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Published in: Journal of Neurology 1/2020

Open Access 01-12-2020 | Vestibular Schwannoma | Review

The “hype” of hydrops in classifying vestibular disorders: a narrative review

Authors: Marly F. J. A. van der Lubbe, Akshayaa Vaidyanathan, Vincent Van Rompaey, Alida A. Postma, Tjasse D. Bruintjes, Dorien M. Kimenai, Philippe Lambin, Marc van Hoof, Raymond van de Berg

Published in: Journal of Neurology | Special Issue 1/2020

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Abstract

Background

Classifying and diagnosing peripheral vestibular disorders based on their symptoms is challenging due to possible symptom overlap or atypical clinical presentation. To improve the diagnostic trajectory, gadolinium-based contrast-enhanced magnetic resonance imaging of the inner ear is nowadays frequently used for the in vivo confirmation of endolymphatic hydrops in humans. However, hydrops is visualized in both healthy subjects and patients with vestibular disorders, which might make the clinical value of hydrops detection on MRI questionable.

Objective

To investigate the diagnostic value of clinical and radiological features, including the in vivo visualization of endolymphatic hydrops, for the classification and diagnosis of vestibular disorders.

Methods

A literature search was performed in February and March 2019 to estimate the prevalence of various features in healthy subjects and in common vestibular disorders to make a graphical comparison between healthy and abnormal.

Results

Of the features studied, hydrops was found to be a highly prevalent feature in Menière’s disease (99.4%). Though, hydrops has also a relatively high prevalence in patients with vestibular schwannoma (48.2%) and in healthy temporal bones (12.5%) as well. In patients diagnosed with (definite or probable) Menière’s disease, hydrops is less frequently diagnosed by magnetic resonance imaging compared to the histological confirmation (82.3% versus 99.4%). The mean prevalence of radiologically diagnosed hydrops was 31% in healthy subjects, 28.1% in patients with vestibular migraine, and 25.9% in patients with vestibular schwannoma. An interesting finding was an absolute difference in hydrops prevalence between the two diagnostic techniques (histology and radiology) of 25.2% in patients with Menière’s disease and 29% in patients with vestibular schwannoma.

Conclusions

Although the visualization of hydrops has a high diagnostic value in patients with definite Menière’s disease, it is important to appreciate the relatively high prevalence of hydrops in healthy populations and other vestibular disorders. Endolymphatic hydrops is not a pathognomic phenomenon, and detecting hydrops should not directly indicate a diagnosis of Menière’s disease. Both symptom-driven and hydrops-based classification systems have disadvantages. Therefore, it might be worth to explore features “beyond” hydrops. New analysis techniques, such as Radiomics, might play an essential role in (re)classifying vestibular disorders in the future.
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Literature
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Metadata
Title
The “hype” of hydrops in classifying vestibular disorders: a narrative review
Authors
Marly F. J. A. van der Lubbe
Akshayaa Vaidyanathan
Vincent Van Rompaey
Alida A. Postma
Tjasse D. Bruintjes
Dorien M. Kimenai
Philippe Lambin
Marc van Hoof
Raymond van de Berg
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue Special Issue 1/2020
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-020-10278-8

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