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Meniers Disease

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.

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Meniers Disease

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  1. 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.

  2. 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

  3. Pathology: • Endolymphatic Sac / Stria Vascularis/ Longitudinal flow

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

  5. 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.

  6. Contd • 2/ Hearing Loss. • SN hearing loss, lower frequencies. fluctuating ,may be normal in remissions? • 3/Diplacusis, distortion of sound . tuning fork pitch

  7. Contd • 4/Hyperacusis. intolerance to loud sounds • 5/ Tinnitus. low pitch • 6/ fullness in ears

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

  9. 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

  10. examine all cranial nerves • Finger nose test • Unterberger test • Hallpike test (BPPV)

  11. Investigations • Pure tone audiometry • Imaging: MRI to Exclude CP angle leision

  12. 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

  13. Cont.. • Summating potentials, basilar membrane and outer hair cells? • Action potential 8th nerve

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

  15. 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.

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

  17. Glycerol test; diagnostic • Glycerol 1.5ml/kg orally • hrs after ingestion ,PTA will show 10db improvement in hearing in adjacent frequencies.

  18. Variants of Meniers disease • Cochlear hydrop, Vestibular hydrop

  19. 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

  20. Treatment when Acute phase is over: • Betahistine(serc)16mg tds • Diureic

  21. 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

  22. Patient with intractable Vertigo and no hearing • Labrynthectomy

  23. Differential diagnosis • central causes of vertigo • infections spreading from middle ear • BPPV, • Sudden vestibular failure • Acoustic Neuroma

  24. 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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