Download - Meniere’s disease
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Meniere’s DiseaseMeniere’s Disease
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DEFINITIONDEFINITION
Disease of inner earDisease of inner ear
Distention of endolymphatic systemDistention of endolymphatic system VertigoVertigo Sensorineural hearing lossSensorineural hearing loss TinnitusTinnitus
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HistoryHistory1861 – Prosper Meniere 1861 – Prosper Meniere describes classic symptomsdescribes classic symptoms
1938 – Hallpike and Portman 1938 – Hallpike and Portman confirm endolymphatic hydropsconfirm endolymphatic hydrops
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AGE AGE DISTRIBUTIONDISTRIBUTION AND AND INCIDENCEINCIDENCE
35-60 yrs35-60 yrs
Females : Male 3:2Females : Male 3:2
FamilialFamilial
Unilateral / bilateralUnilateral / bilateral
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PATHOPHYSIOLOGYPATHOPHYSIOLOGY
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Normal membranous labyrinth Dilated membranous labyrinth in Meniere's disease (Hydrops)
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PathophysiologyPathophysiology
Theories behind endolymphatic hydropsTheories behind endolymphatic hydrops Obstruction of endolymphatic duct/sacObstruction of endolymphatic duct/sac Hypoplasia of endolymphatic duct/sacHypoplasia of endolymphatic duct/sac Alteration of absorption of endolymphAlteration of absorption of endolymph Alteration in production of endolymphAlteration in production of endolymph Autoimmune insult Autoimmune insult Vascular originVascular origin Viral etiologyViral etiology
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AETIOLOGY (primary causes)AETIOLOGY (primary causes)
GeneticGenetic
Anatomical (small vestibular aqueduct)Anatomical (small vestibular aqueduct)
Traumatic (physical, acoustic)Traumatic (physical, acoustic)
Viral infection (HSV type 1)Viral infection (HSV type 1)
AllergyAllergy
AutoimmunityAutoimmunity
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AETIOLOGY (secondary causes)AETIOLOGY (secondary causes)
Developmental insultDevelopmental insult
Metabolic statesMetabolic states (DM, hypothyroidism, hyperlipidaemia)(DM, hypothyroidism, hyperlipidaemia)
SyphilisSyphilis
CSOMCSOM
OtosclerosisOtosclerosis
Abnormal fluid balanceAbnormal fluid balance
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CLINICAL FEATURESCLINICAL FEATURES
VertigoVertigo EpisodicEpisodic NystagmusNystagmus
Hearing lossHearing loss SensorineuralSensorineural ProgressiveProgressive
TinnitusTinnitus Continuous / intermittentContinuous / intermittent
Aural fullnessAural fullness
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DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS
Vestibular neuronitisVestibular neuronitis
Benign paroxysmal positional vertigoBenign paroxysmal positional vertigo
Vestibular schwannomaVestibular schwannoma
Vertibrobasilar insufficiencyVertibrobasilar insufficiency
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EXAMINATIONEXAMINATION
Otoscopy:Otoscopy: NormalNormal
Nystagmus:Nystagmus: During acute attacksDuring acute attacks
Tuning fork tests:Tuning fork tests: RinnieRinnie PositivePositive WeberWeber Lateralized to better earLateralized to better ear ABCABC Reduced in affected earReduced in affected ear
Complete neurological examinationComplete neurological examination
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INVESTIGATIONSINVESTIGATIONSAssessment of cochlear functionAssessment of cochlear function PTAPTA
Rising
Flat
Falling
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INVESTIGATIONSINVESTIGATIONS
Speial audiometric testsSpeial audiometric tests
Evoked response audiometryEvoked response audiometry
Transtympanic electrocochleographyTranstympanic electrocochleography
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INVESTIGATIONSINVESTIGATIONS
Assessment of vestibular functionAssessment of vestibular functionMetabolic screeningMetabolic screening CBC-ESRCBC-ESR UREA / ELETROLYTESUREA / ELETROLYTES VDRL / TPHAVDRL / TPHA BSRBSR GTTGTT CHOLESTEROL / TGCHOLESTEROL / TG TFTTFT
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TREATMENTTREATMENT
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MEDICAL TREATMENTMEDICAL TREATMENTAcute TherapyAcute Therapy
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Medical TreatmentMedical TreatmentSymptomatic reliefSymptomatic relief Salt restrictionSalt restriction Avoid caffeine, nicotine, alcohol, high-Avoid caffeine, nicotine, alcohol, high-
carbohydrate substances, high-carbohydrate substances, high-cholesterol/triglyceride foodscholesterol/triglyceride foods
Vestibular suppressantsVestibular suppressants DiureticsDiuretics Vasodilators (Betahistine)Vasodilators (Betahistine) SteroidsSteroids
Hearing aidsHearing aids
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Chemical ablation of Chemical ablation of vestibular functionvestibular function
Intratympanic gentamicin / streptomycinIntratympanic gentamicin / streptomycin
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Surgical TherapySurgical Therapy
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Endolymphatic Sac SurgeryEndolymphatic Sac Surgery
Decompression:Decompression:
Removal of bone overlying the sacRemoval of bone overlying the sac Shunting:Shunting:
Placement of synthetic shunt to drain Placement of synthetic shunt to drain endolymph into mastoidendolymph into mastoid
Drainage:Drainage:
Incision of the sac to allow drainageIncision of the sac to allow drainage Removal of sac:Removal of sac:
Excision of the sacExcision of the sac
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Endolymphatic Sac SurgeryEndolymphatic Sac Surgery
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Vestibular Nerve SectionVestibular Nerve Section
Approaches: Approaches: Middle FossaMiddle Fossa Retrolabyrinthine/RetrosigmoidRetrolabyrinthine/Retrosigmoid TranscanalTranscanal
ComplicationsComplications Damage to facial nerveDamage to facial nerve Damage to cochlear nerveDamage to cochlear nerve CSF leak (about 13%)CSF leak (about 13%)
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Ultrasonic destruction of Ultrasonic destruction of vestibular labyrinthvestibular labyrinth
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LabyrinthectomyLabyrinthectomy
Approaches: Approaches: TranscanalTranscanal TransmastoidTransmastoid
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THANK YOUTHANK YOU