PMC8027478_01
Course of endolymphatic hydrops (EH) and progression of vertigo attacks in a 68-year-old man. The patient's course was semi-quantitatively assessed by gadolinium-enhanced inner ear magnetic resonance images, which are shown in (A-I) (axial T2-weighted fluid-attenuated inversion recovery). The y axis on the left indicates the volume ratio of EH to the total inner ear volume in the right ear. (J) is a progress chart of the patient's vertigo attacks as frequency per month on the y axis (right-hand side). (A) Significant EH in the right vestibule and cochlea. No EH in the left vestibule and cochlea. May 2015. (B) Mild EH in the right vestibule and cochlea. July 2016. (C) Significant EH in the right vestibule and mild EH in the right cochlea. February 2017. (D) Mild EH in the right vestibule and cochlea. June 2017. (E) Significant EH in the right vestibule and mild EH in the right cochlea. December 2017. (F) No EH in the right vestibule and mild EH in the right cochlea. April 2018. (G) October 2018. (H) April 2019. (I) November 2019. No EH in the right vestibule and mild EH in the right cochlea. The yellow arrowheads indicate EH, and the black areas represent EH in the labyrinth. (J) The red inverted triangle in the chart indicates the day of surgery. The vertical stripes indicate the durations of the positive pressure therapy.
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The first MRI scan revealed significant EH in the right vestibule and cochlea (Figure 1A); the volume ratio of EH relative to total inner ear volume (EH%) was 28.8%. We followed the patient to evaluate vertigo and hearing at least once per month and requested that he record the date, severity, and duration of vertigo attacks in a self-check diary; the course of the vertigo from the month prior to the first examination is shown in Figure 1J. In May 2016, he reported no vertigo, and the second MRI revealed decreased EH (Figure 1B, EH% = 24). However, he suffered frequent vertigo attacks beginning in October 2016, hearing in his right ear worsened to 66.3 dB, and the third MRI revealed increased EH (Figure 1C, EH% = 34.2). Vertiginous episodes resolved, hearing in his right ear improved to 55 dB, and the fourth MRI revealed decreased EH (Figure 1D, EH% = 23). However, vertiginous episodes recurred in November 2017, hearing in his right ear worsened to 65 dB, and the fifth MRI revealed increased EH (Figure 1E, EH% = 28.5). Vertiginous episodes decreased, hearing in his right ear improved to 46.3 dB, and the sixth MRI revealed decreased EH equal to normal volume (Figure 1F, EH% = 8.8). For 2 years beginning in December 2017, he reported no vertigo, and the subsequent MRI revealed overall low EH values (Figures 1G-I: EH% = 11.8, 7.7, and 14, respectively).