Meniers DiseaseMeniers Disease

Periodic episodes of rotary vertigo or dizziness.■Fluctuating, progressive, unilateral (in one ear) or bilateral (in both ears) hearing loss, usually in lower frequencies.[4]■Unilateral or bilateral tinnitus.■A sensation of fullness or pressure in one or both ears.

Periodic episodes of rotary vertigo or dizziness.■Fluctuating, progressive, unilateral (in one ear) or bilateral (in both ears) hearing loss, usually in lower frequencies.[4]■Unilateral or bilateral tinnitus.■A sensation of fullness or pressure in one or both ears.

• Prosper Ménière

Born

June 18, 1799

Angers, France

Died

February 7, 1862 (aged 62)

Nationality

France

Known for

Ménière's disease

• 1938 Hallpike described the pathology Hydrous.etiology still obscure

• Pathology:

• Endolymphatic Sac / Stria Vascularis/ Longitudinal flow

Anatomical-abnormalitiesAnatomical-abnormalities Genetic-autosomal dominant Genetic-autosomal dominant Immunological-immune complex depositionImmunological-immune complex deposition Viral-serum IgE to herpes simples virus types I and II, Viral-serum IgE to herpes simples virus types I and II,

Epstein-Barr virus and CMVEpstein-Barr virus and CMV Vascular-associated with migrainesVascular-associated with migraines Metabolic-potassium intoxicationMetabolic-potassium intoxication

• Clinical Features:

• 1/Vertigo episodic, duration >20minutes, <12 hours, clusters of vertigo and then remissions

• frequency of vertigo

• other symptoms of vagal disturbance

• warning of impeding attack fullness in ear and change in character of tinitus.

• Contd

• 2/ Hearing Loss.

• SN hearing loss, lower frequencies. fluctuating ,may be normal in remissions?

• 3/Diplacusis, distortion of sound . tuning fork pitch

• Contd

• 4/Hyperacusis. intolerance to loud sounds

• 5/ Tinnitus. low pitch

• 6/ fullness in ears

• Diagnosis:

The diagnosis of Meniere disease is made based The diagnosis of Meniere disease is made based on a careful history and physical exam.on a careful history and physical exam.

• Examination{this is how I examine patient with giddy spells or vertigo.

• Ear:RT/Lt> Normal

• Eyes, Nystagmus in Acute attack towards the unaffected ear WRONG WAY, +eye movements+Corneal reflex

• Tuning fork test, And diplacusis

• examine all cranial nerves

• Finger nose test

• Unterberger test

• Hallpike test (BPPV)

• Investigations

• Pure tone audiometry

• Imaging: MRI to Exclude CP angle leision

• Investigation not done routinely

• 1/ Electrochochleography:Its measurement of electrical output of the cochlea and 8th nerve in response to an auditory stimulus.

• a/ cochlear microphonics; wave form,deflection up and down,sourse is hair cells.

• inference; if CM present hair cells of cochlea intact

• Cont..

• Summating potentials, basilar membrane and outer hair cells?

• Action potential 8th nerve

• In Meniers disease there is negative summating potential and SP to AP ratio is >30% (n 20%)

•Caloric test:irrigation of ear with warm and cold water(70degree above and below body temp) and duration of nystagmus noted .

• Direction of nystagmus (COWS) temperature gradiend across scc and movement of endolymph.

• In Meniers disease: canal paresis or reduced response on the affected side or directional preponderance.

• Glycerol test; diagnostic

• Glycerol 1.5ml/kg orally

• hrs after ingestion ,PTA will show 10db improvement in hearing in adjacent frequencies.

• Variants of Meniers disease

• Cochlear hydrop, Vestibular hydrop

• Treatment

• Acute attack. 1/ Admit 2/ Vestibular Sedatives

• 3/ Vasodilators Carbogen 5% co2 with 95% O2

• Histamine drip 2.75mg in 500ml glucose i/v slowly(rarely used because of cardiac complications

• Treatment when Acute phase is over:

• Betahistine(serc)16mg tds

• Diureic

• Surgery: 1/ Preserving Hearing

• Decompression Endolympatic sac

• Grommet insertion

• vestibular Nerve section

• Outcome of Retro-labyrinthine Vestibular Nerve Section Surgery (Original Article), Javed I. Shah & Gerald B. Brookes, Journal of

Medical Sciences, Vol. 13, No. 2 Jul 2005

• Patient with intractable Vertigo and no hearing

• Labrynthectomy

• Differential diagnosis

• central causes of vertigo

• infections spreading from middle ear

• BPPV,

• Sudden vestibular failure

• Acoustic Neuroma

• Question: 30 yrs. old lady with acute giddy spells lasting more than 20minutes with nausea and sickness,fluctuating hearing loss, low pitch tinnitus and fullness in ear,

• whats diagnosis

• Name investigations

• Describe Medical Treatment.

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