Vestibular Aqueduct Grading: an Early Predictor of Progression from Low-Frequency Sensorineural Hearing Loss to Ménière’s Disease

Objective This study investigated vestibular aqueduct (VA) morphology in acute low-frequency sensorineural hearing loss (ALHL) and Ménière’s disease (MD), assessing its association with endolymphatic hydrops (EH) and potential as a predictor for ALHL progression to MD. Methods A retrospective analysis of 135 patients (ALHL = 67, MD = 44, controls = 24) conducted between March 2019 and July 2024 utilized MRI-T2 for VA grading (Grade 0: continuous; Grade 1: discontinuous; Grade 2: non-visible) and 3D real inversion recovery (IR) sequences for EH detection. Results The cohort comprised 135 patients (66 males, 69 females; mean age 45.00 ± 13.79 years), stratified into ALHL (n = 67; 32 without EH, 35 with EH), MD (n = 44), and control (n = 24) groups. Mean age increased progressively from ALHL without EH to ALHL with EH and MD groups (P < 0.0001). VA grading differed significantly between the MD and control groups (P < 0.0001) and between ALHL and control groups (P < 0.05). ALHL without EH showed no VA differences compared to controls. ALHL with EH exhibited VA patterns resembling MD (P = 0.985) and bilateral VA asymmetry (affected vs. unaffected ears, P < 0.05). Grade 2 VA conferred a 5.1-fold increased risk of EH (P = 0.008). During follow-up, 10.45% of ALHL patients progressed to MD, exclusively within the EH subgroup (20% of this subgroup), with 85.7% of progressions occurring in Grade 2 VA patients. Conclusion MRI-T2 thin-slice SPACE sequences can reliably assess VA grading, revealing parallels between ALHL with EH and MD. Elevated VA grades, particularly grade 2, in patients with ALHL serve as predictive indicators for disease progression, with the VA grading system demonstrating clinical value for risk stratification and early MD diagnosis.