Meniere's disease is a disorder of the inner ear that causes episodes of vertigo, hearing loss, and tinnitus. It results from endolymphatic hydrops, or a distension of the endolymphatic system in the inner ear. It typically affects people between 35-60 years old and is more common in females. Treatment involves managing symptoms during attacks and preventing future attacks. Medical treatment focuses on symptom relief through lifestyle changes, medications, and intratympanic injections. Surgical options include endolymphatic sac surgery, vestibular nerve section, ultrasonic destruction of the vestibular labyrinth, and labyrinthectomy.

1. Meniere’s Disease

2. DEFINITION
Disease of inner ear
Distention of endolymphatic system
 Vertigo
 Sensorineural hearing loss
 Tinnitus

3. History
1861 – Prosper Meniere
describes classic symptoms
1938 – Hallpike and Portman
confirm endolymphatic hydrops

4. AGE DISTRIBUTION AND
INCIDENCE
35-60 yrs
Females : Male 3:2
Familial
Unilateral / bilateral

5. PATHOPHYSIOLOGY

6. Dilated membranous labyrinth
Normal membranous labyrinth in Meniere's disease (Hydrops)

7. Pathophysiology
Theories 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. AETIOLOGY (primary causes)
Genetic
Anatomical (small vestibular aqueduct)
Traumatic (physical, acoustic)
Viral infection (HSV type 1)
Allergy
Autoimmunity

9. AETIOLOGY (secondary causes)
Developmental insult
Metabolic states
 (DM, hypothyroidism, hyperlipidaemia)
Syphilis
CSOM
Otosclerosis
Abnormal fluid balance

10. CLINICAL FEATURES
Vertigo
 Episodic
 Nystagmus
Hearing loss
 Sensorineural
 Progressive
Tinnitus
 Continuous / intermittent
Aural fullness

11. DIFFERENTIAL DIAGNOSIS
Vestibular neuronitis
Benign paroxysmal positional vertigo
Vestibular schwannoma
Vertibrobasilar insufficiency

12. EXAMINATION
Otoscopy: Normal
Nystagmus: During acute attacks
Tuning fork tests:
 Rinnie Positive

Weber Lateralized to better ear
 ABC Reduced in affected ear
Complete neurological examination

13. INVESTIGATIONS
Assessment of cochlear function

PTA
Rising
Flat
Falling

14. INVESTIGATIONS
Speial audiometric tests
Evoked response audiometry
Transtympanic electrocochleography

15. INVESTIGATIONS
Assessment of vestibular function
Metabolic screening
 CBC-ESR
 UREA / ELETROLYTES
 VDRL / TPHA
 BSR
 GTT
 CHOLESTEROL / TG
 TFT

16. TREATMENT

17. MEDICAL TREATMENT
Acute Therapy

18. Medical Treatment
Symptomatic relief

Salt restriction

Avoid caffeine, nicotine, alcohol, high-
carbohydrate substances, high-
cholesterol/triglyceride foods
 Vestibular suppressants

Diuretics

Vasodilators (Betahistine)
 Steroids
Hearing aids

19. Chemical ablation of
vestibular function
Intratympanic gentamicin / streptomycin

20. Surgical Therapy

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. Endolymphatic Sac Surgery

23. Vestibular Nerve Section
Approaches:
 Middle Fossa
 Retrolabyrinthine/Retrosigmoid

Transcanal
Complications
 Damage to facial nerve

Damage to cochlear nerve
 CSF leak (about 13%)

24. Ultrasonic destruction of
vestibular labyrinth

25. Labyrinthectomy
Approaches:
 Transcanal
 Transmastoid

26. THANK YOU