Age‐Related Interaction of Endolymphatic Hydrops and Hearing Loss in Meniere's Disease

Abstract Objective To examine the associations among age, endolymphatic hydrops (EH), and hearing thresholds in patients with Meniere's disease (MD) confirmed by gadolinium‐enhanced inner ear magnetic resonance imaging (MRI), and to explore age‐dependent effects of EH on hearing loss. Study Design Retrospective study. Setting Tertiary medical center. Methods We included 455 patients (910 ears) diagnosed with MD between January 2020 and April 2025. EH was graded using established vestibular and cochlear hydrops classification systems on Gd‐enhanced inner ear MRI. Hearing thresholds (0.125‐8 kHz) were obtained by pure‐tone audiometry. Multivariable ordinal logistic regression assessed associations between age and EH grade. Generalized additive models with a Gamma distribution and log link were applied to evaluate nonlinear interactions between age and EH severity across low‐, mid‐, and high‐frequency ranges and four‐frequency averages. Results Age distribution did not differ significantly across EH laterality, site, or grade, and age was not independently associated with EH severity. Both EH grade and age were significantly associated with hearing thresholds ( P < .05). Higher EH grades were consistently correlated with greater hearing loss in both unilateral and bilateral MD. In contrast, the influence of age was most evident at lower EH grades (I‐III) and diminished in higher grades (IV‐V). Conclusion Age was not significantly associated with the presence or severity of EH in patients with MD. Higher EH grades were consistently associated with greater hearing loss. At the same time, the effect of age was most evident in mild‐to‐moderate EH grades and diminished in advanced stages.