Meniere’s disease

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Meniere’s disease

  1. 1. Meniere’s Disease
  2. 2. DEFINITIONDisease of inner earDistention of endolymphatic system Vertigo Sensorineural hearing loss Tinnitus
  3. 3. History1861 – Prosper Menieredescribes classic symptoms1938 – Hallpike and Portmanconfirm endolymphatic hydrops
  4. 4. AGE DISTRIBUTION AND INCIDENCE35-60 yrsFemales : Male 3:2FamilialUnilateral / bilateral
  5. 5. PATHOPHYSIOLOGY
  6. 6. Dilated membranous labyrinthNormal membranous labyrinth in Menieres disease (Hydrops)
  7. 7. PathophysiologyTheories behind endolymphatic hydrops Obstruction of endolymphatic duct/sac Hypoplasia of endolymphatic duct/sac Alteration of absorption of endolymph Alteration in production of endolymph Autoimmune insult Vascular origin Viral etiology
  8. 8. AETIOLOGY (primary causes)GeneticAnatomical (small vestibular aqueduct)Traumatic (physical, acoustic)Viral infection (HSV type 1)AllergyAutoimmunity
  9. 9. AETIOLOGY (secondary causes) Developmental insult Metabolic states  (DM, hypothyroidism, hyperlipidaemia) Syphilis CSOM Otosclerosis Abnormal fluid balance
  10. 10. CLINICAL FEATURESVertigo Episodic NystagmusHearing loss Sensorineural ProgressiveTinnitus Continuous / intermittentAural fullness
  11. 11. DIFFERENTIAL DIAGNOSISVestibular neuronitisBenign paroxysmal positional vertigoVestibular schwannomaVertibrobasilar insufficiency
  12. 12. EXAMINATIONOtoscopy: NormalNystagmus: During acute attacksTuning fork tests: Rinnie Positive Weber Lateralized to better ear ABC Reduced in affected earComplete neurological examination
  13. 13. INVESTIGATIONSAssessment of cochlear function PTA Rising Flat Falling
  14. 14. INVESTIGATIONSSpeial audiometric testsEvoked response audiometryTranstympanic electrocochleography
  15. 15. INVESTIGATIONSAssessment of vestibular functionMetabolic screening CBC-ESR UREA / ELETROLYTES VDRL / TPHA BSR GTT CHOLESTEROL / TG TFT
  16. 16. TREATMENT
  17. 17. MEDICAL TREATMENT Acute Therapy
  18. 18. Medical TreatmentSymptomatic relief Salt restriction Avoid caffeine, nicotine, alcohol, high- carbohydrate substances, high- cholesterol/triglyceride foods Vestibular suppressants Diuretics Vasodilators (Betahistine) SteroidsHearing aids
  19. 19. Chemical ablation of vestibular functionIntratympanic gentamicin / streptomycin
  20. 20. Surgical Therapy
  21. 21. Endolymphatic Sac Surgery Decompression: Removal of bone overlying the sac Shunting: Placement of synthetic shunt to drain endolymph into mastoid Drainage: Incision of the sac to allow drainage Removal of sac: Excision of the sac
  22. 22. Endolymphatic Sac Surgery
  23. 23. Vestibular Nerve SectionApproaches: Middle Fossa Retrolabyrinthine/Retrosigmoid TranscanalComplications Damage to facial nerve Damage to cochlear nerve CSF leak (about 13%)
  24. 24. Ultrasonic destruction of vestibular labyrinth
  25. 25. LabyrinthectomyApproaches: Transcanal Transmastoid
  26. 26. THANK YOU

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