The document discusses Meniere's disease, which is a disorder of the inner ear characterized by episodes of vertigo, hearing loss, tinnitus, and a feeling of fullness. It was first described by Prosper Meniere in 1861. The pathology involves a distortion of the membranous labyrinth and endolymphatic hydrops. Symptoms include episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness. Diagnosis involves tests like caloric testing, ENG, and VEMPs. Treatments range from medical management to non-ablative procedures like endolymphatic sac surgery to ablative procedures like intratympanic gentamicin or vest

1. Saurabh Gupta
Prof. (Dr.) S. K. Jaiswal unit

2. Introduction
 Meniere's disease (idiopathic endolymphatic hydrops)
is a disorder of the inner ear associated with a
symptoms consisting of spontaneous, episodic attacks
of vertigo; sensorineural hearing loss which usually
fluctuates; tinnitus; and often a sensation of aural
fullness.
 dramatic variability is the hallmark of this disease.

3. Introduction : History
 First described by Prosper
Meniere in 1861.
 In 1902, Parry performed a
CN VIII division for vertigo
in a patient with suspected
Meniere’s disease.
 Portman did
endolymphatic sac
decompression via a
transmastoid approach in
1926.
 In 1931,McKenzie
performed a selective
vestibular neurectomy.

4. Pathology
 Distortion of the membranous labyrinth.
 This condition reflects the changes in the anatomy of
the membranous labyrinth as a consequence of the
over-accumulation of endolymph.
 Mainly affects scala media and saccule
 Bulging of reissner’s membrane
 Saccule may come to lie against the stapes footplate.

6. Etiology
A. Defective absorption by endolymphatic sac-
• Poor vascularity of sac
• Less absorptive tubular epithelium
• increased perisaccular fibrosis
B. Rupture of reissner’s membreane leading to mixing of
perilymph & endolymph- Schuknecht
• allow leakage of the potassium-rich endolymph into
the perilymph, bathing the eighth cranial nerve and
lateral sides of the hair cells

8. Etiology
 Spasm of int. auditory artery – Sym. Overactivity
 Allergy – inner ear is shock organ
 Sodium & water retention
 Hypothyroidism
 Autoimmune
 Viral

10. Clinical features
 Affects in 4th -5th decade of life
 Male:Female 1:1
 Prevalence more in whites.
 VERTIGO : episodic attacks , asso. with nystagmus,
nausea & vomiting , vagal disturbance
 Tullio phenomenon may be seen

11. Clinical features
 HEARING LOSS
1. Fluctuating
2. SNHL
3. Progressive
4. Unilateral
5. Distortion of sound
6. Intolerance to loud sound

12. Clinical features
 TINNITUS
1. Low pitched roaring
2. Subjective
3. Unilateral
 AURAL FULLNESS
1. Fluctuates , in prodromal phase

13. Diagnosis

14. Investigations
 Tuning forks tests :
SNHL
 PTA
 Speech audiometry
 Recruitment test +ve
 SISI >70%
 Tone decay <20 dB

15. Investigations
 Caloric testing – canal paresis
 ENG
 Head Thurst test
 ECoG – SP is larger & more negative
 SP/AP ratio increases > 30%
 Glycerol test
 VEMP – elevated threshold

16. VEMPs

17. Staging
STAGE PURE TONE AVERAGE IN dB IN PREVIOUS 6 MONTHS
1 = < 25
2 26-40
3 41-70
4 >70

18. Variants
 Cochlear hydrops – no vertigo
 Vestibular hydrops – no heaing loss
 Drop attacks
 Lermoyez syndrome- hearing loss followed by vertigo

19. Treatment
 Medical management –
 ACUTE stage : labyrinth sedatives + anti-emetics
 Carbogen, Histamine drip
 Frustenberg Regimen -
1. Low salt diet
2. Diuretics + Pot. chlor
3. High protein
 Beta histine – to relieve vascular ischemia
 Stop caffeine, nicotine, alcohol & tobacco

20. Non ablative procedures
 Portman -1926
 Endolymphatic sac surgery
1. Subarachnoid shunt
2. Mastoid shunt

21. Non ablative procedures
 Intratympanic steroids
 May benefit in autoimmune causes of meniere’s
syndrome.
 Sacculotomy
 Cochleosacculotomy

22. Ablative procedures
 Intratympanic gentamicin – Schuknecht (1957)

23. Ablative procedures
 Selective Vestibular nerve sectioning

24. Ablative procedures
 Ultrasonic destruction of vest. Labyrinth
 Cryodestruction
 Labyrinthectomy - when cochlear function has been
totally deteoriated ,higher rate of vertigo control seen
than that typical for vestibular neurectomy

25. Recent advances
 decrease hydrops by pulsing pressure in the middle
ear
 Meniett device - handheld air pressure generator that
the patient self-administers
 The pressure is delivered in complex pulses of up to
20 cm of water, over a 5 minute period.
 The device requires a ventilation tube to be placed in
the tympanic membrane before initiation of therapy

26.  Pressure at the RW passes to perilypmh and decreases
pressure in endolymph by redistributing it.