Copy of Meniere Disease
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Transcript of Copy of Meniere Disease
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MeniereMenieres Diseases Disease
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What is MeniereWhat is Menieress
Disease?Disease? In 1861 Prosper Meniere described aIn 1861 Prosper Meniere described asyndrome characterized by deafness,syndrome characterized by deafness,
tinnitus, and episodic vertigo !e "in#edtinnitus, and episodic vertigo !e "in#ed
this condition to a disorder of the innerthis condition to a disorder of the innerearear
In 1$%8 !a""pi#e and &airns described theIn 1$%8 !a""pi#e and &airns described the
under"ying patho"ogy of Meniereunder"ying patho"ogy of Meniere s diseases disease
as being endo"ymphatic hydrops but theas being endo"ymphatic hydrops but the
precise etio"ogy sti"" remains e"usiveprecise etio"ogy sti"" remains e"usive
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Normal membranous labyrinthDilated membranous labyrinthin Meniere's disease (Hydrops)
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'ge'ge DistributionDistributionandand
Incidence of the DiseaseIncidence of the Disease
Women(MenWomen(Men
In the US: 50% of patients have a positive family history.
The estimated prevalene is !50 ases per !00"000 population
#0$s and 50$s
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)ymptoms)ymptoms
Periodic episodesPeriodic episodes
of rotatory vertigoof rotatory vertigo
or dizzinessor dizziness
*"uctuating,*"uctuating,progressive, "o+progressive, "o+
fre-uency hearingfre-uency hearing
"oss"oss
.innitus.innitus
*u""ness/pressure*u""ness/pressure
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DiagnosisDiagnosis
The diagnosis of Meniere disease is madeThe diagnosis of Meniere disease is made
based on a careful history and physical exam.based on a careful history and physical exam.
If the work-up is normal and the classicIf the work-up is normal and the classic
symptoms continue, the diagnosis of Menieresymptoms continue, the diagnosis of Menieredisease is made.disease is made.
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!istory!istory
Most important part of the diagnosisMost important part of the diagnosis
Pattern of symptomsPattern of symptoms
ssociation between hearing loss, tinnitus,ssociation between hearing loss, tinnitus,and !ertigoand !ertigo
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Physica" 0aminationPhysica" 0amination
"xamination results !ary, depending upon the phase"xamination results !ary, depending upon the phaseof disease. #uring remission, physical examinationof disease. #uring remission, physical examinationfindings may be completely normal, particularly if thefindings may be completely normal, particularly if thepatient is symptom free.patient is symptom free.
#uring an acute attack, the patient has se!ere#uring an acute attack, the patient has se!ere
!ertigo.!ertigo. Patients are sometimes diaphoretic and pale.Patients are sometimes diaphoretic and pale. $ital signs may show ele!ated blood pressure, pulse,$ital signs may show ele!ated blood pressure, pulse,
and respirationand respiration..
%pontaneous nystagmus directed toward affected ear%pontaneous nystagmus directed toward affected earis typical during an acute attack.is typical during an acute attack.
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Physica" 0amination 2conPhysica" 0amination 2cont3t3
The &omberg test generally shows significant instabilityThe &omberg test generally shows significant instability
and worsening when the eyes are closed.and worsening when the eyes are closed.
The 'eber tuning fork test usually laterali(es away fromThe 'eber tuning fork test usually laterali(es away from
the affected ear.the affected ear.
The &inne test usually indicates that air conductionThe &inne test usually indicates that air conduction
remains better than bone conduction.remains better than bone conduction.
)omplete neurologic e!aluation is important. *ew-onset)omplete neurologic e!aluation is important. *ew-onset
!ertigo might be an early sign of stroke, migraine, or!ertigo might be an early sign of stroke, migraine, or
brainstem compression that may re+uire emergentbrainstem compression that may re+uire emergent
e!aluation and care.e!aluation and care.
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Imaging )tudiesImaging )tudies
Magnetic resonance imagingMagnetic resonance imaging
)T scans)T scans
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4ther tests4ther tests
AudiometryAudiometry Transtympanic electrocochleographyTranstympanic electrocochleography
"lectronystagmography"lectronystagmography
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.reatment.reatment
Medical therapy is both symptomaticMedical therapy is both symptomaticie, acute attacks and prophylactic.ie, acute attacks and prophylactic.
$estibulosuppressants eg, mecli(ine$estibulosuppressants eg, mecli(inedecrease symptoms, but generallydecrease symptoms, but generallyonly mask the !ertigo by decreasingonly mask the !ertigo by decreasingthe brains response to !estibularthe brains response to !estibular
input.input. #iuretic or diuretic-like medication#iuretic or diuretic-like medication
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.reatment.reatment &ont&ontdd
nti-inflammatory properties of steroidsnti-inflammatory properties of steroids
/ifestyle and dietary/ifestyle and dietary
#ia(epam#ia(epam
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.reatment.reatment &ont&ontdd
Surgical Care:Surgical Care:
0 %urgical therapy for M1ni2re disease is%urgical therapy for M1ni2re disease is
reser!ed for medical treatment failures and isreser!ed for medical treatment failures and is
otherwise contro!ersial.otherwise contro!ersial.
0 %urgical procedures are di!ided into 3 ma4or%urgical procedures are di!ided into 3 ma4or
classifications as follows5classifications as follows5
#estructi!e surgical procedures#estructi!e surgical procedures
*ondestructi!e surgical procedures*ondestructi!e surgical procedures
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PrognosisPrognosis
Prognosis is !ariable, since the disease patternPrognosis is !ariable, since the disease pattern
of exacerbation and remission makes e!aluationof exacerbation and remission makes e!aluation
of treatment and prognosis difficult to predict.of treatment and prognosis difficult to predict.