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Meniere disease

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Meniere disease

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Meniere disease

  1. 1. MENIERE’S DISEASE
  2. 2. WHAT IS MENIERE’S DISEASE? In 1861 Prosper Meniere described a syndrome characterized by deafness, tinnitus, and episodic vertigo. He linked this condition to a disorder of the inner ear. Underlying pathology of Meniere’s disease is endolymphatic hydrops.
  3. 3. POSSIBLE CAUSES Anatomicalabnormalities Genetic-autosomal dominant Immunologicalimmune complex deposition Viral-serum IgE to herpes simples virus types I and II, EpsteinBarr virus and CMV Vascular-associated with migraines Metabolic-potassium intoxication
  4. 4. Normal membranous labyrinth Dilated membranous labyrinth in Meniere's disease (Hydrops)
  5. 5. AGE DISTRIBUTION AND INCIDENCE OF THE DISEASE 40’s and 50’s Women>Men
  6. 6. SYMPTOMS  Periodic episodes of rotatory vertigo or dizziness Fluctuating, progressive, lowfrequency hearing loss Tinnitus Fullness/pressure
  7. 7. DIAGNOSIS: HISTORY Association between hearing loss, tinnitus, and vertigo
  8. 8. 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. Spontaneous nystagmus directed toward affected ear is typical during an acute attack.
  9. 9. PHYSICAL EXAMINATION (CON’T) oThe Romberg test generally shows significant instability and worsening when the eyes are closed. oThe Weber tuning fork test usually lateralizes away from the affected ear. oThe Rinne test : air conduction > bone conduction.
  10. 10. OTHER STUDIES Magnetic resonance imaging CT scans Audiometry Transtympanic electrocochleography (ECOG) Electronystagmography (ENG)
  11. 11. TREATMENT Vestibulosuppressants (eg, meclizine) decrease the vertigo by decreasing the brain's response to vestibular input. Diuretics or diuretic-like medications (eg, hydrochlorothiazide) actually decrease the fluid pressure load in the inner ear.
  12. 12. TREATMENT CONT’D In an acutely vertiginous patient, management is directed toward vertigo control. Intravenous (IV) or intramuscular (IM) diazepam provides excellent vestibular suppression and antinausea effects. Steroids can be given for anti-inflammatory effects in the inner ear. IV fluid support can help prevent dehydration and replaces electrolytes.
  13. 13. TREATMENT CONT’D Surgical Care: Surgical procedures are divided into 2 major classifications as follows:  Destructive surgical procedures  Nondestructive surgical procedures
  14. 14. SURGICAL PROCEDURES CONT’D Destructive surgical procedures  Rationale to control vertigo:
  15. 15. SURGICAL PROCEDURES CONT’D Nondestructive surgical procedures: 1. endolymphatic sac decompression or shunt 2. vestibular nerve section 3. Labyrinthectomy 4. transtympanic medication perfusion.
  16. 16. THE END

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