Meniere's disease is a disorder of the inner ear that causes episodes of vertigo, ringing in the ears (tinnitus), and fluctuating hearing loss. It occurs when the inner ear fluid balance is disturbed, causing pressure to build up within the inner ear. Symptoms include vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear. Diagnosis is based on symptoms and tests such as audiometry and electronystagmography are used to support the diagnosis. Treatment focuses on controlling symptoms and includes medications, diet changes, Meniere's devices, and sometimes surgery if other treatments are not effective. Complications can include permanent hearing loss and difficulties with balance affecting daily activities

1. YosephA.N.
13.14
FKUPNVJ2013
Meniere Disease

2. ● “Menierediseaseadalahpenyakityangdisebabkanolehadanya
hidropsendolimfapadakokleadanvestibulum.”(THTKepala&Leher,
FKUI)
● “Ménièrediseaseisadisorderofthein erearthatisalsoknownas
idiopathicendolymphatichydrops.Endolymphatichydropsreferstoa
condition of increased hydraulic pres ure within the in er ear
endolymphaticsystem.”(Medscape)
Definisi

5. ● Biasanyaterjadihanyapadasalahsatutelinga
● Dapaterjadidisemuaumur,namunlebihseringpadadewasaantara
usia40 –60tahun
● NIDCDmenemukansebanyak615.000kasusdiUSdan45.50 k a s u s
barutiaptahun y a
Epidemiologi

6. ● PenyebabpenyakitMenierebelum diketahui,penambahanvolume
endolimfadiperkirakanolehadanyagang uanbiokimiacairan
endolimfadangang uanklinikpadamembranlabirin
● Namunbeberapapenelitimenyatakanbahwahidropsendolimfa
bukanlahmerupakanetiologi,karenaditemukankasushidrops
endolimfa namun tidak menunjuk an gejala Meniere
Etiologi

7. ● MeniereDisease
● Secaradefinisiadalahidiopatik
● MeniereSyndrome
● Dapatberasaldariberbagaigang uanyangmenyebabkanabnormalitas
endolimfa(contoh:kelainanendokrin,trauma,ketidakseimbangan
elektrolit,disfungsiautoimun,obat-obatan,infeksiparasit,hyperlipidemia)
Klasifikasi

8. ● TetradMeniere:
● Vertigohilangtimbul,biasanyaberdurasi20menitsampaibeberapajam
● Tinitus,telingaberdengung
● Tulisensorineuralfluktuatif,terutamanadarendah,kadangterdapatkasus
tulipermanen
● Rasapenuhatautekanandidalam telinga
● Mualdanmuntahsatseranganyangberat
● Gejalamakinringansetelahseranganpertama
Gejala Klinis

9. ● Tetradsymptoms:
1. Fluctuatinghearingloss
2. Ocasionalepisodicvertigo(usuallyaspinningsensation,sometimes
violent)
3. Tinnitusoringingintheears(usuallylow-toneroaring)
4. Auralfullness(eg,pressure,discomfort,fullnesssensationintheears)
Diagnosa

10. ● Audiometry
● Brainstem auditoryevokedpotentials
● Electrocochleography(ECOG)
● Otoscopy
● Calorictesting/electronystagmography(ENG)
Px. Penunjang

11. ●Px.Darahtidakdapatmenunjuk anMeniereDiseasesecaraspesifik
●Px.Penunjanglain:
● Thyroid-stimulatinghormone(TSH),T4,andT3toruleouthyperthyroidism andhypothyroidism
● Glucoseleveltoruleoutdiabetes
● Erythrocytesedimentationrate(ESR)andantinuclearantibody(ANA)testoruleout
autoimmunedisorders
● Urinalysistoruleoutproteinuriaandhematuriaandindicatorsofotorenalsyndrome
● Completeblodcount(CBC)toruleoutanemiaandleukemia
● Electrolytelevelstoruleoutsalt/waterimbalance
● VenerealDiseaseResearchLaboratorytest(VDRL)andfluorescentreponemalantibody(FTA -
ABS)toruleoutneurosyphilisandLymedisease
● Allergytestingforallergy-mediatedMénièresyndrome
● C-reactiveprotein(CRP)
Px. Penunjang

12. ● SKDI:3A
● “Lulusandoktermampumembuatdiagnosisklinikdanmemberikan
terapipendahuluanpadakeadaanyangbukangawatdarurat.Lulusan
doktermampumenentukanrujukanyangpalingtepatbagipenanganan
pasienselanjutnya.Lulusandokterjugamampumenindaklanjutisesudah
kembalidarirujukan.”
● Belum adapengobatanyangspesifikuntukpenyakitini
● Tujuandariterapiutamanyaadalahsimtomatik,terutamauntuk
kontroldarivertigo
Terapi

13. ● Dietrendahgaram
● Menghindarikafein
● Berhentimerokok
Edukasi

14. 1. Vestibulosuppresants
2. Corticosteroids
3. Diuretics
4. AdrenergicAgonists
Medikamentosa

15. ●Meclizine
● Dosage:25-10 mg/dayPOinsingledailydoseordividedq6 -12hr
● Mechanism : Antihistamine with activity against nebulized histamine; blocks
vasodepresoresponsetohistamine,withslightblockingactionagainst
acetylcholine
●Dimenhydrinat
● Dosage:25-50mgPOq8hrformaintenance,50mgIM foracuteatack
● Mechanism :EthanolamineH1antagonistcontainingdiphenhydramineand8 -
chloro-theophylline;pharmacologicaleffectsprincipallyresultfrom
diphenhydraminemoiety,hasCNSdepresant,anticholinergic,antiemetic,
antihistamine,andlocalanestheticeffects
● Antiemeticactionmayresultfrom inhibitingvestibularstimulation,andinhibiting
acetylcholine sedative
Vestibulosuppressants

16. ● Scopolamine(antiemeticagent)
● Dosage:0.3-0.65mgIV/IM/SC;repeatq6-8hrifnecessary
● Mechanism :Maypreventmotion-inducednauseaandvomitingby
blocking transmission of cholinergic impulse from vestibular nuclei to
higher centers in CNS and from reticular formation to vomiting center
Vestibulosuppressants

17. ● Hydrochlorotiazide
● Dosage:25mgPOqDayortwicedaily;notoexceed20 m g / d a y
● Mechanism :Thiazidediuretic;inhibitssodium reabsorptionindistalrenal
tubules,resultinginincreasedexcretionofwaterandofsodium,
potassium,andhydrogenions
Diuretics

18. ● Ephedrine
● Dosage:10–25mg/dayPO,6qhrformaintenance
● Mechanism : Moderate beta-1 & weak alpha ef
f
ects resulting in alpha- and
beta-adrenergicstimulationthatincreaseCO&BP,decreaserenal
perfusion&variableperipheralvascularetention
Adrenergic Agonists

19. Terapi
Vertigo

20. ●Itsuseisnotpreciselyamedicaltreatment
●Doesnotrequiresurgicalinstallation
●Itdoes,however,requireinsertionofa
tympanostomytubesothathedevicecan
work;therefore,itsusemayqualifyasa
surgicaltreatment.
●TheMenietdevicedeliverspulsesofpresure
totheinnerearviathetympanostomytube.
Althoughnooneknowsexactlywhythis
approachworks,somepatientshave
symptomaticreliefwhenthedeviceisusedon
adailybasis.Becauseitisrelativelynew,long-
term resultshavenotbenfullyevaluated.
Meniett Device

21. ●TheMenietdevicedeliversacomputer-
controled,complexalgorithm o f
micropresurepulsesthatare
transmitedtothemid leearspaceand
actontheovalandroundwindows.It's
believedthatheenergyoftheMeniet's
micropresurepulsescausesa
displacementoftheperilymphaticfluid,
which stimulates the flow of
endolymphaticfluidandreducesit,thus
relievingthesymptomsofMénière's
disease.
Meniett Device

22. ● Endolymphaticsacdecompresionorshuntplacement
● Vestibularnervesection
● Labyrinthectomy
● Intratympanicinjectionofmedicationssuchasgentamicinorsteroids
Tindakan Invasif

23. ● Purpotedtoad resthesiteofobstructioncausinghydrops
● 4 t y p e s :
● Decompression–removalofbonearoundthesac
● Shunting–placementofsyntheticshuntodrainendolymphintomastoid
● Drainage – incision of the sac a low drainage
● Removalofthesac –toad resstheposibilitythathesacmayactualyplayarole
inendolymphproduction
● Sucesrates(intermsofcontrollingvertigoandstabilizinghearing
acuity)withthisprocedurearereportedat60-80%
Endolymphatic Sac Surgery

24. Vestibular Nerve
Section
Vestibularnervesectionhastheadvantageofahigh
rateofvertigocontrol(95-98%)withahighratepf
hearingpreservationintheoperatedear(95%)

25. ● LabyrinthectomyforMénièrediseasehastheadvantageofahighcure
rate(>95%)andisusefulinpatientswhosehearingonthediseasedside
hasbendestroyedalreadybyMénièredisease
● Labyrinthectomycarrieslesdangerofcerebrospinalfluid(CSF)leak
andmeningitisbecausecraniotomyisnotrequired
Labyrinthectomy

26. ● TranstympanicperfusionofmedicationwaspopularizedbyDr.John
Sheain1995
● Intranstympanicperfusion,medicationsforMénièrediseaseare
a p liedthroughamyringotomywithinthemid leearcavity,where
theypresumablyareabsorbedthroughtheroundwindow membrane
in to thein e r e a r
● Ifsteroidsareadministeredwiththistranstympanictechnique,the
procedureisclasifiedasnondestructive
● Ifaminoglycosides(Gentamycin/Streptomycin)areadministered,the
surgeryisclasifiedasdestructive
Transtympanic Perfusion of Medication

27. ● Vertigoyangmuncultiba-tibadankehilanganpendengeranpermanen
d a p a t m e n g a n g uaktivitassehari-harisehingadapatmuncul
kelelahan,stresemosional,depresi,sertakepanikan
● Vertigodapatmenyebabkansulitmenjagakeseimbangansehinga
dapatberesikojatuhdankecelakansatmengemudiatau
mengoperasikanalatberat
Komplikasi

28. ● THTKepaladanLeher,FKUI
● Medscape
● NIDCD(NationalInstituteonDeafnesandOtherCommunication
Disorders)
● Meniere’sAustraliaResourceandInformationCenter
Referensi