MENIER'S DISEASE
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What is Meniere disease Its Pathophysiology , etiology & Clinical features Examination & Investigation Treatment plan Ménière's disease, also called endolymphatic hydrops, is a disorder of the inner ear where the endolymphatic system is distended with endolymph. It is characterized by a triad of Deafness (sensorineural hearing loss) Vertigo (Episodic) Tinnitus Moreover, there is sense of aural fullness
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MENIER'S DISEASE
- 1. MÉNIÈRE'S DISEASE DR AWAIS IRSHAD Fazaia Ruth Pfau Medical College ENT Department 1
- 2. LEARNING OBJECTIVES • What is Meniere disease • Its Pathophysiology , etiology & Clinical features • Examination & Investigation • Treatment plan Fazaia Ruth Pfau Medical College ENT Department 2
- 3. MÉNIÈRE'S DISEASE • Ménière's disease, also called endolymphatic hydrops, is a disorder of the inner ear where the endolymphatic system is distended with endolymph. • It is characterized by a triad of i. Deafness (sensorineural hearing loss) ii. Vertigo (Episodic) iii. Tinnitus Moreover, there is sense of aural fullness Fazaia Ruth Pfau Medical College ENT Department 3
- 4. PATHOPHYSIOLOGY • Overproduction or undersecretion of endolymph resulting in excessive accumulation of endolymph • Bulging and Rupture of Reissner membrane • Mixing of endolymph and perilymph • Accumulation of fluid in Cochlea causes Deafness • Accumulation of fluid in Membranous Labrynth causes Vertigo Fazaia Ruth Pfau Medical College ENT Department 4
- 5. Fazaia Ruth Pfau Medical College ENT Department 5
- 6. ETIOLOGY Fazaia Ruth Pfau Medical College ENT Department 6 The exact cause of Ménière's disease is.....? Hint : (Bell’s Palsy) However, according to various theories, the cause may be • Defective absorption by endolymphatic sac • Vasomotor spasm • Allergy to foodstuff or inhalant • Sodium and water retention • Hypothyroidism • Viral infections • Autoimmune disorders
- 7. CLINICAL SYMPTOMS • Vertigo accompanied by symptoms of vagal disturbances • Fluctuating hearing loss with slow and progressive deterioration of permanent deafness • Intolerance to loud sounds. So, hearing aid is of no use • Tinnitus • Sense of fullness • Emotional Stress Fazaia Ruth Pfau Medical College ENT Department 7
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- 9. MÉNIÈRE'S DISEASE VS MÉNIÈRE'S SYNDROME Fazaia Ruth Pfau Medical College ENT Department 9
- 10. EXAMINATION • Otoscopy • Nystagmus • Tuning Fork Tests i. Rennie’s Test ii. Absolute Bone Conduction iii. Weber Test Fazaia Ruth Pfau Medical College ENT Department 10
- 11. INVESTIGATIONS • Pure Tone Audiometry i. In early stage ii. In late stage • Speech Audiometry • Special Audiometry • Electrocochleography • Caloric Test • Glycerol Test Fazaia Ruth Pfau Medical College ENT Department 11
- 12. TREATMENT • . GENERAL MEASURES • 1. Reassurance. • 2. Cessation of smoking. • 3. Low salt diet. • 4. Avoid excessive intake of water • 5. Avoid over indulgence in coffee, tea and alcohol • 6. Avoid stress and bring a change in lifestyle. • 7. Avoid activities requiring good body balance. Fazaia Ruth Pfau Medical College ENT Department 12
- 13. • B. MANAGEMENT OF ACUTE ATTACK • 1. Reassurance • 2. Bed rest • 3. Vestibular sedatives • 4. Vasodilators • a) Inhalation of carbogen • b) Histamine drip. Fazaia Ruth Pfau Medical College ENT Department 13
- 14. • C. MANAGEMENT OF CHRONIC PHASE • 1. Vestibular sedatives. • 2. Vasodilators • 3. Diuretics. • 4. Propantheline bromide • 5. Elimination of allergen. • 6. Hormones Fazaia Ruth Pfau Medical College ENT Department 14
- 15. SURGICAL TREATMENT 1.Conservative procedures. a) Decompression of endolymphatic sac b) Endolymphatic shunt operation. c) Sacculotomy d) Section of vestibular nerve. e) Ultrasonic destruction of vestibular labyrinth 2.. Destructive procedures Labyrinthectomy. Fazaia Ruth Pfau Medical College ENT Department 15
- 16. • A 45 years old patient is complaining of sudden attacks of imbalance for past 3 years, which last for more than 20 minutes and associated with tinnitus. These episodes of imbalance and tinnitus occur now more frequently and with increasing ear fullness. • 1. What specific questions will you ask to reach the diagnosis? • 2. Give differential diagnosis? • 3. Give management plan of your diagnosis? (diagnosis and treatment) • 4. What complications can develop? • 5. Write the prescription for your patient? Fazaia Ruth Pfau Medical College ENT Department 16