Meniere’s disease
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MENIERE’S DISEASE
Saurabh GuptaProf. (Dr.) S. K. Jaiswal unit
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IntroductionMeniere's disease (idiopathic endolymphatic
hydrops) is a disorder of the inner ear associated with a symptoms consisting of spontaneous, episodic attacks of vertigo; sensorineural hearing loss which usually fluctuates; tinnitus; and often a sensation of aural fullness.
dramatic variability is the hallmark of this disease.
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Introduction : HistoryFirst described by
Prosper Meniere in 1861.
In 1902, Parry performed a CN VIII division for vertigo in a patient with suspected Meniere’s disease.
Portman did endolymphatic sac decompression via a transmastoid approach in 1926.
In 1931,McKenzie performed a selective vestibular neurectomy.
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Pathology Distortion of the membranous labyrinth.This condition reflects the changes in the
anatomy of the membranous labyrinth as a consequence of the over-accumulation of endolymph.
Mainly affects scala media and sacculeBulging of reissner’s membrane Saccule may come to lie against the stapes
footplate.
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EtiologyA. Defective absorption by endolymphatic sac-• Poor vascularity of sac• Less absorptive tubular epithelium• increased perisaccular fibrosisB. Rupture of reissner’s membreane leading to
mixing of perilymph & endolymph- Schuknecht
• allow leakage of the potassium-rich endolymph into the perilymph, bathing the eighth cranial nerve and lateral sides of the hair cells
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EtiologySpasm of int. auditory artery – Sym.
OveractivityAllergy – inner ear is shock organSodium & water retentionHypothyroidismAutoimmuneViral
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Clinical featuresAffects in 4th -5th decade of lifeMale:Female 1:1Prevalence more in whites.VERTIGO : episodic attacks , asso. with nystagmus,
nausea & vomiting , vagal disturbanceTullio phenomenon may be seen
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Clinical featuresHEARING LOSS 1. Fluctuating2. SNHL3. Progressive 4. Unilateral5. Distortion of sound6. Intolerance to loud sound
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Clinical featuresTINNITUS1. Low pitched roaring2. Subjective3. Unilateral AURAL FULLNESS1. Fluctuates , in prodromal phase
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Diagnosis
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InvestigationsTuning forks tests :
SNHLPTA Speech audiometryRecruitment test
+veSISI >70%Tone decay <20 dB
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Investigations Caloric testing – canal paresisENGHead Thurst testECoG – SP is larger & more negativeSP/AP ratio increases > 30%Glycerol testVEMP – elevated threshold
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VEMPs
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StagingSTAGE PURE TONE AVERAGE IN dB IN PREVIOUS 6
MONTHS
1 = < 25
2 26-40
3 41-70
4 >70
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Variants Cochlear hydrops – no vertigoVestibular hydrops – no heaing lossDrop attacksLermoyez syndrome- hearing loss followed by
vertigo
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Treatment Medical management –ACUTE stage : labyrinth sedatives + anti-
emeticsCarbogen, Histamine dripFrustenberg Regimen -1. Low salt diet2. Diuretics + Pot. chlor3. High protein Beta histine – to relieve vascular ischemia Stop caffeine, nicotine, alcohol & tobacco
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Non ablative proceduresPortman -1926Endolymphatic sac surgery1. Subarachnoid shunt2. Mastoid shunt
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Non ablative proceduresIntratympanic steroids May benefit in autoimmune causes of
meniere’s syndrome.Sacculotomy Cochleosacculotomy
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Ablative proceduresIntratympanic gentamicin – Schuknecht
(1957)
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Ablative proceduresSelective Vestibular nerve sectioning
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Ablative proceduresUltrasonic destruction of vest. Labyrinth CryodestructionLabyrinthectomy - when cochlear function
has been totally deteoriated ,higher rate of vertigo control seen than that typical for vestibular neurectomy
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Recent advancesdecrease hydrops by pulsing pressure in the
middle earMeniett device - handheld air pressure
generator that the patient self-administersThe pressure is delivered in complex pulses
of up to 20 cm of water, over a 5 minute period.
The device requires a ventilation tube to be placed in the tympanic membrane before initiation of therapy
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Pressure at the RW passes to perilypmh and decreases pressure in endolymph by redistributing it.
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THANK YOU