内淋巴导管夹闭术治疗梅尼埃病前后内淋巴积水和听力的相关性研究

Research on the Relationship between Endolymphatic Hydrops and Hearing before and after Endolymphatic Duct Blockage for Meniere’s Disease

目的应用内耳钆造影磁共振成像(MRI)动态评估梅尼埃病患者内淋巴导管夹闭术(endolymphatic duct blockage,EDB)前后的内淋巴积水(endolymphatic hydrops,EH)变化,以探讨EH与听力变化的相关性。方法选取2018年1月至2019年2月在中南大学湘雅二医院耳鼻咽喉头颈外科就诊的24例药物保守治疗无效的难治性梅尼埃病患者,24例行内耳钆造影MRI证实存在EH,行EDB术,22例术后复查内耳钆造影MRI。使用内淋巴—前庭容积比(endolymph to vestibule-volume ratio,EVVR)评估EDB手术前后两次EH的变化,并与EDB手术前后的听力进行对比分析。结果22例患者术前内耳钆造影MRI证实患侧耳均存在耳蜗和前庭EH。在7例听力改善(听力阈值下降≥10dB)的患者中,6例表现为耳蜗和前庭EH的减少。在听力下降(听力阈值升高≥10dB)的2例患者中,有1例显示耳蜗和前庭EH的增加。EDB手术前后的EVVR和纯音听阈呈显著正相关(P=0.000,r=0.852,n=22)。结论内耳钆造影MRI所见梅尼埃病患者EH与其纯音听阈呈显著相关性,MD的听力损失很可能是由积水引起的,这种听力功能可以通过EH的变化来调节。

Objective Gadolinium(Gd)-enhanced inner-ear MRI was used to dynamically evaluate changes of endolymphatic hydrops(EH)in patients with Meniere’s disease before and after endolymphatic duct blockage(EDB)to investigate the correlation between EH and hearing changes.Methods EH was confirmed by Gd-enhanced inner-ear MRI in 24 patients with refractory Meniere’s disease(MD)treated in the Department of Otorhinolaryngology,Head and Neck Surgery of the Second Xiangya Hospital of Central South University from January 2018 to February 2019 were selected,followed by EDB treatment.Endolymph-vestibular volume ratio(EVVR)was measured on Gd-enhanced inner-ear MRI postoperatively in 22 patients to evaluate changes of EH after EDB.Hearing before and after EDB was also compared.Results Cochlear and vestibular EH was confirmed by Gd-enhanced inner-ear MRI in the 22 patients before EBD operation.Hearing improved by≥10 dB after EDB in 7 patients and deteriorated by≥10 dB in 2 patients.Post-EDB Gd-enhanced inner-ear MRI showed decreased EH in 6 patients and increased EH in 1 patient with deteriorated hearing.Pre-and post-EDB EVVRs and pure tone hearing thresholds were positively correlated(P=0.000,r=0.852,n=22).Conclusion EH on Gd-enhanced inner-ear MRI is closely correlated to pure tone hearing thresholds in patients with MD,indicating a causal relationship between hearing loss in MD and EH and the rationale to correct EH in MD.