BY-DR.SUDEEP K.C.. Meniere’s disease : It is aslo called endolymphatic hydrops,is a disorder of...
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Transcript of BY-DR.SUDEEP K.C.. Meniere’s disease : It is aslo called endolymphatic hydrops,is a disorder of...
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MENIERE’S DISEASE
BY-DR.SUDEEP K.C.
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Meniere’s disease : It is aslo called endolymphatic hydrops ,is a disorder of inner ear where endolymphatic system is distended.
Pathology: Distension of endolymphatic system mainly affecting cochlear duct and sacculecompletely fill the scala vestibulidistended saccule may come to lie against stapes foot plate.
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Aetiology:Distension of endolymphatic system can result either from increased production of endolymph or its faulty absorption or both.
1)Defective absorption by endolymphatic sac.2)Vasomotor disturbance3)Allergy4)Sodium and water retention5)Hypothyroidism6)Autoimmune and viral aetiologies.
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Clinical features:Age and sex: commonly seen in 35-60 yrs of age . Male>female.Usually disease is unilateral .
Vertigo : It comes in attack with sudden onset . usually attack is accompanied by nausea vomiting with ataxia and nystagmus and also by vagal disturbances in severe attack. “Tullio phenomenon”_ loud sounds produce vertigo due to distended saccule lying against stapes footplate.
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2) Hearing loss: It usually accompanies vertigo or may precede it . Hearing improves after the attack and may be normal during the periods of remission . Some complain of distorted hearing and intolerance to loud sounds.
3)Tinnitus : It is aggravated during acute attacks may persist during periods of remission . Change in intensity and pitch of tinnitus may be the warning symptom of attack.
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4) Sense of fullness or pressure: It may accompany or precede an attack of vertigo.
5)Other features : patient may show emotional upset due to repetition of attacks.
Examination:Otoscopy normalNystagmus seen only during acute attack.Tuning fork test indicate the SNHL.
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Investigation:
1)Pure tone audiomerty : There is SNHL.inearly stages, lower frequencies and later on higher frequencies are affected.
2)Caloric test : It shows reduced response on the affected side in 75% of cases . often it reveals a canal paresis on the affected side.
3)Glycerol test : It is a dehydrating agent when given orally it reduces endolymph pressure and thus causes an improvement in hearing.
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Treatment: A) General measures: ReassuranceCessation of smokingLow salt dietAvoid excessive intake of waterAvoid over intake of coffee , tea and alchol.Avoid stress and bring a change in life style.Avoid activities requiring good body balance.
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B) Management of acute attack:
ReassuranceBed restVestibular sedativesVasodilators –inhalation of carbogen ,histamine drip.
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C)Management of chronic phase: vestibula sedativesVasodilatorsDiureticsPropantheline bromideElimination of allergenHormones Intra tympanic gentamicin therapy
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D)Surgical Treatment: Decompression of endolymphatic sac.Endolymphatic shunt operation.SacculotomySection of vestibular nerveUltrasonic destruction of vestibular labyrinth.Labyrinthectomy.
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