Download Meniers disease PPT Dr Javed shah

Meniers 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.
•
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
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Anatomical-abnormalities
Genetic-autosomal dominant
Immunological-immune complex deposition
Viral-serum IgE to herpes simples virus types I and II, EpsteinBarr virus and CMV
Vascular-associated with migraines
Metabolic-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
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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