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5. menier's disease
 

5. menier's disease

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    5. menier's disease 5. menier's disease Presentation Transcript

    • Meniere’s Disease DR. RS MEHTA, BPKIHS
    • • The disease is named after a French doctor - Prosper Ménière who described the condition as being characterised by sudden attacks of dizziness, nausea, vomiting, loss of hearing and a buzzing in the ears (tinnitus). DR. RS MEHTA, BPKIHS
    • Meniers disease is a disorder of inner ear where the endolymphatic system is distended. It is chracterised by i. Virtigo ii. Sensorial hearing loss iii. Tinnitus and iv. Aural fullness DR. RS MEHTA, BPKIHS
    • Function of ear • Hearing: Sound conduction and transmission • Balance and equilibrium DR. RS MEHTA, BPKIHS
    • Anatomy of ear It consists of: • Outer ear • Middle ear • Inner ear DR. RS MEHTA, BPKIHS
    • Inner ear  Bony labyrinth:  Vestibule  Semicircular canals  Cochlea  Membranous labyrinth Cochlear duct Utricle and saccules Semi-circular ducts Endolymphatic duct DR. RS MEHTA, BPKIHS
    • Definition • Meniere’s disease is a disorder of inner ear in which the endolymphatic system is distended. • It is also called endolymphatic hydrops. DR. RS MEHTA, BPKIHS
    • Incidence • • • • Male are affected more than female. Disease is mainly unilateral. It is more common in age group 35-60 years About 50,000 - 100,000 people of world develop Meniere's disease in a year. • About 50 % of the patients who have Meniere's disease have a positive family history of this disease. DR. RS MEHTA, BPKIHS
    • Etiology • • • • • • • • • The exact cause of Meniere’s disease is unknown. Possible causes include: Defective absorption by endolymphatic sac Allergies Sodium and water retention Hypothyroidism Autoimmune and viral aetiologies Mumps Syphilis Head trauma Previous infection • Hormonal (Pregnant females are more prone) DR. RS MEHTA, BPKIHS
    • DR. RS MEHTA, BPKIHS
    • Risk factors • • • • • • • Smoking Alcohol use Fatigue Respiratory infection Stress Use of certain medications, including aspirin Genetics may also play a role DR. RS MEHTA, BPKIHS
    • Pathophysiology Obstruction of endolymphatic duct/sac Alteration in production and absorption of endolymph Distension of endolymphatic sac Increased in pressure and rupture of inner membranes Vertigo, tinnitus, hearing loss( Meniere’s) DR. RS MEHTA, BPKIHS
    • Normal membranous labyrinth Dilated membranous labyrinth in Meniere's disease (Hydrops) DR. RS MEHTA, BPKIHS
    • Clinical features Cardinal symptoms of Miniere’s disease are: • Episodic vertigo  Sudden onset  Feeling of rotation of himself/environment • Fluctuating hearing loss Following /accompanying vertigo  Deterioration in hearing with each attack DR. RS MEHTA, BPKIHS
    • Cont • Tinnitus  Low pitch roaring type • Sense of aural fullness: Accompany/ preceed vertigo DR. RS MEHTA, BPKIHS
    • Other features • • • • Headache Pain or discomfort in the abdomen Nausea and vomiting Uncontrollable eye movements DR. RS MEHTA, BPKIHS
    • Physical Examination • • • During an acute attack, the patient has severe vertigo. Patients are sometimes diaphoretic and pale. Vital signs may show elevated blood pressure, pulse, and respiration. DR. RS MEHTA, BPKIHS
    • • The Weber tuning fork test usually lateralized to the better ear. • The Rinne test is positive absolute bone conduction is reduced in the affected ear Weber Test: Normal: equal hearing both sides of same type Abnormal – Tone louder in on one side =Conductive loss – tone louder on affected side =SNHL – tone louder on contralateral side Rinne test: Normal: AC > BC Abnormal Negative Rinne – louder on mastoid process Positive Rinne – Bilateral SNHL DR. RS MEHTA, BPKIHS
    • Investigations • • • • Otoscopy Audiometry Electrocochleography Caloric test: reduced respond on the affected site DR. RS MEHTA, BPKIHS
    • Imaging Studies • Magnetic resonance imaging: Brain scan should be done to rule out abnormal anatomy or mass lesions. • CT scans reveal dehiscent superior semicircular canals and/or widened cochlear and vestibular aqueducts DR. RS MEHTA, BPKIHS
    • Transtympanic electrocochleography • Transtympanic electrocochleography (ECOG) specifically detects distortion of the neural membranes of the inner ear. DR. RS MEHTA, BPKIHS
    • Electronystagmography (ENG) • Electronystagmography (ENG) is a test of the inner ear function (particularly the semicircular canals). DR. RS MEHTA, BPKIHS
    • Management General measures: • • • • • Reassurance: psychological support Cessation of smoking Low salt diet Avoid excessive intake of water Life style modification DR. RS MEHTA, BPKIHS
    • Cont.. Management of acute attack • Reassurance • Bed rest • Vestibular sedatives: prochlorperazine,diazepam • Vasodilators: adenosine triphosphate DR. RS MEHTA, BPKIHS
    • Cont… Management of chronic phase • Vestibular sedatives: prochlorperazine, • Vasodilators: nicotinic acid, betahistine • Diuretics: furesemide • Avoid allergen • Chemical labyrinthectomy: intratympanic gentamicin therapy DR. RS MEHTA, BPKIHS
    • Cont.. Surgical management • Conservative procedure: Endolymphatic decmpression Endolymphatic shunt operation Ultrasonic destruction of vestibular labyrinth • Destructive measure: Labyrinthectomy DR. RS MEHTA, BPKIHS
    • Rx: summary 1. Atropine: stop attack for 20-30 Minutes 2. Bed rest in quite environment 3. Labyrinthine sedative like: Prochlorperazine (stemetil), Idmenhydrinate (Dramamine) to control giddiness and N/V 4. Vasodilators: Nicotinic acid, betahistamine to control vasospasm 5. Tranquilizer and anti-depressant to relieve anxiety 6. Prphylactic antihistamine or mild sedative: Phenobarbitone, diazepam may be helpful. 7. Steroid to reduce inflamation 8. Antibiotics: esp. Aminoglycocise groups DR. RS MEHTA, BPKIHS
    • Nursing management • Assess the severity and frequency of attack, any associated ear symptoms (hear loss, tinnitus). • Help patient prevent from aura, so patient has time to prepare for an attack. • Encourage patient to lie down during attack in safe place. • Put side rails in the bed if patient is in bed • Place pillow to restrict movement. DR. RS MEHTA, BPKIHS
    • Cont.. • Administer or teach anti-vertiginous medication and sedation medication as prescribed • Avoid noises and glary bright light which may initiate attack. • Advise patient to avoid food that cause allergy. • Assist with ambulation when indicated. • Provide comfort measures and avoid stress producing activities. DR. RS MEHTA, BPKIHS
    • Post operative instructions: • Antibiotic and other medication are to be taken as prescribed. • Nose blowing to be avoided (few weeks). • Sneezing and coughing should be done with the mouth open for a few weeks after surgery. • Heavy lifting, straining, and bending are to be avoided for a few weeks after surgery. • Minor discomfort is expected can relief by analgesic, excessive pain should be reported to surgeon. DR. RS MEHTA, BPKIHS
    • • Some slightly bloody or serosanganious drainage from the ear is normal after surgery. • Excessive or purulent drainage should be reported to the surgeon. • The cotton ball in the ear can be changed as needed but not to touch or remove any packing from the external auditory canal. • Post auricular suture line should be cleaned and antibiotic oint. Applied twice daily. • The surgeon should consult for regular air travel. • Getting water in the operated ear must be avoided for 2 weeks after surgery. DR. RS MEHTA, BPKIHS
    • • • • • • • • Dressing first open-3rd day Suture removal 10th day Head up 300 (3-10 days) Avoid: Chewing, sneezing, coughing etc Prevent water in ear: 6 weeks Never put oil in ear Hearing may be impaired for few months RT edema, blood, fluid • Observe complications: Facial nerve palsy (VII), brain abscess, meningitis etc • Avoid flying in air for 2 months • BIPP dressing (bismuth icthymol parafin paste) while doning mastoid surgery DR. RS MEHTA, BPKIHS
    • Complications • Inability to walk or function due to uncontrollable vertigo. • Hearing loss on the affected side. • Possible of injury due to imbalance. DR. RS MEHTA, BPKIHS
    • Prognosis • The outcome varies. Meniere's disease can often be controlled with treatment. • The condition may get better on its own sometimes. • Meniere's may be chronic disabling causing permanent hearing loss. DR. RS MEHTA, BPKIHS
    • Thank You DR. RS MEHTA, BPKIHS