source:-ENT textbook by Dhingra

3. The disease cause due to distension of
endolymphatic system by endoymph and
characterised by …….
•Vertigo
•Sensor neural hearing loss
•Tinnitus
•Aural fullness

5. The main pathology in
menieres disease is
distension of
endolymphatic system
which results from :-
•Increased production
of endolymph
•Decreased drainage of
the endolymph

6. 1. Defective absorption by endolymphatic sac
(ischemia of sac –defective absorption –
distension—rupture--vertigo)
2.Vasomotor disturbance
( anoxia of capallaries—incr permeability—
increased production)
3.Allergy (50%)
4.Sodium and water retention
5.Hypothyroidism (3%)
6.Autoimmune and viral aetiology

7. •Commonly seen in an age group of 35-60 years
•Males are affected more than female
1.Vertigo + tullio phenomenon
2.Sensory neural hearing loss
3.Tinnitus
4.Sense of fullness of head
5.Other features

8. 1.Otoscopy:- normal
2.Nystagmus :- during attacks
3.Tuning fork test :- sensory neural hearing
loss

11. •Beetween attacks :- 55-85% are discriminated
•During and following the attack:- impaired

12. They indicates the cochlear nature of the disease and
helps to differentiate from retro cochlear pathology
•Recruitment test positive
•SISI is better than 70% of the in two-third
patients
•Tone decay test:- normally there is decay of 20db

13. SP/AP normal is 30% but in this it is greater than 30%
•It shows reduced response on affected side in 75% of
cases
•It reveals canal paresis on the affected side

15. 1.Cochlear hydrops

16. 2. Vestibular hydrops

17. •Drop attacks (tumarkins otolithic crisis)
•Lermoyez synrome

18. •Menieres disease is idiopathic
•Menieres syndrome:- similar features where the
cause may be
•Head injury(ear surgery)
•Viral infection(measles and mumps)
•Otosclerosis
•Cogans syndrome
•Autoimmune disorders

19. •General measures
•Management of acute attack
•Management of chronic phase
•Surgical treatment

20. •Reassurance
•Cessation of smoking
•Low salt intake
•Avoid excessive water intake
•Avoid over indulging in coffee, tea and
alcohol
•Avoiding activities requiring body balance

21. •Reassurance
•Bed rest
•Vestibular sedatives
(dimenhydranate, diazepam, prochloroperazine)
•Vasodilators
(inhalation of carbogen and histamine drip)

22. •Vestibular sedatives
•Vasodilators
•Diuretics
•Elimination of allergens
•Hormone replacement theraphy

23. •Conservative procedures
(decompression of sac, endolymphatic shunt operations,
sacculotomy, section of vestibular nerve)
•Destructive procedures
(labrynthectomy)
•Intermittent low pressure pulse
therapy (meniett device therapy)