Quantitative evaluation of endolymphatic hydrops with MRI through intravenous gadolinium administration and VEMP in unilateral definite Meniere’s disease

  • Ping Guo
  • Wenfang Sun
  • Suming Shi
  • Fang zhang
  • Jiali Wang
  • Wuqing WangEmail author



To help clinicians to further understand the significance of vestibular-evoked myogenic potential (VEMP) examinations to diagnose MD and the quantitative relationship between VEMP and MRI in assessing the location and degree of endolymphatic hydrops (EH) in definite Meniere’s disease (MD) patients.


Fifty-six patients with unilateral definite MD participated in this study, which used MRIs through intravenous gadolinium administration (IV-Gd), audiometry, caloric tests and VEMP tests. The VEMP results of 26 healthy volunteers were used as a normal reference value.


The participants were found through MRI to have differing degrees of vestibular and cochlear EH. Quantitative comparison of MRI and VEMP results found that the response rates of oVEMP decreased with cochlear EH increasing; the asymmetry ratio (AR) of oVEMP can be used to find whether cochlear EH or not, and the P1–N1 amplitude was lower in the extreme cochlear EH group (P < 0.01). The AR of cVEMP was larger in severe vestibular EH group than that of the mild or no vestibular EH group (P < 0.01). The correlation between the degree of cochlear EH and the mean PTA threshold was statistically significant (P < 0.05). The duration of MD correlated positively with vestibular EH (P < 0.05). The abnormal rate of caloric tests was higher in severe vestibular EH group than that of the mild or no vestibular EH group (P < 0.05).


The advantages of MRIs by IV-Gd administration were obvious in assessing the location and degree of EH. oVEMP and PTA can be indirectly used to evaluate the extent of cochlear EH, cVEMP and caloric tests can be used to assess the extent of vestibular EH on the condition of absent MRIs.


Endolymphatic hydrops MRI VEMP Meniere’s disease 



This work was supported by the National Nature Science Foundation of China (Grant: 81670933 to Wuqing Wang;

Compliance with ethical standards

Conflict of interest

No potential conflict of interest relevant to this article was reported. The study’s protocol was approved by the Ethics Committee of Fudan University’s review board, and written informed consent forms were obtained from the participants.


  1. 1.
    Goebel JA (2016) 2015 Equilibrium Committee Amendment to the 1995 AAO-HNS Guidelines for the Definition of Meniere’s Disease. Otolaryngol Head Neck Surg 154:403–404CrossRefGoogle Scholar
  2. 2.
    Nakashima T, Naganawa S, Sugiura M, Teranishi M, Sone M, Hayashi H et al (2007) Visualization of endolymphatic hydrops in patients with Meniere’s disease. Laryngoscope 117:415–420CrossRefGoogle Scholar
  3. 3.
    Homann G, Vieth V, Weiss D, Nikolaou K, Heindel W, Notohamiprodjo M et al (2015) Semi-quantitative vs. volumetric determination of endolymphatic space in Meniere’s disease using endolymphatic hydrops 3T-HR-MRI after intravenous gadolinium injection. PLoS One 10:e0120357CrossRefGoogle Scholar
  4. 4.
    Imai T, Uno A, Kitahara T, Okumura T, Horii A, Ohta Y et al (2017) Evaluation of endolymphatic hydrops using 3-T MRI after intravenous gadolinium injection. Eur Arch Otorhinolaryngol 274:4103–4111CrossRefGoogle Scholar
  5. 5.
    Naganawa S, Kawai H, Taoka T, Sone M (2017) Improved HYDROPS: imaging of endolymphatic hydrops after intravenous administration of gadolinium. Magn Reson Med Sci 16:357–361CrossRefGoogle Scholar
  6. 6.
    Curthoys IS (2010) A critical review of the neurophysiological evidence underlying clinical vestibular testing using sound, vibration and galvanic stimuli. Clin Neurophysiol 121:132–144CrossRefGoogle Scholar
  7. 7.
    Manzari L, Burgess AM, Curthoys IS (2010) Dissociation between cVEMP and oVEMP responses: different vestibular origins of each VEMP? Eur Arch Otorhinolaryngol 267:1487–1489CrossRefGoogle Scholar
  8. 8.
    Kushiro K, Zakir M, Ogawa Y, Sato H, Uchino Y (1999) Saccular and utricular inputs to sternocleidomastoid motoneurons of decerebrate cats. Exp Brain Res 126:410–416CrossRefGoogle Scholar
  9. 9.
    Wang SJ, Weng WJ, Jaw FS, Young YH (2010) Ocular and cervical vestibular-evoked myogenic potentials: a study to determine whether air- or bone-conducted stimuli are optimal. Ear Hear 31:283–288CrossRefGoogle Scholar
  10. 10.
    Fang ZM, Chen X, Gu X, Liu Y, Zhang R, Cao DR et al (2012) A new magnetic resonance imaging scoring system for perilymphatic space appearance after intratympanic gadolinium injection, and its clinical application. J Laryngol Otol 126:454–459CrossRefGoogle Scholar
  11. 11.
    Zou J, Sood R, Zhang Y, Kinnunen PK, Pyykko I (2014) Pathway and morphological transformation of liposome nanocarriers after release from a novel sustained inner-ear delivery system. Nanomedicine (Lond) 9:2143–2155CrossRefGoogle Scholar
  12. 12.
    Sun W, Guo P, Ren T, Wang W (2017) Magnetic resonance imaging of intratympanic gadolinium helps differentiate vestibular migraine from Meniere disease. Laryngoscope 127:2382–2388CrossRefGoogle Scholar
  13. 13.
    Gürkov RFW, Louza J, Strupp M, Ertl-Wagner B, Krause E (2012) In vivo visualized endolymphatic hydrops and inner ear functions in patients with electrocochleographically confirmed Ménière’s disease. Otol Neurotol 33:1040–1045CrossRefGoogle Scholar
  14. 14.
    Wu Q, Dai C, Zhao M, Sha Y (2016) The correlation between symptoms of definite Meniere’s disease and endolymphatic hydrops visualized by magnetic resonance imaging. Laryngoscope 126:974–979CrossRefGoogle Scholar
  15. 15.
    Jongkees LBMJP, Philipszoon AJ (1962) Clinical nystagmography. A detailed study of electronystagmography in 341 patients with vertigo. Pract Otorhinolaryngol 24:65–93Google Scholar
  16. 16.
    Zhou YJ, Wu YZ, Cong N, Wang J, Chi FL (2017) Contrasting results of tests of peripheral vestibular function in patients with bilateral large vestibular aqueduct syndrome. Clin Neurophysiol 128:1513–1518CrossRefGoogle Scholar
  17. 17.
    Bruderer SG, Bodmer D, Stohler NA, Jick SS, Meier CR (2017) Population-Based Study on the Epidemiology of Meniere’s Disease. Audiol Neuro-otol 22:74–82CrossRefGoogle Scholar
  18. 18.
    Yang S, Zhu H, Zhu B, Wang H, Chen Z, Wu Y et al (2018) Correlations between the degree of endolymphatic hydrops and symptoms and audiological test results in patients with Meniere’s Disease: a reevaluation. Otol Neurotol 39:351–356CrossRefGoogle Scholar
  19. 19.
    Nakada T, Yoshida T, Suga K, Kato M, Otake H, Kato K et al (2014) Endolymphatic space size in patients with vestibular migraine and Meniere’s disease. J Neurol 261:2079–2084CrossRefGoogle Scholar
  20. 20.
    Winters SMCT, Grolman W, Klis SF (2011) Ocular vestibular evoked myogenic potentials in response to air-conducted sound in Ménière’s disease. Otol Neurotol 32:1273–1280CrossRefGoogle Scholar
  21. 21.
    Taylor RL, Wijewardene AA, Gibson WP, Black DA, Halmagyi GM, Welgampola MS (2011) The vestibular evoked-potential profile of Meniere’s disease. Clin Neurophysiol 122:1256–1263CrossRefGoogle Scholar
  22. 22.
    Huang CH, Wang SJ, Young YH (2011) Localization and prevalence of hydrops formation in Meniere’s disease using a test battery. Audiol Neuro-otol 16:41–48CrossRefGoogle Scholar
  23. 23.
    Merchant SN, Rauch SD, Nadol JB Jr (1995) Meniere’s disease. Eur Arch Otorhinolaryngol 252:63–75CrossRefGoogle Scholar
  24. 24.
    Okuno T, Sando I (1987) Localization, frequency, and severity of endolymphatic hydrops and the pathology of the labyrinthine membrane in Meniere’s disease. Ann Otol Rhinol Laryngol 96:438–445CrossRefGoogle Scholar
  25. 25.
    Stephanie M. Winters TC, Wilko Grolman, Sjaak FL, Klis (2011) Ocular vestibular evoked myogenic potentials in response to air-conducted sound in Me´nie`re’s disease. Otol Neurotol 32:1273–1280CrossRefGoogle Scholar
  26. 26.
    Okumura T, Imai T, Takimoto Y, Takeda N, Kitahara T, Uno A et al (2017) Assessment of endolymphatic hydrops and otolith function in patients with Meniere’s disease. Eur Arch Otorhinolaryngol 274:1413–1421CrossRefGoogle Scholar
  27. 27.
    Young YH, Huang TW, Cheng PW (2003) Assessing the stage of Meniere’s disease using vestibular evoked myogenic potentials. Arch Otolaryngol Head Neck Surg 129:815–818CrossRefGoogle Scholar
  28. 28.
    Fraysse BG, Alonso A, House WF (1980) Meniere’s disease and endolymphatic hydrops: clinical-histopathological correlations. Ann Otol Rhinol Laryngol Suppl 89:2–22CrossRefGoogle Scholar
  29. 29.
    Young YH (2013) Potential application of ocular and cervical vestibular-evoked myogenic potentials in Meniere’s disease: a review. Laryngoscope 123:484–491CrossRefGoogle Scholar
  30. 30.
    Cordero-Yanza JA, Arrieta Vazquez EV, Hernaiz Leonardo JC, Mancera Sanchez J, Hernandez Palestina MS, Perez-Fernandez N (2017) Comparative study between the caloric vestibular and the video-head impulse tests in unilateral Meniere’s disease. Acta Otolaryngol 137:1178–1182CrossRefGoogle Scholar
  31. 31.
    Rubin F, Simon F, Verillaud B, Herman P, Kania R, Hautefort C (2018) Comparison of video head impulse test and caloric reflex test in advanced unilateral definite Meniere’s disease. Eur Ann Otorhinolaryngol Head Neck Dis 135:167–169CrossRefGoogle Scholar
  32. 32.
    Choi JE, Kim YK, Cho YS et al (2017) Morphological correlation between caloric tests and vestibular hydrops in Meniere’s disease using intravenous Gd enhanced inner ear MRI. PLoS One 12:e0188301CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.NHC Key Laboratory of Hearing Medicine, Department of OtolaryngologyEye Ear Nose & Throat Hospital Shanghai, Fudan UniversityShanghaiPeople’s Republic of China
  2. 2.Department of OtolaryngologyChongqing General HospitalChongqingPeople’s Republic of China
  3. 3.Department of RadiologyEye Ear Nose & Throat Hospital ShanghaiShanghaiPeople’s Republic of China

Personalised recommendations