ent

1. Dr Manya Thakur
RESIDENT 2nd year

2. DEFINITION
 Spontaneus attacks of vertigo,with
associated fluctuating sensorineural
hearing loss, tinnitus,& aural fullness.
- PROSPER
MENIERE

3. AETIOLOGY
 Genetic – 20% chromosome 6
 Anatomical causes –small vestibular
aqueduct
 Traumatic- dysfunction of cells
ofmembranous labyrinth
 Viral infection-hsv 1
 Allergy
 Autoimmunity- antibodies against type 2
collagen
 Psychosomatic & personalty disorders

4. SECONDARY
ENDOLYMPHATIC HYDROPS
 DEVELOPMENTAL INSULT-- mondini’s deformity
 Abnormal metabolic endocrine states- glucose levels
 Syphilis
 Csom
 Viral infection
 Autoimmunity
 Otosclerosis
 Abnormal fluid balance- change in plasma osmolality
 Leukemia

5. PATHOPHYSIOLOGY
ISCHAEMIA
REDUCED
ABSORPTION
OF ENDOLYMPH
INCREASED
VOLUME OF
ENDOLYMPH
DISTENTION OF
MEMBRANOUS
LABYRINTH
RUPTURE-
CHEMICAL
IMBALANCE
DAMAGE TO
VESTIBULAR
SYSTEM &
ORGAN OF CORTI

7. Dilated endolymphatic
duct
Normal endolymhatic
duct

8.  Age Distribution- 40- 50 yrs
 Incidence – f>m

9. CLINICAL
MANIFESTATIONS
 Periodic episodes of rotatory vertigo or
dizziness
 Fluctuating, progressive, lateralized
low-frequency hearing loss
 Tinnitus
 Aural Fullness/pressure
 Nausea ,vomiting

10. Typical attack has three phases
Irritative
phase
Paretic
phase
Recovery
phase

11. AAO-HNS criteria
 MAJOR SYMPTOMS-
 VERTIGO
 Recurrent ,well defined episodes of
spinning or rotation
 Duration from 20 mins to 24 hr
 Nystagmus associated with attacks
 Nausea and vomiting during vertigo
spells are common

12.  DEAFNESS
 Hearing deficits fluctuate
 Snhl
 Hearing loss progressive ,u/l
 TINNITUS
 Variable ,often low pitched & louder during
attacks
 Usually u/l
 Subjective

14. Diagnosis
 Possible Meniere’s Disease
 Episodic vertigo without hearing loss
 SNHL,fluctuating or fixed,with
dysequilibrium,but without definitive
episodes
 Other causes excluded

15.  Probable meniere’s disease –
 One definitive episode of vertigo
 Hearing loss documented by audiogram
atleast once
 tinnitus or aural fullness in suspected
ear
 Other causes excluded

16.  Definite Meniere’s Disease
 Two or more definitive spontaneus
episodes of vertigo lasting atleast 20
mins
 Audiometrically documented hearing
loss on atleast one occasion.
 tinnitus or aural fullness in suspected
ear
 Other causes excluded

17.  Certain Meniere’s Disease
 Definite Meniere’s disease,plus
histopathologic confirmation

18. Differential diagnosis
 Labyrinthitis
 Acoustic neuroma
 Ototoxicity
 Trauma to labyrinth d/t head injury
 Perilymph fistula

19. Investigations
 TFT- SNHL
 PTA
 Recruitment +
 Vestibular function tests – canal paresis
 SISI > 70%
 Electrocochleography –SP/AP >30%
 GLYCEROL TEST- oral dose 1.5 ml/mg
 Bekesy audiometry- type 2 tracing

20. Early stage-low tone SNHL

21. Middle stage-hearing is reduced at all
frequencies,but more on high & low
frequency

22. Typical late stage meniere’s
disease,hearing is flat,
unaidable on rt

23. Variants in Meniere’s disese
 LERMOYEZ SYNDROME
 COCHLEAR HYDROPS
 VESTIBULAQR HYDROPS

25. MANAGEMENT
 Conservative
 Medical t/t
 General t/t
 Labyrinthine exercise
 Conservative surgery
 Destructive
 Partial destruction of labyrinth
by cryosurgery
 Destruction of labyrinth by
laser
 Labyrinthectomy
 Vestibular neurectomy

26. Medical treatment
 Absolute bed rest
 Labyrinthine sedatives
 Vasodilators – carbagen
 Betahistine dihydrochloride
 Diuretics

27.  Labyrinthine exercise
 Cooksey Cawthorne’s Exercise
 General treatment
 Salt & fluid destruction
 Correction of metabolic disorder

28. Conservative surgery
 Stellate ganglion block
 Cervical sympathectomy
 Endolymphatic sac decompression
 Shunt operation like-
 Endolymphatic-mastoid shunt
 Endolymphatic-subarachnoid shunt

29. Intratympanic injection of Gentamycin via
tympanotomy tube
 Vestibulotoxic
 Gain access to inner ear by diffusion through
round window membrane
 Selectively concentrated in hair cells &
supporting cells
 “Chemical labyrinthectomy”

30. Local overpressure therapy
 Meniett’s device- hand held pressure
generator
 Mechanism –increased endolymh
pressure facilitates it’s absorption

31. Intratympanic delivery
techniques
 Direct injection through tm
 Inserted ventiltion tube
 Indwelling cathetor inserted into middle
ear
 Sponge through tm
 Directly into round window niche
 minipumps

33. Endolymphatic sac
decompression
 Sacculotomy
 Otic-periotic shunt
 cochleosacculotomy

34. Benefit of endolymphatic sac
decompression
 Release of external compression on sac
 Neovascularization of perisaccular
region
 Passive diffusion of endolymph
 Creation of osmotic gradient out of sac

35. Vestibular neurectomy
 Retrosigmoid
 Middle fossa
 Retrolabyrinthine
 Transmeatal cochleovestibular
neurectomy

36. Labyrinthectomy
 Destroys both hearing & vestibular
function
 Patients having no hearing,failed
conservative t/t
Transcanal
Transmastoid

37. THANK YOU