Magnetic Resonance Imaging of the Endolymphatic Duct in Patients With Meniere’s Disease: Correlation With Endolymphatic Hydrops Severity and Clinical Findings

OBJECTIVE: This study aims to evaluate endolymphatic duct radiological morphology in symptomatic and asymptomatic ears in patients with unilateral Ménière's disease. STUDY DESIGN: Retrospective. SETTING: University hospital. PATIENTS: This retrospective case-control study included 84 patients with unilateral MD. MRI scans were performed using a 3D-FLAIR protocol. MAIN OUTCOME MEASURES: The degree of cochlear and vestibular hydrops was graded using the Barath and Bernaerts scales, respectively. The morphology of the endolymphatic duct was assessed with the three-grade Attyé scale. Correlation between endolymphatic duct visibility and the degree of cochlear and vestibular hydrops were analyzed. Radiological findings were evaluated in the context of the clinical presentation and pure-tone audiometry results. RESULTS: Cochlear hydrops was present in 72 (85.7%) of symptomatic ears but only 3 (3.6%) of asymptomatic ears. Vestibular hydrops was found in 73 (86.9%) of symptomatic ears versus 9 (10.7%) of asymptomatic ears. The endolymphatic duct was not visible in 63 (75.0%) of symptomatic ears, compared to 38 (45.2%) of asymptomatic ears. A significant positive correlation was observed between the severity of EH and absence of visualization of the endolymphatic duct (P<0.0001). Both hydrops and endolymphatic duct morphology correlated with audiological results, while only EH degree was significantly associated with vertigo frequency. CONCLUSIONS: There is a strong association between the severity of MRI-assessed EH and morphological alterations of the endolymphatic duct in MD. Advanced MRI techniques provide valuable imaging biomarkers that may improve diagnostic accuracy and help differentiate symptomatic from asymptomatic ears. These results support the potential role of endolymphatic duct assessment in the clinical management and monitoring of MD. Correlations between radiological and clinical findings confirms that endolymphatic space morphology contributes to the development of auditory and vestibular symptoms.