menieres disease
TRANSCRIPT
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MENIERES DISEASEDr. Pradeep Divakaran Specialist ENT surgeon
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Ménière disease was first described in 1861 by the French physician Prosper Ménière.
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Endolymphatic hydrops Disorder of inner ear where the
endolymphatic system is distended
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Episodic Vertigo low frequency SNHL Low pitched Tinnitus Aural Fullness
Characterised by
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Distention of endolymphatic system
Affecting the cochlear duct and the saccule , and to some extent utricle and saccule
Pathology
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Distention of endolymphatic system
Increased production or decreased absorption
Etiologies
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Postulates are 1.defective absorption Ishemia of the endolymphatic sac poor vascularity and poor absorption
2. vasomotor disturbances
Sympathetic over activity - spasm of the of internal auditory artery – cochlear and vestibular neuroendothelial dysfunction (deafness and vertigo )
Etiology of MD is not known
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Anoxia of stria vascularis- causes transudation and increased production of endolymph
3 . Allergy :food stuff or inhalant – inner ear produces excess endolymph
50% of MD suffering from allergy (food or inhalational )
4. Sodium and water retention : increased production of endolymph
5.Auto immune and viral etiologies
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Vertigo episodic vertigo accopmpanied by nausea and vomiting
with nystagmus Sudden onset, comes in clusters with
spontaneous remission and for weeks months or years
Vagal disturbances abd. Cramps ,diarrhoea cold sweats . Pal;lor and bradycardia
Tullio phenomenon
Clinical features
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Usually accompanies vertigo or may precede it fluctuating hearing loss- Normal hearing after
the attack and during remission Recurrent attacks leading to slow and
permanent deterioration of hearing Intolerance to loud sound
Hearing loss- SNHL
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Low pitched roaring or hissing type Aggravated during attack May persists during remission
Change in the character of the tinnitus may be a warning symptom of a new attack
Tinnitus
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It may accompany or precedes the vertigo
Aural fullness
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Otoscopy normal Nystagmus only during acute attack TFT: SNHL
signs
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PTA low frequency SNHL
INVESTIGATIONS
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SPEECH AUDIOMETRY
55-85% is normally during remissions and much impaired during and immediately following attack
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Recruitment positive
SISI better than 70%
Tone decay less than 20 db
Shows cochlear nature of the disease than retro cochlear
Special audiometry tests
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Dehydrating agent ,when given orally will reduce endolymph
1.5mg /kg with water PTA and speech discrimination recorded
before and after 1-2 hours 10 db improvement in PTA 10 % gain in speech discrimination No improvement for tinnitus and sense of
fullness Diagnostic and prognostic value
Glycerol test
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General measures Cessation of smoking Low salt diet Avoid excessive intake of water Avoid coffee tea and alcohol Stress releving methods Avoid activities requiring body balance Flying , underwater diving.heights
Management
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Reassurance Bed rest Vestibular sedatives Prochlorperazine / promethazine Diazepam
Mangement of acute attack
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Carbogen inhalation 5% co2 +95%o2 Histamine drip - histamine diphosphate
2.75mg dissolved in 500 ml glucose given IV
Vasodialators
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Vestibular sedatives Prochoperazine 10 mg Vasodilators Diuretics Propantheline bromide Elimination of allergen Hormonal replacement Intratympanic gentamycin therapy
Mx of chronic phase
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1. COSERVATIVE PROCEDURES 2. DESTRUCTIVE PROCEDURES
Surgical management
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Endolymphatic sac decompression
CONSERVATIVE PROCEDURES
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Endolymphatic shunt operation
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Sacculotomy
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Vestibular nerve section
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Ultrasonic destruction of vestibular labyrinth
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Labyrinthectomy 1.Through LSCC By transmastoid approach 2. Oval window through trans canal approach
Destructive procedure
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MENIETT DEVICE