Secondary Endolymphatic Hydrops: Causes & Treatment

Secondary endolymphatic hydrops (SEH) is a pathological condition of the inner ear caused by a build-up of endolymphatic fluid. It normally manifests as episodic vertigo, hearing loss, tinnitus and a feeling of fullness in the ear.

What is secondary endolymphatic hydrops?

Primary endolymphatic hydrops occurs spontaneously, without an underlying cause. Secondary endolymphatic hydrops, on the other hand, is a build-up of fluid that overlaps with other temporal bone pathologies and inner ear diseases.

How does endolymphatic hydrops occur?

Maintaining endolymphatic fluid homeostasis is essential for the proper functioning of the vestibular and cochlear parts of the inner ear, which are critical for hearing and balance. Together, these specialised cells detect sound, changes in gravity and changes in the speed or direction of head movement.

If there is an excess accumulation of endolymphatic fluid, the cells may not function properly, which in turn may cause spells of hearing loss, dizziness, tinnitus and aural fullness. However, not all people with endolymphatic hydrops experience these symptoms.

Excess endolymph within the membranous labyrinth can be caused by trauma or inflammation. Delayed secondary endolymphatic hydrops occurs weeks, months or even years after the trigger.

Causes of secondary endolymphatic hydrops

Possible causes include:

• Infections, such as otitis media or labyrinthitis
• Noise-induced hearing loss, caused by exposure to loud noises such as gunshots or explosions
• Medications that reduce swelling and fluid retention in the tissues
• Surgeries such as cochlear implantation or stapedotomy for otosclerosis
• Changes in cerebrospinal fluid pressure
• Tumours (acoustic neuromas)
• Other inflammations, such as mumps, measles, meningitis or influenza

Sometimes even head injuries can cause secondary endolymphatic hydrops.

Symptoms of endolymphatic hydrops

• Episodes of vertigo (the feeling that you or the room is spinning)
• Fluctuating hearing loss
• Fluctuating tinnitus (ringing in the ears)
• Aural fullness

Diagnosis

The diagnosis is made by the specialist ENT neuro-otologist at the EYiasis Vertigo and Neuro-otology Lab.

Secondary endolymphatic hydrops is suspected based on a complete medical history, including injuries, illnesses and medications taken or discontinued recently. In addition, the ENT specialist at EYiasis will perform a thorough clinical examination.

Diagnostic tests

• Audiogram (hearing test)
• Vestibular function tests
• Balance tests
• Imaging tests (CT or MRI)

Many conditions cause similar symptoms, so some of these tests are performed to rule out other health problems before a diagnosis is made.

Treatment of secondary endolymphatic hydrops

To improve symptoms, it is important to identify the cause of the secondary endolymphatic hydrops. Lifestyle changes may be needed to reduce the severity of the symptoms.

What treatment depends on

Treatment depends on the patient’s age and on the frequency and severity of the symptoms. Other coexisting conditions, such as migraine, arthritis or allergies, must also be taken into account.

Initially, management includes lifestyle changes and medication, especially if the symptoms are mild to moderate. Mainly diuretics may be recommended to reduce fluid accumulation in the inner ear. Medications that reduce the severity of vertigo or nausea may also be given.

If the symptoms are severe and lifestyle modifications do not bring the desired results, medical acupuncture, intratympanic LLLT therapy or even more invasive options, such as intratympanic injections, will be recommended.

Dietary changes

• Good hydration
• Low-salt diet
• Caffeine reduced to less than 100 mg per day
• Avoiding foods such as chocolate, red wine, dairy products and pickles (foods that often cause migraines can trigger attacks)

Additional measures

• Avoiding factors that cause or worsen symptoms (alcoholic drinks, high salt intake, caffeine)
• Avoiding smoking or other tobacco use
• Reducing intense physical activity, which may worsen symptoms
• Treating allergies and avoiding exposure to allergens
• Improving working conditions to reduce stress, overwork and fatigue
• Avoiding environmental triggers, such as bright or flashing lights, pressure changes, noisy environments and certain visual patterns such as stripes

Keeping a diary of symptoms and possible triggers is often recommended, so that any identified triggers can be avoided.

If you experience recurrent vertigo, tinnitus or fluctuating hearing, contact EYiasis to book a specialised neuro-otology assessment.

References

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3. Eckhard AH, Zhu M, O’Malley JT, Williams GH, Loffing J, Rauch SD, et al. Inner ear pathologies impair sodium-regulated ion transport in Meniere’s disease. Acta Neuropathol. (2019) 137:343–57.
4. Young YH, Lin KT. Potential application of hydrops MR Imaging: a systematic review. J Otolaryngol Head Neck Surg. (2024) 53:19160216241250350.
5. Yun JM, Kim SH, Bae SH. Vestibular dysfunction in lateral semicircular canal dysplasia. Front Neurol. (2024) 15:1341812.