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5. menier's disease


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5. menier's disease

  1. 1. Meniere’s Disease DR. RS MEHTA, BPKIHS
  2. 2. • 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
  3. 3. 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
  4. 4. Function of ear • Hearing: Sound conduction and transmission • Balance and equilibrium DR. RS MEHTA, BPKIHS
  5. 5. Anatomy of ear It consists of: • Outer ear • Middle ear • Inner ear DR. RS MEHTA, BPKIHS
  6. 6. Inner ear  Bony labyrinth:  Vestibule  Semicircular canals  Cochlea  Membranous labyrinth Cochlear duct Utricle and saccules Semi-circular ducts Endolymphatic duct DR. RS MEHTA, BPKIHS
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. DR. RS MEHTA, BPKIHS
  11. 11. 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
  12. 12. 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
  13. 13. Normal membranous labyrinth Dilated membranous labyrinth in Meniere's disease (Hydrops) DR. RS MEHTA, BPKIHS
  14. 14. 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
  15. 15. Cont • Tinnitus  Low pitch roaring type • Sense of aural fullness: Accompany/ preceed vertigo DR. RS MEHTA, BPKIHS
  16. 16. Other features • • • • Headache Pain or discomfort in the abdomen Nausea and vomiting Uncontrollable eye movements DR. RS MEHTA, BPKIHS
  17. 17. 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
  18. 18. • 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
  19. 19. Investigations • • • • Otoscopy Audiometry Electrocochleography Caloric test: reduced respond on the affected site DR. RS MEHTA, BPKIHS
  20. 20. 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
  21. 21. Transtympanic electrocochleography • Transtympanic electrocochleography (ECOG) specifically detects distortion of the neural membranes of the inner ear. DR. RS MEHTA, BPKIHS
  22. 22. Electronystagmography (ENG) • Electronystagmography (ENG) is a test of the inner ear function (particularly the semicircular canals). DR. RS MEHTA, BPKIHS
  23. 23. Management General measures: • • • • • Reassurance: psychological support Cessation of smoking Low salt diet Avoid excessive intake of water Life style modification DR. RS MEHTA, BPKIHS
  24. 24. Cont.. Management of acute attack • Reassurance • Bed rest • Vestibular sedatives: prochlorperazine,diazepam • Vasodilators: adenosine triphosphate DR. RS MEHTA, BPKIHS
  25. 25. 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
  26. 26. Cont.. Surgical management • Conservative procedure: Endolymphatic decmpression Endolymphatic shunt operation Ultrasonic destruction of vestibular labyrinth • Destructive measure: Labyrinthectomy DR. RS MEHTA, BPKIHS
  27. 27. 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
  28. 28. 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
  29. 29. 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
  30. 30. 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
  31. 31. • 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
  32. 32. • • • • • • • 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
  33. 33. 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
  34. 34. 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
  35. 35. Thank You DR. RS MEHTA, BPKIHS