Relationship between stress levels and endolymphatic space volume in Meniere's disease

Hiroto Fujita; Keita Ueda; Hajime Kageyama; Tomoyuki Shiozaki; Hiroshi Inui; Tadashi Kitahara

doi:10.1016/j.anl.2023.03.006

Relationship between stress levels and endolymphatic space volume in Meniere's disease

Auris Nasus Larynx. 2023 Dec;50(6):866-873. doi: 10.1016/j.anl.2023.03.006. Epub 2023 Apr 8.

Authors

Hiroto Fujita¹, Keita Ueda¹, Hajime Kageyama¹, Tomoyuki Shiozaki¹, Hiroshi Inui¹, Tadashi Kitahara²

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara-city, Nara, Japan.
² Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Kashihara-city, Nara, Japan. Electronic address: tkitahara@naramed-u.ac.jp.

PMID: 37037749
DOI: 10.1016/j.anl.2023.03.006

Abstract

Objectives: Since the first report by Hallpike and Yamakawa in 1938, many more patients with Meniere's disease (MD) with endolymphatic hydrops (EHs) have been described. Mental/physical stress and a subsequent increase in the release of the anti-diuretic hormone (ADH) supposedly triggers MD. In the present study, to assess the relationship between stress and EHs, we conducted a series of stress-related questionnaires as well as a 3D endolymphatic space (ELS) analysis in patients with unilateral MD.

Methods: We enrolled 76 patients with unilateral MD (uMD) as the active group and 75 patients with unilateral benign paroxysmal positional vertigo (uBPPV) as the control group; both underwent examinations between June 2014 and November 2019. All patients underwent 3-T magnetic resonance imaging (MRI) 4 h after intravenous gadolinium injection. We used the total fluid space (TFS), ELS, and ELS rate (ELS/TFS × 100), which is the percentage of the volume of the ELS relative to that of the TFS, for a precise evaluation of the ELS and EHs in MD. Stress was evaluated using the Self-Rating Depression Scale (SDS), the psychological Stress Response Scale (SRS), and the modified Dizziness Handicap Inventory (mDHI). Stress scores and blood ADH levels were compared across patient groups.

Results: In patients with uMD, ELS rates significantly correlated with SRS scores on both the affected and the healthy side and with mDHI scores on the affected side, while the SDS and ADH showed no significant correlation with the ELS rates. Correlations were much stronger in the group with severe SDS and one with low ADH levels.

Conclusions: The present results indicate that stress may be involved in EHs development in uMD, not only in the ipsilateral but also the contralateral ear. They also suggest that patients with neuropsychiatric tendencies may develop EHs and MD in response to a stressful lifestyle.

Keywords: 3D inner ear MRI; Depression; Endolymphatic hydrops volume; Meniere's disease; Stress; Vasopressin.

MeSH terms

Benign Paroxysmal Positional Vertigo
Ear, Inner* / diagnostic imaging
Endolymphatic Hydrops* / diagnostic imaging
Humans
Injections, Intravenous
Magnetic Resonance Imaging
Meniere Disease* / diagnostic imaging