Ménière's disease is a disorder of the inner ear that causes episodes of vertigo, hearing loss, tinnitus, and a feeling of pressure in the ear. It occurs when the endolymphatic system within the inner ear becomes distended with fluid. Symptoms include vertigo, hearing loss, tinnitus, and a feeling of fullness in the ear. Examinations show sensorineural hearing loss but normal eardrums. Treatment involves managing acute attacks with rest and medications, along with long term measures like a low salt diet and intratympanic injections to control episodes and hearing loss. Surgery may be considered if conservative treatments are not effective.

1. Menerie’s disease

2. Definition
It is the disorder of inner ear, also known as Endolymphatic
hydrops.
Endolymphatic system is distended with endolymph.

4. ENDOLYMPH
 The fluid Present in the membranous labyrinth is
known as endolymph.
 It is potassium rich in nature similar to I/C fluid.
 Normal flow is Cochlea, Saccule , Utricle
 Endolymphatic duct and sac

6. Pathology:
 Distension of endolymphatic system.
 Mainly effects the Scala media and saccule.
 Bulging of the Reissners’s membrane.
 Distended saccule may come to lie against
the foot plate of stapes.

8. Aetiology:
 Defective absorption
 Vasomotor disturbance
 Allergy
 Sodium and water retention
 Hypothyroidism
 Autoimmune and viral aetiologies.

9. Clinical features:
Vertigo

10. Hearing loss

11. Tinnitus

12. Sense of fullness or pressure.

13. Examination:
Otoscopy:
No abnormality is seen in tympanic
membrane.
Nystagmus:
the quick component of
nystagmus is seen towards the unaffected
ear.
Tuning fork tests:
they indicate sensorineural hearing
loss.

14. Rinne’s test is positive.
Weber test lateralized
to the better ear.
ABC test is reduced in
effected ear.

15. Investigations:
Pure tone audiometry:
There is sensorineural hearing loss.
In early stage lower frequencies are
effected and curve is of rising type.

16. Caloric test:
It is contraindicated in acute attacks.
It shows canal paresis on effected side.

17. Variants of Meniere’s disease.
 Cochlear Hydrops : Cochlear Symptoms Present .
 Vestibular Hydrops : Vestibular Symptoms Present .
 Drop attacks : Without Loss of consciousness.
 Lermoyez Syndrome: Symptoms in reverse order .

18. Treatment:
 General Measures
 Management Of Acute Attack
 Management Of Chronic Attack
 Surgical

19. General meaures:
 Reassurance
 Cessation Of Smoking
 Low Salt Diet
 Avoid Excess Intake of Water & Salt
 Avoid Stress
 Change in Life style.

20. Management of acute attacks:
 Reassurance
 Bed rest
 Vestibular sedatives
 Vasodilators

21. Management of chronic attacks:
 Vestibular Sedatives
 Vasodilators
 Diuretics
 Elimination Of Allergens
 Hormones

22. Intratympanic gentamycin
therapy

23. Surgical:
 Conservative : Used when hearing is still
useful but vertigo is disabling .
 Destructive : Used when cochlear function
is not serviceable .

24. Conservative treatment:
 Decompression of Endolymphatic Sac
 Endolymphatic Shunt Operation
 Sacculotomy
 Ultrasonic Destruction Of
Vestibular Labyrinth.

25. Destructive treatment:
 Labyrinthectomy
 Meniett Device Therapy.