Advances in imaging analysis of the inner ear in patients with Meniere's disease

Purpose of review Visualization of endolymphatic hydrops using MRI has become a cutting-edge method not only for diagnosing Meniere's disease but also for pathophysiological elucidation of the disease. Here, we review recent advances in imaging analysis of the inner ear in Meniere's disease, which could provide additional information over previous findings. Recent findings In addition to identification of endolymphatic hydrops on MRI, high-intensity signals in the perilymph, which represent alterations in vascular permeability in the blood–perilymph barrier (BPB), might be a key to elucidating the pathophysiology of Meniere's disease. Moreover, high-intensity signals in the endolymphatic duct, which indicate disturbances of the lymph–capillary system, might provide new information for elucidating the pathogenesis of hearing loss and dizziness/vertigo not associated with endolymphatic hydrops. Summary Presence of endolymphatic hydrops is not necessarily the cause of symptoms related to Meniere's disease. Alteration of the BLB might lead to additional disturbances in ears with Meniere's disease and induce clinical symptoms. Disturbances of the lymph–capillary system in endolymphatic duct might induce audio-vestibular symptoms in ears without endolymphatic hydrops. Further development of MRI evaluation of inner ear conditions is desirable not only for accurate diagnosis and elucidation of the pathophysiology of the diseases, but also for early medical intervention to prevent their progression.