Background: Ménière's disease (MD) is a chronic inner ear disorder with a multifactorial etiology. Decreased visualization of the endolymphatic duct (ED) and sac (ES) is thought to be associated... Show moreBackground: Ménière's disease (MD) is a chronic inner ear disorder with a multifactorial etiology. Decreased visualization of the endolymphatic duct (ED) and sac (ES) is thought to be associated with MD, although controversy exists about whether this finding is specific to MD. Recent literature has revealed that two distinct ES pathologies, developmental hypoplasia and epithelial degeneration, can be distinguished in MD using the angular trajectory of the vestibular aqueduct (ATVA) or ED-ES system as a radiographic surrogate marker. It has been suggested that these two subtypes are associated with distinct phenotypical features. However, the clinical differences between the ATVA subtypes require further validation.Research objective: The objective of this study is to investigate whether (1) non-visualization of the ED-ES system is a discriminative radiological feature for MD in a cohort of vertigo-associated pathologies (VAPs) and whether (2) different angular trajectories of the ED-ES system in MD are associated with distinguishable clinical features.Setting: The study was conducted in the Vertigo Referral Center (Haga Teaching Hospital, The Hague, the Netherlands).Methods: We retrospectively assessed 301 patients (187 definite MD and 114 other VAPs) that underwent 4h-delayed 3D FLAIR MRI. We evaluated (1) the visibility of the ED-ES system between MD and other VAP patients and (2) measured the angular trajectory of the ED-ES system. MD patients were stratified based on the angular measurements into αexit ≤ 120° (MD-120), αexit 120°-140° (MD-intermediate), or αexit ≥ 140° (MD-140). Correlations between ATVA subgroups and clinical parameters were evaluated.Results: Non-visualization of the ED-ES system was more common in definite MD patients compared with other VAPs (P < 0.001). Among definite MD patients, the MD-140 subtype demonstrated a longer history of vertigo (P = 0.006), a higher prevalence of bilateral clinical disease (P = 0.005), and a trend toward a male preponderance (p = 0.053). No significant differences were found between ATVA subgroups regarding the presence or severity of auditory symptoms, or the frequency of vertigo attacks.Conclusion: Non-visualization of the ED-ES system is significantly associated with MD. Among MD patients with a visible ED-ES system, we demonstrated that the MD-140 subtype is associated with a longer disease duration, a higher prevalence of bilateral MD, and a trend toward a male preponderance. Show less
ObjectiveResultsLevel of evidence This study explores how treatment with intratympanic steroid injection affects quality of life, as well as several subjective complaints in patients with Meniere's... Show moreObjectiveResultsLevel of evidence This study explores how treatment with intratympanic steroid injection affects quality of life, as well as several subjective complaints in patients with Meniere's disease. Methods Patients filled in the Meniere's Disease Outcome Questionnaire (MDOQ) and answered questions about subjective complaints. Scores before and after treatment were compared using pairedttests. Forty-nine patients treated with intratympanic steroid injection were included. Quality of life was improved in 36 (73%) patients, the same in 9 (18%) patients, and lower in 4 (8%) patients. Overall, the mean change in MDOQ was +20.6 points (95% confidence interval +14.5 to +26.7 points, p < 0.001). The improvement was seen in the emotional, physical, and mental domain. Most patients experienced less vertigo and instability but did not notice change in subjective hearing, tinnitus, or aural fullness after treatment. Conclusion Treatment with intratympanic steroid injection leads to an improvement in quality of life in most patients. Moreover, the procedure is only minimally invasive. Based on the findings in this study, treatment with ITS should be discussed with every patient suffering from vertigo attacks due to active Meniere's disease. Level 4 Show less
Pont, L.M.H. de; Steekelenburg, J.M. van; Verhagen, T.O.; Houben, M.; Goeman, J.J.; Verbist, B.M.; ... ; Hammer, S. 2021
Research Objective: To investigate the correlation between clinical features and MRI-confirmed endolymphatic hydrops (EH) and blood-labyrinth barrier (BLB) impairment.Study Design: Retrospective... Show moreResearch Objective: To investigate the correlation between clinical features and MRI-confirmed endolymphatic hydrops (EH) and blood-labyrinth barrier (BLB) impairment.Study Design: Retrospective cross-sectional study.Setting: Vertigo referral center (Haga Teaching Hospital, The Hague, the Netherlands).Methods: We retrospectively analyzed all patients that underwent 4 h-delayed Gd-enhanced 3D FLAIR MRI at our institution from February 2017 to March 2019. Perilymphatic enhancement and the degree of cochlear and vestibular hydrops were assessed. The signal intensity ratio (SIR) was calculated by region of interest analysis. Correlations between MRI findings and clinical features were evaluated.Results: Two hundred and fifteen patients with MRI-proven endolymphatic hydrops (EH) were included (179 unilateral, 36 bilateral) with a mean age of 55.9 yrs and median disease duration of 4.3 yrs. Hydrops grade is significantly correlated with disease duration (P < 0.001), the severity of low- and high-frequency hearing loss (both P < 0.001), and the incidence of drop attacks (P = 0.001). Visually increased perilymphatic enhancement was present in 157 (87.7%) subjects with unilateral EH. SIR increases in correlation with hydrops grade (P < 0.001), but is not significantly correlated with the low or high Fletcher index (P = 0.344 and P = 0.178 respectively). No significant differences were found between the degree of EH or BLB impairment and vertigo, tinnitus or aural fullness.Conclusion: The degree of EH positively correlates with disease duration, hearing loss and the incidence of drop attacks. The BLB is impaired in association with EH grade, but without clear contribution to the severity of audiovestibular symptoms. Show less
This study describes the complication rate and use of autologous and/or homologous cartilage in a large 20-year cohort of septo(rhino)plasty surgeries in a Dutch hospital, in relation to... Show moreThis study describes the complication rate and use of autologous and/or homologous cartilage in a large 20-year cohort of septo(rhino)plasty surgeries in a Dutch hospital, in relation to postoperative complications of septo(rhino)plasty surgery described in previous studies. A retrospective medical chart review was conducted. 2606 patients, mean age 34.7 (+/- 13.2) and 59.9% male, underwent primary or revision septo(rhino)plasty surgery from 01/01/1999 to 01/09/2019. Follow-up was known in 1384 of 2606 patients (53.1%) with a mean duration of 47.5 months. Complication registration was complete for 1774 patients. The overall complication rate was 270 out of 1774 (15.2%). The use of autologous costal cartilage (ACC) was a risk factor for overall complication with an odds ratio (OR) of 11.1 (95% CI 0.03-0.30;P < 0.01) as compared to 5.9 (95% CI 0.06-0.45;P < 0.01) when using homologous costal cartilage (HCC). Infections were more likely when ACC (5/26 [19.2%]) was used than when HCC (1/28 [3.6%]) was used. Notable resorption of cartilage was more likely when HCC (9/28 [32.1%]) was used than when ACC (1/26 [3.8%]) was used. Both the use of autologous costal cartilage grafts (OR 11.1) and homologous costal cartilage grafts (OR 5.9) lead to an increased risk of complications. When choosing cartilage type for reconstruction in septo(rhino)plasty, it should be taken into account that both ACC and HCC are associated with a higher risk of complications. Show less
Steekelenburg, J.M. van; Weijnen, A. van; Pont, L.M.H. de; Vijlbrief, O.D.; Bommelje, C.C.; Koopman, J.P.; ... ; Hammer, S. 2020
BACKGROUND AND PURPOSE:M?ni?re disease is characterized by endolymphatic hydrops, whereas perilymphatic enhancement on MR imaging has been suggested to be of additional value in diagnosing M?ni?re... Show moreBACKGROUND AND PURPOSE:M?ni?re disease is characterized by endolymphatic hydrops, whereas perilymphatic enhancement on MR imaging has been suggested to be of additional value in diagnosing M?ni?re disease. This study evaluates the presence of endolymphatic hydrops and perilymphatic enhancement in patients with M?ni?re disease and with other vertigo-associated inner ear pathology.MATERIALS AND METHODS:A 3D-FLAIR sequence 4?hours after intravenous gadolinium injection was performed to visualize the endolymph and perilymph in 220 patients suspected of having M?ni?re disease. Patients? ears were retrospectively categorized as having M?ni?re disease (probable or definite) or other vertigo-associated inner ear pathology not attributable to M?ni?re disease. Endolymphatic hydrops was evaluated using a visual classification system, and perilymphatic enhancement was scored both visually and quantitatively.RESULTS:Endolymphatic hydrops was present in 137 (91.9%) of the definite M?ni?re disease ears and in 9 (7.0%) of the ears with other vertigo-associated inner ear pathology (P Show less
