Meniere's disease: a reappraisal supported by a variable latency of symptoms and the MRI visualisation of endolymphatic hydrops

Objectives: To evaluate the onset of vertigo, hearing loss and tinnitus in Meniere's disease and the associated endolymphatic hydrops (EH) of the inner ear. Design: Multicentre evaluation of three patient groups. Settings: Disease-specific symptoms were reviewed among referred patients in a tertiary referral hospital in Finland and in members of a Finnish Meniere Association in Finland. The MRI of a separate group of patients was undertaken in a tertiary referral centre in Japan. Participants: 340 patients were reviewed in the referral hospital along with 740 members of the Meniere Association. MRI was undertaken in 224 patients in Japan. Primary and secondary outcome measures: Latency and symptom development in Meniere's disease, and the appearance of EH of the inner ear in monosymptomatic patients and in Meniere's disease. Results: The mean age of the first symptom was 43.8 years, with 10% of the patients being older than 65 years. The time delay between hearing loss and vertigo was more than 5 years in 20% of the members and of the patients. Gadolinium-contrasted MRI demonstrated EH in 90% of the patients with Meniere's disease, in which 75% was bilateral among patients with unilateral symptoms. In monosymptomatic patients with vertigo, tinnitus or hearing loss; EH was demonstrated in 55-90% of the patients either in the cochlea and/or the vestibulum of the symptomatic ear. Conclusions: Meniere's disease often shows bilateral EH and comprises a continuum from a monosymptomatic disease to the typical symptom complex of the disease. We suggest that a 3T MRI measurement should be carried out in patients with sensory-neural hearing loss, vertigo and tinnitus, 4 h after the intravenous injection of a gadolinium-contrast agent to verify the inner ear pathology. This may lead to a better management of the condition.