This document discusses Meniere's disease, including its history, symptoms, pathophysiology, variants, and diagnostic criteria. Some key points:
- Meniere's disease causes episodes of vertigo, hearing loss, tinnitus, and a feeling of fullness in the ear. It is associated with endolymphatic hydrops (fluid buildup) in the inner ear.
- The cause is multifactorial but may involve abnormalities in endolymphatic fluid production, absorption, or circulation within the inner ear.
- Diagnosis requires recurrent episodes of vertigo, hearing loss, and tinnitus. Hearing loss must be sensorineural and involve low frequencies.
-
This presentation discusses oropharyngeal tumors and their management. It contains a few surgical video clippings embedded from my you tube uploads. If you get a security warning just give yes to view the video clipping. I assure you it is safe
This presentation provides insight into the unique software created using eiki engine. This is available in 2 flavors, one which runs right out of a pendrive the other one is installable using dvd media. This is an initiative of drtbalu's otolaryngology online
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Meniere’s disease is defined as a symptom complex associated with:
1. Roaring tinnitus
2. Sensorineural hearing loss (Low frequency)
3. Vertigo (episodic)
4. Fullness of the ear
5. These symptoms are associated with dilated membranous
labyrinth filled with endolymph
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2
3. 1. 1747 – Antonio Scarpa described anatomy of membranous
labyrinth
2. 1861 – Prosper Meniere described the classic features of
Meniere’s disease & attributed it to labyrinthine causes
3. 1871 – Knappin theorized that dilated membranous labyrinth to
be the cause of this disorder
4. 1927 – Guild described endolymphatic ciruclation
5. 1938 – Hallpike and Portmann described pathology of Meniere’s
disease by studying temporal bones.
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3
4. 1. 150 years have passed since this syndrome was described
2. Amount of literature accumulated has virtually doubled
3. Only consensus reached so far is that its cause is multifactorial
4. Not all individuals with histological features of Meniere’s disease
manifested the classic clinical features (? Unknown factors
protecting the individuals)
5. Surgical destruction of sac ameliorates symptoms. (? What role
does sac play exactly in endolymphatic circulation)
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4
5. 1. Inner ear contains two types of fluids (perilyimph and endolymph
separated by membranous labyrinth.
2. Perilymph is similar in composition to CSF (Containing high Na and low K
ions)
3. Endolymph similar in composition to intracellular fluid (Containing low Na
and high K concentration). It is secreted by stria vascularis
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5
6. Duct begins at ductus reuniens
Duct is a single lumen tube
about 2 mm long
The duct narrows at the isthmus
which lies at the level of
vestibular aqueduct
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6
7. 1. Secretory function
2. Absorptive function
3. Immune / defense function
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7
8. 1. Aquaporins
2. Glycoproteins like Saccain
3. Endolymph
4. Glycoproteins act as a driving force
for longitudinal flow
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8
10. 1. Was first proposed by Guild
2. Striavascularis is the principal source
3. This is a slow process
4. Elimination occurs at the endolymphatic
sac level
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10
11. 1. First proposed by Lawrence
2. This is a combination of both
longitudinal and radial flow patterns
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11
12. 1. This is active process (energy consuming)
2. Production occurs from dark vestibular cells &
planum semilunatum
3. Absorption occurs at the striavestibularis
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12
13. 1. This is a small membranous bulb located where the
endolymphatic duct enters the vestibule
2. This is where the volume of circulating endolymph is monitored
3. Monitoring the volume of endolymph is not possible by sac
because it will be interfered by CSF pressure and pressure
exerted by lateral sinus
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13
15. 1. Composition of endolymph is maintained by stria vascularis by controlling
the influx of water
2. Normally endolymph is a biological puddle with very little radial /
longitudinal flow
3. Only under exceptional circumstances like increased endolymphatic fluid
volumes does radial / longitudinal movement towards sac occurs
4. Under normal circumstances radial flow alone is sufficient to maintain
endolymph fluid balance and the longitudinal flow due to saccmechanics is
not necessary
5. The longitudinal flow is restricted by the isthmus portion of the duct which
acts like the constriction seen in the hour glass
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15
19. 1. Small amounts of excess endolymph can be cleared by radial flow
2. Larger volumes need longitudinal flow for their clearance
3. Endolymphatic sinus temporarily accommodates excess endolymph till
the sac is ready for it
4. Endolymphatic valve of Bast isolates pars superior and prevents
endolymph from draining out of the utricle
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19
22. This is a variant of Meniere’s disease. It is characterized by sudden sensori
neural hearing loss which improves during or immediately after the attack of
vertigo.
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22
23. This variant is characterized by abrupt falling attacks of brief duration
without loss of consciousness. This is caused due to an enlarging utricle
due to excess endolymphatic volume. Utricular crisis is used to indicate
this condition.
In the later disease stages the valve of Bast remaining patent may cause
sudden drainage of endolymph from the utricle due to longitudinal flow
resulting in these drop attacks
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23
24. Roughly 1 in 1000 individuals are affected
Constitutes 10% of all patients attending vertigo clinic
Female preponderance
Rare in children under the age of 10
Commonly begins between 4th and 5th decades of life
Bilateral Meniere’s syndrome is seen in 5% of these patients
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24
25. 1. Endolymphatic hydrops causes distortion of membranous labyrinth
2. Pressure building up in the scala media may cause mirco ruptures of
membranous labyrinth
3. This would account for the episodic nature of the attacks
4. Healing of these ruptures causes resolution of the disorder
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27. 1. Stage I – Patient has solely cochlear symptoms
2. Stages II – IV – Patients have progressively more cochlear and
vestibular symptoms
3. Stage V – End stage Meniere’s disease (dead ear)
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27
28. 1. Irritative nystagmus during the first 20 mins of attack
2. Paralytic nystagmus follows
3. Later recovery nystagmus starts
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28
29. Possible Meniere’s disease:
Episodic vertigo of Meniere’s type without documented hearing loss
Fluctuating hearing loss with disequilibrium but without definite episodes
Probable Meniere’s disease:
One definitive episode of vertigo
Audiometrically documented hearing loss at least during one attack
Definitive Meniere’s disease
Two or more definitive episodes of spontaneous vertigo one atleast lasting for
20 mins.
Audiometrically documented hearing loss at least on one occasion
Tinnitus and aural fullness in the treated ear
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29
30. Sensori neural hearing loss combined with:
Tinnitus now / in the past
Vertigo attacks (at least two present now or in the past)
Exclusion of other pathology following Groningen protocol
Hearing loss:
Sensori neural in nature
No demonstrable conductive element
Hearing loss of 20 dB or more at one of the usually measured
audiometric thresholds
Vertigo:
Paroxysmal rotatory dizziness, accompanied by nausea / vomiting
At least two episodes should be reported during a course of illness.
One of the attack should last at least for 5 mins
In between attacks there may be periods of unsteadiness
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31. 1. Sensori neural in nature
2. Fluctuating and progressive
3. Affects low frequencies
4. Mild low frequency conductive hearing loss (rare)
5. Profound sensori neural hearing loss (End stage)
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31
32. Roaring in nature
Could be continuous / intermittent
Non pulsatile in nature
Frequency of tinnitus corresponds to the region of cochlea which has suffered
the maximum damage
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32
33. 1. This is abnormal growth in the perceived intensity of sound
2. This is usually positive in patients with Meniere’s disease
3. ABLB is the test used to look for the presence of recruitment
4. This test is really time consuming
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33
34. 1. Increased summating potential / action potential ratio. 1:3 is normal
2. Widened summating potential / action potential complex. A widening of
greater than 2 ms is significant
3. Small distorted cochlear microphonics
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34
35. 1. Not mandatory for diagnosis of Meniere’s disease
2. Caloric test is still performed
3. It is low frequency stimulation (0.003 Hz) of lateral canal
4. Caloric asymmetry will point to the diseased ear
5. 20% difference between the two ears (Jongkee’s formula) is significant
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35
36. 1. Vestibular evoked myogenic potential
2. Measures the relaxation of sternomastoid muscle in response to ipsilateral click
stimulus
3. Brief high intensity ipsilateral clicks produce large short latency inhibitory
potentials (VEMP) in the toncially contracted Ipsilateral sternomastoid muscle
4. This test is due to the presence of vestibulo collic reflex
5. Afferent arises from sound responsive cells in the saccule, conducted via the
inferior vestibular nerve.
6. Efferent is via vestibulo spinal tract
7. Normal responses are composed of biphasic (positive-negative) waves
8. VEMP reveals saccular dysfunction
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36
37. 1. Glycerol
2. Frusemide
3. Isosorbide
4. Tests are positive if there is pure tone improvement of 10dB or more
at two / more frequencies between 200-2000Hz
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37
38. 1. First introduced by Klockhoff and Lindblom – 1966
2. Glycerol is administered in doses of 1.5 mg/kg body wt in empty stomach
3. Serum osmolality should increase at least by 10 mos/kg
4. Side effects include Headache, Nausea, vomiting, drowsiness
5. PTA is performed 2-3 hours after administration
6. False positivity is rare
7. Positivity depends on the phase of the disease
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38
40. 1. Intravenous fluids – dehydration
2. Vestibular suppressants – May delay recovery / rehabilitation process
3. Corticosteroids – May help if tinnitus and deafness are debilitating
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40
41. 1. Frustenberg diet
2. 2 grams / 24 hours (restricted salt intake)
3. Life style modification
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41
42. 1. Diuretics play a vital role in alleviating acute symptoms
2. This has been in use since 1930’s
3. Thiazide group of drugs are commonly used
4. Frusemide may be used to alleviate acute symptoms
5. Clear scientific evidence is lacking regarding the usefulness of diuretics
(cochrane review)
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42
43. 1. Cochlear vascular insufficiency has been proposed as one of the
mechanism of Meniere's disease
2. Betahistine is supposed to cause vasodilatation of cochlear blood
vessels
3. Betahistine has weak H1 agonistic property and considerable H3
antagonist properties
4. It reduces the frequency & intensity of vertigo. Has minimal effect on
tinnitus
5. Doesn’t help much with hearing loss (Cochrane review)
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43
44. 1. Immune modulating effects
2. Improves fluid dynamics of inner ear due to mineralocorticoid effects
3. Vertigo was controlled on an immediate basis
4. Methylprednisolone has the best effect as it penetrates the round window
better
5. Silverstein microwick can be used for intratympanic drug administration
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44
45. 1. Isordil
2. ϒ – globulin
3. Urea
4. Glycerol
5. Lithium
6. Anticholinergics – Glycopyrrolate 1-2 mg /day
7. Antidopaminergics – Droperidol 2.5 – 10 mg orally / day
8. Leuprolide acetate – Blocks normal sex hormone production
9. Innovar – A combination of droperidol and fentanyl can be used to
suppress vestibular symptoms (can replace endolymphatic sac surgery)
10. Hyperbaric oxygen therapy
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45
46. 1. Stress reduction
2. Patient education
3. Hearing aids – can be used to suppress troublesome tinnitus
4. Tinnitus retraining
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46
47. 1. Meniett Device
2. Low pressure pulse generator
3. Vibrations are transmitted via external
auditory canal
4. Vibrations alter inner ear fluid dynamics by
their effects on the oval and round
windows
5. Exact mechanism of action is not known
6. It is totally non invasive
7. This device is portable
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47
48. 1. Diagnosis should be confirmed
2. Ventilation tube should be inserted
3. Patient should be trained for self administration of the treatment
4. Usually administered thrice a day about 5 mins each time
5. Treatment lasts for 5 weeks
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48
49. 1. Classic unilateral Meniere’s disease
2. Intense vestibular / cochlear symptoms
3. Failed medical therapy
4. Over 65 years of age
5. Imbalance / aural fullness / tinnitus after gentamycin treatment
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49
51. 1. Vestibulotoxic effects are put to therapeutic use.
2. Sensation of vertigo reduced while hearing is preserved
3. Streptomycin / gentamycin are predominantly Vestibulotoxic
4. Intratympanic administration is preferred
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51
52. 1. Fixed dose protocol is used
2. 40 mg/ml gentamycin is buffered with soda bicarb (pH6.4) final concentration
26.7mg/ml.
3. T tube grommet inserted into the postero inferior quadrant of ear drum. A
mcirocatheter is inserted through the grommet
4. 1ml of gentamycin solution is injected into the middle ear cavity via the
microcatheter
5. Three injections are given per day in outpatient setting
6. Injections are given for 4 days
7. After injection patient should lie supine with the infiltrated ear up for 30 mins
8. Vertigo usually develops between 2-4 days after cessation of treatment
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52
54. 1. External shunts – Drains the sac into mastoid cavity / subarachnoid space
2. Internal shunts – Drains excessive endolymph into the perilymphatic space
(cochleosacculotomy / labyrinthotomy)
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54
56. 1. Helpful in treating debilitated patients
2. Involves disruption of osseous spiral lamina
3. Angular pick introduced via round window towards oval window. It will
accommodate 3 mm long pick
4. After perforation the pick is withdrawn and the round window is sealed by
fat
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56
Schematic of how the endolymphatic sinus detects and regulates endolymph volume status. When endolymph volume is normal (left), pressure elevations in the vestibule (black arrow) produce only small endolymph movements into the sac before the sinus membrane occludes the duct. In contrast, when the endolymphatic sinus is dilated (right), pressure elevations in the vestibule result in a larger volume being forced into the sac before the duct is occluded. The increase in volume delivered to the sac with dilation of the endolymphatic sinus will act to counteract the volume increase, acting to stabilize endolymph volume within a specific range.
The excess volume tends to accumulate in the apical end of the cochlea, where the membranes are more lax than elsewhere, even though the endolymph pressure would be similar elsewhere in the cochlea.