Radiographic Evidence of Occult Intracranial Hypertension in Patients with Ménière's Disease.

Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery

PubMedID: 28349763

Tawfik KO, Stevens SM, Mihal D, Costello MS, Cornelius RS, Samy RN, Pensak ML. Radiographic Evidence of Occult Intracranial Hypertension in Patients with Ménière's Disease. Otolaryngol Head Neck Surg. 2017;194599817699401.
OBJECTIVES
(1) Describe the prevalence of radiographic signs of intracranial hypertension (ICH) in Ménière's disease (MD) and (2) compare the prevalence of radiographic signs of ICH in MD patients managed medically to those managed surgically.

STUDY DESIGN
Case-control study.

SETTING
Academic neurotologic practice.

SUBJECTS AND METHODS
Adult MD patients (aged =17 years) treated from 2011 to 2015 were reviewed.Inclusion required magnetic resonance imaging (MRI) of the head and follow-up >6 months. Patients with intracranial tumors, mass effect, trauma, previous intracranial surgery, and glaucoma were excluded. MD patients were separated by administered treatment into medical and surgical subgroups. Cochlear implant (CI) recipients served as radiographic controls. Eighty-four MD patients (46 surgical, 38 medical) and 37 CI controls were assessed. MRI measurements assessed for empty/partial sella (ES/PS), dilated/tortuous optic nerve sheath (ONS), and posterior globe flattening (PGF).

RESULTS
Mean age was 53.8 ± 1. 3 years and median body mass index (BMI) was 28. 2 kg/m(2). Of the patients, 64% were female and 92% were white. MRI findings in the MD cohort were as follows: ES/PS, 46. 4%; ONS change, 42. 8%; and PGF, 8. 3%. The prevalence of ONS change was higher in MD patients than in controls (42. 8% vs 13. 5%, P =. 003). The surgical MD group had higher prevalence of ONS change (52%) compared with the medical group (31. 5%, P =. 05) and controls (13. 5%, P =. 0004). The surgical group had a higher prevalence of =2 simultaneous MRI findings compared with medical MD patients (39% vs 10%, P =. 01) and controls (14%, P =. 01).

CONCLUSION
MD patients demonstrate a high prevalence of radiographic signs of ICH.MD patients who required surgery had a greater prevalence of radiographic signs of ICH compared with non-MD patients and medically managed MD patients.