Ear diseases,OTOLOGY, ENT

1. Joyce MWATONOKA
MD5
JUNE 2017

2. OUTLINE
 Introduction
 Pathophysiology
 Diagnosis
 Diagnostic testing
 Management
 References

3. Introduction
 Meniere's disease is a disorder of the inner ear which
causes episodes of vertigo, ringing in the ears
(tinnitus), a feeling of fullness or pressure in the ear,
and fluctuating hearing loss
 There is no single known cause for Meniere’s Disease

4. Proposed theories;
1. Endolymphatic hydrops
 Autopsies show the inner ear membranes distension
(hydrops)
 The theory is that progressive dilation of the inner ear
structures causes micro-ruptures in the delicate
membranes causing contamination of the inner ear
nerve endings
 What causes this dilation is unknown

5. Cont…
2. Autoimmune:
 There is evidence that the body’s own immune
mechanism may be responsible for this disorder
 Researchers have found antibodies to inner ear
proteins circulating in the bloodstreams of many
patients with the disorder

6. Cont…
3. Anatomy:
 The endolymphatic sac is thought to be responsible for
cleansing the inner ear fluids. Physical abnormalities
of the bone surrounding the sac may be responsible for
dysfunction of this cleansing system
4. Viral:
 Viral particles have been identified within the inner
ear of many Meniere’s patients

7. Cont…

8. Cont…

9. Diagnosis of Meniere’s Disease
 Periodic episodes of rotatory vertigo or dizziness
 Fluctuating, progressive, low-frequency hearing loss
(bass) + loudness intolerance; usually unilateral
 Tinnitus; directly temporally related to the vertigo and
hearing loss episodes
 Aural fullness

10. Other symptoms that may be
present;
 Hyperacusis
 Extreme fatigue
 Vision problems
 Photosensitivity
 Mood swings
 Mental disorientation
 Poor physical coordination

11. Diagnostic Testing
 Testing is rarely helpful in the diagnosis
 Audiologic evaluation (hearing test) most helpfull
-The typical “Meniere’s pattern” is a low frequency
sensorineural hearing loss. Later on the hearing loss
becomes moderate to severe

12. Cont…
 ENG (Electronystagmogram) testing is often done
but is also of limited usefulness, although important in
documenting the health of the balance system in the
other ear
 ECoG (electrocochleography); previously used, was of
little benefits no more recommended

13. Treatment
 Diet and drugs: initially treated conservatively with a
salt restriction diet and diuretics
 Transtympanic gentamicin injection (chemical
labyrinthectomy)
-This procedure takes advantage of the toxic effects of
the drug to poison and weaken the balance nerve
ending in the diseased ear
-Complication; further hearing loss that may be
permanent and profound

14. Cont…
 Endolymphatic Sac Shunt (decompression
procedure); drains excess endolymph from the inner
ear. Usually preserves hearing
 Vestibular Neurectomy; the balance nerve is cut as it
leaves the inner ear and goes to the brain/ through
mastoidectomy the balance nerve is cut before it
enters the inner ear. Vertigo attacks are permanently
cured and hearing is preserved in most cases

15. Cont…
Labyrinthectomy and Eighth Nerve Section;
 The balance and hearing mechanism in the inner ear
are destroyed on one side
 This is considered when the patient with Meniere's
disease has poor hearing in the affected ear
 Has the highest rates for control of vertigo attacks

16. REFERENCES;
 Otolaryngology – Basic Science and Clinical Review, 1E
2006
 Diseases of the Ear,Nose and Throat P.D. BULL, Ninth
Edition
 Medscape
 googleimages

17. Thank You For Your
Attention!!