Clin Exp Otorhinolaryngol.  2023 Nov;16(4):334-341. 10.21053/ceo.2023.00486.

Findings of Intravenous Gadolinium Inner Ear Magnetic Resonance Imaging in Patients With Acute Low-Tone Sensorineural Hearing Loss

• Seo HW
• Kim Y
• Kim HJ
• Chung WH
• Cho YS

• KMID: 2548362
• DOI: http://doi.org/10.21053/ceo.2023.00486

Abstract

Objectives
Acute low-tone sensorineural hearing loss (ALHL) is thought to have a different etiology from that of idiopathic sudden sensorineural hearing loss. We hypothesized that endolymphatic hydrops (EH) in the inner ear organ contributes to ALHL, even in patients without vertigo. This study investigated the presence of EH in ALHL and compared the clinical characteristics of patients with or without EH.
Methods
We retrospectively reviewed 38 patients diagnosed with ALHL without vertigo from January 2017 to March 2022. EH was measured in all patients using inner ear magnetic resonance imaging (MRI). In addition, we selected patients who showed only mid- or high-frequency hearing loss and had available MRI data as a control group and compared the ALHL and control groups.
Results
After treatment, the pure-tone average at low frequencies significantly improved compared to the initial hearing (P<0.001). Hearing recovery was observed in 63.1% of patients; however, the recovery rate did not differ based on the treatment method. During the follow-up period, six patients (15.8%) progressed to Meniere’s disease, and 18 (47.4%) experienced recurrence. In the ALHL group, the cochlear hydrops ratio on the affected side (0.34±0.09) was significantly higher than on the contralateral side (0.29±0.12) (P=0.005), and most patients showed hydrops in the apex area of the cochlea. Compared with the control group (0.25±0.15), the ALHL group showed a significantly higher cochlear hydrops ratio (P=0.043). The correlation analysis showed a tendency for hearing thresholds at low frequencies to increase as the hydrops ratio increased, albeit without statistical significance.
Conclusion
The cochlear hydrops ratio, especially in the apex area on the affected side, was significantly higher in patients with ALHL, suggesting that EH in the cochlea contributes to the pathogenesis of ALHL.

Keyword

Sensorineural Hearing Loss; Low Frequency Hearing Loss; Endolymphatic Hydrops; Magnetic Resonance Imaging

Figure

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  Fig. 1. Hearing changes at low frequencies after treatment. The hearing thresholds at frequencies significantly improved from 46.1±11.9 dB before treatment to 31.2±17.1 dB after treatment (P<0.001).

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  Fig. 2. Endolymphatic hydrops (EH) ratio in acute low-tone sensorineural hearing loss patients. Results showing the proportions of (A) cochlear hydrops and (B) vestibular hydrops on the affected side and the contralateral side. (C) Measurements of cochlear hydrops in apical and midbase turns on the affected side. Values are presented as mean±standard deviation.

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  Fig. 3. Setting a region of interest (ROI) by dividing the cochlear area. (A) In a magnetic resonance cisternography (MRC) image, the apical turn and mid-base turn of the cochlea were identified, and an ROI was set by drawing along their contours. (B) The previously determined ROI from the MRC image was then copied and pasted into the HYDROPS-Mi2 image. The endolymphatic hydrops ratio was calculated by dividing the number of pixels with negative signal intensity (black area) within the ROI by the total number of pixels in the total ROI.

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  Fig. 4. Cochlear hydrops ratio compared between the acute lowtone sensorineural hearing loss (ALHL) group and control groups. Values are presented as mean±standard deviation. MD, Meniere’s disease; MF, mid-frequency; HF, high-frequency.

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  Fig. 5. (A) Correlation between the overall cochlear hydrops ratio and hearing threshold at low frequencies. (B) Correlation between the hydrops ratio in the apex and hearing threshold at low frequencies. The correlation analysis showed a tendency for hearing thresholds at low frequencies to increase as the hydrops ratio increased, albeit without statistical significance (P=0.140, P=0.308, respectively).

Reference

1. Abe T. Acute sensorineural hearing loss in low frequencies. Otolaryngol (Tokyo). 1982; 54:385–92.

2. Kim JH, Kwak SH, Bae SH, Kim SH, Nam GS. Prognosis of sudden low frequency hearing loss during long-term follow-up. Res Vestib Sci. 2018; Sep. 17(3):102–8.

3. Chen D, Wang Z, Jia G, Mao H, Ni Y. The role of anti-endothelial cell autoantibodies and immune response in acute low-tone hearing loss. Ear Nose Throat J. 2021; Jun. 100(3_suppl):292S–300S.

4. Ma Y, Sun Q, Zhang K, Bai L, Du L. High level of IgE in acute lowtone sensorineural hearing loss: a predictor for recurrence and Meniere Disease transformation. Am J Otolaryngol. 2021; Mar-Apr. 42(2):102856.

5. Xue J, Ma X, Lin Y, Shan H, Yu L. Audiological findings in patients with vestibular migraine and migraine: history of migraine may be a cause of low-tone sudden sensorineural hearing loss. Audiol Neurootol. 2020; Mar. 25(4):209–14.

6. Kim H, Lee H, Kim YC, Park E, Choi J, Rah YC, et al. Update on clinical manifestation in acute low-tone hearing loss. Korean J Otorhinolaryngol-Head Neck Surg. 2020; Sep. 63(9):403–8.

7. Im GJ, Kim SK, Choi J, Song JJ, Chae SW, Jung HH. Analysis of audio-vestibular assessment in acute low-tone hearing loss. Acta Otolaryngol. 2016; Jul. 136(7):649–54.

8. Imamura S, Nozawa I, Imamura M, Murakami Y. Clinical observations on acute low-tone sensorineural hearing loss. Survey and analysis of 137 patients. Ann Otol Rhinol Laryngol. 1997; Sep. 106(9):746–50.

9. Yamasoba T, Sugasawa M, Kikuchi S, Yagi M, Harada T. An electrocochleographic study of acute low-tone sensorineural hearing loss. Eur Arch Otorhinolaryngol. 1993; 250(7):418–22.

10. Naganawa S, Yamazaki M, Kawai H, Bokura K, Sone M, Nakashima T. Visualization of endolymphatic hydrops in Meniere’s disease with single-dose intravenous gadolinium-based contrast media using heavily T(2)-weighted 3D-FLAIR. Magn Reson Med Sci. 2010; 9(4):237–42.

11. Cho YS, Ahn JM, Choi JE, Park HW, Kim YK, Kim HJ, et al. Usefulness of intravenous gadolinium inner ear mr imaging in diagnosis of Meniere’s disease. Sci Rep. 2018; Dec. 8(1):17562.

12. Yoshida T, Sone M, Kitoh R, Nishio SY, Ogawa K, Kanzaki S, et al. Idiopathic sudden sensorineural hearing loss and acute low-tone sensorineural hearing loss: a comparison of the results of a nationwide epidemiological survey in Japan. Acta Otolaryngol. 2017; Apr. 137(sup565):S38–43.

13. Fuse T, Aoyagi M, Funakubo T, Sakakibara A, Yoshida S. Short-term outcome and prognosis of acute low-tone sensorineural hearing loss by administration of steroid. ORL J Otorhinolaryngol Relat Spec. 2002; Jan-Feb. 64(1):6–10.

14. Seo HW, Chung JH, Byun H, Lee SH. Vestibular mapping assessment in idiopathic sudden sensorineural hearing loss. Ear Hear. 2022; Jan/Feb. 43(1):242–9.

15. Shin SH, Byun SW, Park S, Kim EH, Kim MW, Lee HY. Optimal firstline therapy for acute low-tone sensorineural hearing loss. J Audiol Otol. 2021; Oct. 25(4):209–16.

16. Zhu Y, Li G, Zhuang H, Yang Z, Sun J, Xiong G, et al. Meta-analysis comparing steroids and diuretics in the treatment of acute low-tone sensorineural hearing loss. Ear Nose Throat J. 2021; Jun. 100(3_suppl):281S–5S.

17. Fushiki H, Junicho M, Aso S, Watanabe Y. Recurrence rate of idiopathic sudden low-tone sensorineural hearing loss without vertigo: a long-term follow-up study. Otol Neurotol. 2009; Apr. 30(3):295–8.

18. Nakashima T, Pyykko I, Arroll MA, Casselbrant ML, Foster CA, Manzoor NF, et al. Meniere’s disease. Nat Rev Dis Primers. 2016; May. 2:16028.

19. Gurkov R, Pyyko I, Zou J, Kentala E. What is Meniere’s disease? A contemporary re-evaluation of endolymphatic hydrops. J Neurol. 2016; Apr. 263 Suppl 1:S71–81.

20. Shimono M, Teranishi M, Yoshida T, Kato M, Sano R, Otake H, et al. Endolymphatic hydrops revealed by magnetic resonance imaging in patients with acute low-tone sensorineural hearing loss. Otol Neurotol. 2013; Sep. 34(7):1241–6.

21. Inui H, Sakamoto T, Ito T, Kitahara T. Magnetic resonance-based volumetric measurement of the endolymphatic space in patients with Meniere’s disease and other endolymphatic hydrops-related diseases. Auris Nasus Larynx. 2019; Aug. 46(4):493–7.

22. Inui H, Sakamoto T, Ito T, Kitahara T. Magnetic resonance imaging of the endolymphatic space in patients with acute low-tone sensorineural hearing loss. Auris Nasus Larynx. 2019; Dec. 46(6):859–65.