Using actual diagnostic criteria, the diagnosis of certain Menière's disease remains impossible during life without histopathologic confirmation. Assessing the value of a diagnostic test is difficult due to the lack of a gold standard. Recent studies reported on the use of MRI after intratympanic
gadolinium injection to demonstrate
endolymphatic hydrops in vivo. We evaluate whether MRI after intratympanic
gadolinium administration is useful for predicting the effect and outcome of intratympanic
gentamicin therapy. The correlation between transtympanic electrocochleographic (TT-ECoG) results and
hydrops grade on MRI images is also investigated. Twelve definite Menière's disease patients with incapacitating
vertigo attacks, not responding to
drug and behavioral treatment, were selected for partial chemolabyrinthectomy with intratympanic
gentamicin. All patients underwent transtympanic electrocochleography followed by surgical middle ear inspection, partial chemolabyrinthectomy (
gentamicin solution 40 mg/ml applied during 60 min) and intratympanic
gadolinium injection with clear exposure of the round window membrane. The MR images were reviewed and a
hydrops grade was assigned. Correlation between the
hydrops grade and the electrocochleographic data was assessed. Only 5 of 12 patients showed
gadolinium enhancement in the inner ear. However, 6 of the 7 patients that did not show postoperative intracochlear or intralabyrinthine
gadolinium distribution did report the clinical improvement after intratympanic
gentamicin therapy.
Hydrops grade correlated with the result of transtympanic electrocochleography in four of five cases that showed
gadolinium enhancement. We conclude that the use of intratympanic
gadolinium has no added value in predicting the clinical outcome of intratympanic
gentamicin application. However, based on these data, a correlation between the result of TT-ECoG and
hydrops grading on MRI images can be suggested.