Endolymphatic space imaging in patients with delayed endolymphatic hydrops.

CONCLUSION: Magnetic resonance imaging (MRI) after intratympanic gadolinium injection can reveal endolymphatic hydrops (ELH) in patients with delayed ELH (DELH). Patients with contralateral DELH may have bilateral ELH. OBJECTIVE: DELH has previously been diagnosed based on clinical history, hearing and vestibular examinations. DELH is classified into three types: ipsilateral, contralateral and bilateral indicate the side with the longstanding hearing loss. Ipsilateral DELH occurs in the ear with a profound hearing loss, contralateral DELH in the better hearing ear and bilateral DELH in both ears. Imaging diagnosis of the endolymphatic space may add a new dimension to the diagnosis and treatment of DELH. PATIENTS AND METHODS: Gadodiamide hydrate was diluted eightfold with saline. The diluted gadodiamide hydrate was injected intratympanically through the tympanic membrane in two patients with ipsilateral DELH and five patients with contralateral DELH. One day after the injection, 3 Tesla MRI was performed to evaluate the endolymphatic space. RESULTS: ELH was observed in all patients. In three patients who underwent bilateral intratympanic injection of gadolinium and were diagnosed with contralateral DELH, ELH was observed bilaterally. In one of these three patients, ELH was observed in the cochlea on the left and in the vestibule on the right.

Clinical significance of endolymphatic imaging after intratympanic gadolinium injection.

CONCLUSION: Using three-dimensional real inversion recovery (3D-real IR) and three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI), various degrees of endolymphatic hydrops were observed in the basal and upper turns of the cochlea and in the vestibular apparatus after intratympanic gadolinium (Gd) injection. MRI may contribute to our understanding of inner ear diseases and may be a useful addition to intratympanic drug therapy in the management of inner ear diseases. OBJECTIVE: To evaluate 3D-real IR MRI and 3D-FLAIR MRI with clinical symptoms and signs in patients with inner ear disease. PATIENTS AND METHODS: Gd was diluted in saline and injected intratympanically in 73 patients with inner ear disease. The endolymphatic space was evaluated with 3-Tesla MRI at 1 day after the intratympanic Gd injection. RESULTS: 3D-real IR MRI was generally better than 3D-FLAIR MRI in discriminating between the perilymphatic space and endolymphatic space in the cochlear turns and in the vestibular apparatus. However, when Gd concentration was insufficient in the perilymph, it was more difficult to visualize the Gd with 3D-real IR MRI than with 3D-FLAIR MRI. Endolymphatic hydrops was observed using MRI in patients with 'probable' Meniere's disease based on the criteria.

Transmeatal low-power laser irradiation for tinnitus.

OBJECTIVE: To evaluate effectiveness of 60-mW laser irradiation in the treatment of tinnitus. STUDY DESIGN: Prospective, randomized double-blind study. METHODS: This investigation included 68 ears in 45 patients with disabling unilateral or bilateral tinnitus. The active or placebo laser treatment was administered transmeatally once a week for 6 minutes. Laser irradiation was performed four times during a 4-week period. A questionnaire was administered to evaluate the loudness, duration, quality, and annoyance of tinnitus before and after irradiation. The loudness and pitch match for tinnitus were obtained, and distortion product otoacoustic emissions were also examined. RESULTS: No significant difference was observed between the active and placebo laser groups with regard to outcome of loudness, duration, quality, and annoyance of tinnitus. In one patient who received active laser treatment, acute hearing deterioration occurred after the third irradiation. CONCLUSION: Transmeatal low-power laser irradiation with 60 mW is not effective for the treatment of tinnitus.