnitus (p = 0.03) but not aural fullness (p = 0.063). At 24 months, PTA, BCA and SDS were significantly worst in the ITMP group when compared to preoperative levels (p = 0.038, p = 0.027, p = 0.016). PTA in the EDB group was stable with no difference compared to ITMP group (p = 0.48). BCA and SDS in the EDB group were stable and better than the ITMP group (p = 0.032; p = 0.036). In each group, vestibular paresis was not significantly different before (p = 0.06) and after treatment (p = 0.68).
CONCLUSIONS: EDB is more effective than the ITMP for controlling the vertigo symptoms of Ménière\'s disease and in preserving hearing function. It is a novel surgical technique with promising results for a complete treatment of Ménière\'s disease. ITMP decreases the frequency and the severity of the symptoms but only control vertigo in 27.8% of cases.

OBJECTIVE: Patients suffering from Ménière\'s disease (MD) experience vertigo, and impairments in hearing and quality of life (QoL). This study aims to investigate the impact of cochlear implantation (CI) on various aspects affecting patients with MD.
METHODS: A single tertiary centre\'s CI database for CI recipients with MD between 2014 and 2022 was screened retrospectively. Hearing, vertigo, tinnitus symptoms, and hearing-related QoL were assessed. Pre- and postoperative hearing tests in conjunction with subjective outcome measures by visual analogue scale (VAS) and validated tools such as the Dizziness Handicap Inventory (DHI), Tinnitus Handicap Inventory (THI) and Nijmegen Cochlear Implant Questionnaire (NCIQ), as well as the assessment of the pre- and postoperative Functional Level Scale (FLS) were examined.
RESULTS: Eleven ears were included (median age: 59 years at implantation). Following implantation, there was a significant enhancement in Word Recognition Scores at sound levels of 65 dB and 80 dB compared to before treatment (preop vs. 12 months postop: p = 0.012). However, no significant enhancement was observed for 50 dB. MD-related impairments improved significantly postoperatively, as measured by the VAS (vertigo: p = 0.017; tinnitus: p = 0.042), DHI (p = 0.043), THI (p = 0.043) and NCIQ (p < 0.001). The FLS improved significantly (p = 0.020).
CONCLUSIONS: CI has positive effects on all areas examined in our cohort. However, discrimination of speech at low sound pressure levels remained problematic postoperatively. In patients suffering from MD, the prioritized treatment goals include not only improved hearing but also the rehabilitation of vertigo and tinnitus, as well as the enhancement of QoL. Validated instruments are useful screening tools.

UNASSIGNED: Previous studies have highlighted associations between certain inflammatory cytokines and Ménière\'s Disease (MD), such as interleukin (IL) -13 and IL-1β. This Mendelian randomization aims to comprehensively evaluate the causal relationships between 91 inflammatory cytokines and MD.
UNASSIGNED: A comprehensive two-sample Mendelian randomization (MR) analysis was conducted to determine the causal association between inflammatory cytokines and MD. Utilizing publicly accessible genetic datasets, we explored causal links between 91 inflammatory cytokines and MD risk. Comprehensive sensitivity analyses were employed to assess the robustness, heterogeneity, and presence of horizontal pleiotropy in our findings.
UNASSIGNED: Our findings indicate that MD causally influences the levels of two cytokine types: IL-10 (P=0.048, OR=0.945, 95%CI =0.894~1.000) and Neurotrophin-3 (P=0.045, OR=0954, 95%CI =0.910~0.999). Furthermore, three cytokines exhibited significant causal effects on MD: CD40L receptor (P=0.008, OR=0.865, 95%CI =0.777-0.963), Delta and Notch-like epidermal growth factor-related receptor (DNER) (P=0.010, OR=1.216, 95%CI =1.048-1.412), and STAM binding protein (P=0.044, OR=0.776, 95%CI =0.606-0.993).
UNASSIGNED: This study suggests that the CD40L receptor, DNER, and STAM binding protein could potentially serve as upstream determinants of MD. Furthermore, our results imply that when MD is regarded as the exposure variable in MR analysis, it may causally correlate with elevated levels of IL-10 and Neurotrophin-3. Using these cytokines for MD diagnosis or as potential therapeutic targets holds great clinical significance.

BACKGROUND: The vestibular aqueduct (VA) serves an essential role in homeostasis of the inner ear and pathogenesis of Ménière\'s disease (MD). The bony VA can be clearly depicted by high-resolution computed tomography (HRCT), whereas the optimal sequences and parameters for magnetic resonance imaging (MRI) are not yet established. We investigated VA characteristics and potential factors influencing MRI-VA visibility in unilateral MD patients.
METHODS: One hundred patients with unilateral MD underwent MRI with three-dimensional sampling perfection with application optimized contrasts using different flip angle evolutions (3D-SPACE) sequence and HRCT evaluation. The imaging variables included MRI-VA and CT-VA visibility, CT-VA morphology and CT-peri-VA pneumatization.
RESULTS: The most frequent type of MRI-VA and CT-VA visualization was invisible VA and continuous VA, respectively. The MRI-VA visibility was significantly lower than CT-VA visibility. MRI-VA visibility had a weak positive correlation with ipsilateral CT-VA visualization. For the affected side, the MRI-VA visualization was negatively correlated with the incidence of obliterated-shaped CT-VA and positively with that of tubular-shaped CT-VA. MRI-VA visualization was not affected by CT-peri-VA pneumatization.
CONCLUSIONS: In patients with MD, the VA visualization on 3D-SPACE MRI is poorer than that observed on CT and may be affected by its osseous configuration. These findings may provide a basis for further characterization of VA demonstrated by MRI and its clinical significance.

OBJECTIVE: To compare the correlation between different grading methods of vestibular endolymphatic hydrops (EH) and the severity of hearing loss in Ménière\'s disease (MD), and evaluate the diagnostic value of these methods in diagnosing MD.
METHODS: This retrospective study included 30 patients diagnosed with MD from June 2021 to August 2023. All patients underwent inner ear MR gadolinium-enhanced imaging using three-dimensional (3D)-real inversion recovery sequences and pure-tone audiometry. The EH levels were independently evaluated according to the classification methods outlined by Nakashima et al. (Acta Otolaryngol Suppl 5-8, 2009. https://doi.org/10.1080/00016480902729827 ) (M1), Fang et al. (J Laryngol Otol 126:454-459, 2012. https://doi.org/10.1017/S0022215112000060 ) (M2), Barath et al. (Am J Neuroradiol 35:1387-1392, 2014. https://doi.org/10.3174/ajnr.A3856 ), (M3), Liu et al. (Front Surg 9:874971, 2022. https://doi.org/10.3389/fsurg.2022.874971 ), (M4), and Bernaerts et al. (Neuroradiology 61:421-429, 2019. https://doi.org/10.1007/s00234-019-02155-7 ) (M5), with a subsequent comparison of interobserver agreement. After achieving a consensus, an analysis was performed to explore the correlations between vestibular EH grading using different methods, the average hearing thresholds at low-mid, high-, and full frequencies and clinical stages. The diagnostic capabilities of these methods for MD were then compared.
RESULTS: The interobserver consistency of M2-M5 was superior to that of M1. The EH grading based on M4 showed a significant correlation with the average hearing thresholds at low-mid, high-, and full frequencies and clinical stages. M1, M2, M3, and M5 correlated with some parameters. A receiver operating characteristic curve analysis indicated that M5 significantly outperformed M1, M2, M3, and M4 in terms of diagnostic efficiency for MD.
CONCLUSIONS: M4 showed the strongest correlation with the degree of hearing loss in patients with MD, whereas M5 showed the highest diagnostic performance.