Menière and Friends: Imaging and Classification of Hydropic Ear Disease

BACKGROUND:Over 75 years ago, endolymphatic hydrops was discovered as the pathologic correlate of Menièreʼs disease. However, this pathologic finding could be ascertained only in postmortem histologic studies. Due to this diagnostic dilemma and the variable manifestation of the various audiovestibular symptoms, diagnostic classification systems based on clinical findings have been used hitherto. METHODS:A review of the literature of magnetic resonance (MR) imaging of hydropic ear disease. RESULTS:Recent developments of high resolution MR imaging of the inner ear have now enabled us to visualize in vivo endolymphatic hydrops in patients with suspected Menièreʼs disease. The existing knowledge from temporal bone histologic studies and from the emerging evidence on imaging based evaluation of patients with suspected Menièreʼs disease indicate that endolymphatic hydrops not only is responsible for the full-blown clinical triad of simultaneous attacks of auditory and vestibular dysfunction, but also for other clinical presentations such as “vestibular” and “cochlear Menièreʼs disease.” CONCLUSION:As a consequence, we propose the term “Hydropic Ear Disease” as a new terminology which is based on symptomatic and imaging characteristics of these clinical entities to clarify and simplify their diagnostic classification.