BACKGROUND AND PURPOSE: Endolymphatic hydrops has been recognized as the underlying pathophysiology of Menière disease. We used 3T MR imaging to detect and grade endolymphatic hydrops in patients with Menière disease and to correlate MR imaging findings with the clinical severity. MATERIALS AND METHODS: MR images of the inner ear acquired by a 3D inversion recovery sequence 4 hours after intravenous contrast administration were retrospectively analyzed by 2 neuroradiologists blinded to the clinical presentation. Endolymphatic hydrops was classified as none, grade I, or grade II. Interobserver agreement was analyzed, and the presence of endolymphatic hydrops was correlated with the clinical diagnosis and the clinical Menière disease score. RESULTS: Of 53 patients, we identified endolymphatic hydrops in 90% on the clinically affected and in 22% on the clinically silent side. Interobserver agreement on detection and grading of endolymphatic hydrops was 0.97 for cochlear and 0.94 for vestibular hydrops. The average MR imaging grade of endolymphatic hydrops was 1.27 ± 0.66 for 55 clinically affected and 0.65 ± 0.58 for 10 clinically normal ears. The correlation between the presence of endolymphatic hydrops and Menière disease was 0.67. Endolymphatic hydrops was detected in 73% of ears with the clinical diagnosis of possible, 100% of probable, and 95% of definite Menière disease. CONCLUSIONS: MR imaging supports endolymphatic hydrops as a pathophysiologic hallmark of Menière disease. High interobserver agreement on the detection and grading of endolymphatic hydrops and the correlation of MR imaging findings with the clinical score recommend MR imaging as a reliable in vivo technique in patients with Menière disease. The significance of MR imaging detection of endolymphatic hydrops in an additional 22% of asymptomatic ears requires further study.

Hypothesis: To aid in realistic counseling of patients at the time of their first visit concerning their chances for recovery, we created a simple prognostic model for predicting hearing recovery in idiopathic sudden sensorineural hearing loss (ISSHL). Background: An important element of research on ISSHL is to identify prognostic factors for this disease. Many studies have described predictive indicators to identify patients with a good prognosis needing no or minimal treatment. Only a few of these studies have included a model for calculating the probability for patient recovery, which may be important for clinical work, but these prognostic tables have not achieved widespread use clinically. Methods: Evaluation of an electronic patient data base of 541 patients with ISSHL. The standard treatment was carbogen inhalation (95% O₂ and 5% CO₂ 8 times per day in duration of 30 min) and prednisone orally (100 mg in 1 morning dose) for 7 days. Factors that were analyzed included the patient's age, the interval between the onset of symptoms and beginning of treatment, the presence or absence of vertigo and tinnitus, audiometric patterns, the severity of hearing loss, and hearing in the opposite ear. Hearing gain was expressed either as absolute hearing gain or as relative hearing gain. Significant recovery of hearing was defined as the final pure-tone audiometry of 30 dB or less (or the same as the pure-tone audiometry of the opposite ear). Results The absolute hearing gain was 15.1 dB. The mean relative hearing gain was 47%. Three hundred one (57%) patients had significant recovery of hearing, and 228 (43%) did not have significant recovery of hearing. Using step-wise multiple linear regression analysis, the most important factors for prognosis included severity of hearing loss, presence of vertigo, time between onset and treatment, the hearing of the other ear, and the audiogram shape (β coefficient was −0.216, −0.231, 0.211, 0.113, and −0.064, respectively; constant, 0.968). A recovery expectancy table was developed using the data from this study. Conclusion: Based on a retrospective analysis, prognostic indicators for hearing recovery in ISSHL were found to be severity of hearing loss, presence of vertigo, time between onset and treatment, the hearing of the other ear, and the audiogram shape. We created a model for calculating the probability for hearing recovery based on the analysis of 529 patients with unilateral ISSHL.

Dizziness is frequently encountered in medical practice, often takes a chronic course and can impair the health related quality of life (HRQoL). However results on the extent of this impairment of HRQoL are mixed. Furthermore, the relationship between dizziness and the HRQoL is only partially understood. The role of clinical symptoms of dizziness and psychosocial factors such as emotional distress on this relationship is for the most part unknown.

Research from JAMA Otolaryngology–Head & Neck Surgery — A New Dynamic Visual Acuity Test to Assess Peripheral Vestibular Function