Anatomical variation of inner ear may be a predisposing factor for unilateral Ménière's disease rather than for ipsilateral delayed endolymphatic hydrops

Abstract

Objective: Radiological anatomical variations, measured by magnetic resonance imaging (MRI), were evaluated in patients with ipsilateral delayed endolymphatic hydrops (DEH) and unilateral Ménière's disease (MD). The role of anatomical variations in different subtypes of hydropic ear disease was investigated.

Methods: Twenty-eight patients with ipsilateral DEH, 76 patients with unilateral MD, and 59 control subjects were enrolled. The radiological indices included the distance between the vertical part of the posterior semicircular canal and the posterior fossa (MRI-PP distance) and the visibility of vestibular aqueduct (MRI-VA). These variations among patients with DEH, MD, and control subjects were compared. The correlation between radiological anatomical variations and clinical features or audio-vestibular findings was also examined.

Results: (1) MRI-PP distance in the affected side of unilateral MD was shorter than that in ipsilateral DEH (Z = - 2.481, p = 0.013) and control subjects (Z = - 2.983, p = 0.003), while the difference of MRI-PP distance between the affected side of ipsilateral DEH and control subjects was not statistically significant (Z = - 0.859, p = 0.391). (2) There was no significant interaural difference of MRI-PP distance in patients with unilateral MD (Z = - 0.041, p = 0.968) and ipsilateral DEH (t = - 0.107, p = 0.915) respectively. (3) No significant interaural difference of MRI-VA visibility was observed in patients with unilateral MD (χ² = 0.742, p = 0.389) and ipsilateral DEH (χ² = 0.327, p = 0.567) respectively. (4) No correlation was found between these anatomical variables and clinical features or audio-vestibular findings in patients with unilateral MD and ipsilateral DEH respectively (p > 0.05).

Conclusions: Anatomical variations of inner ear may be a predisposing factor in the pathogenesis of unilateral MD rather than ipsilateral DEH.

Key points: • Patients with ipsilateral delayed endolymphatic hydrops showed normal distance between the vertical part of the posterior semicircular canal and the posterior fossa. • Compared to patients with ipsilateral delayed endolymphatic hydrops and control subjects, patients with unilateral Ménière's disease exhibited shorter distance between the vertical part of the posterior semicircular canal and the posterior fossa. • Anatomical variations of inner ear may be a predisposing factor in the pathogenesis of unilateral Ménière's disease rather than ipsilateral delayed endolymphatic hydrops.

Keywords: Endolymphatic hydrops; Endolymphatic sac; Magnetic resonance imaging; Ménière’s disease.

Fig. 1

A 0.5-mm axial 3D-SPACE MRI scan showing detailed image of the right ear at the level of the measured distance between the vertical part of the posterior semicircular canal (a) and the posterior fossa (b)

Fig. 2

3D-SPACE MRI images of a 63-year-old male in control group. (a, b, c, d, e, f, g) Axial, high-resolution, T2-weighted MRI scan showing visualization of the vestibular aqueduct on both sides

Fig. 3

3D-SPACE MRI images of a 53-year-old male with left-sided unilateral MD. (a, b, c, d, e, f, g, h) Axial, high-resolution, T2-weighted MRI scan showing non-visualization of the vestibular aqueduct on both sides

Fig. 4

Bar graph showing the distribution of 3D-SPACE MRI-PP distances in patients with unilateral MD (a, including affected and non-affected side), ipsilateral DEH (b, including affected and non-affected side), control subjects (c, including right and left side), and comparison among patients with MD, DEH, and control group (d, including the affected side of MD, DEH, and the right side of control subjects). The curve is fitted according to the histogram and reflects the distribution of variables