MENIERE’S DISEASE

BY-DR.SUDEEP K.C.

Meniere’s disease : It is aslo called endolymphatic hydrops ,is a disorder of inner ear where endolymphatic system is distended.

Pathology: Distension of endolymphatic system mainly affecting cochlear duct and sacculecompletely fill the scala vestibulidistended saccule may come to lie against stapes foot plate.

Aetiology:Distension of endolymphatic system can result either from increased production of endolymph or its faulty absorption or both.

1)Defective absorption by endolymphatic sac.2)Vasomotor disturbance3)Allergy4)Sodium and water retention5)Hypothyroidism6)Autoimmune and viral aetiologies.

Clinical features:Age and sex: commonly seen in 35-60 yrs of age . Male>female.Usually disease is unilateral .

Vertigo : It comes in attack with sudden onset . usually attack is accompanied by nausea vomiting with ataxia and nystagmus and also by vagal disturbances in severe attack. “Tullio phenomenon”_ loud sounds produce vertigo due to distended saccule lying against stapes footplate.

2) Hearing loss: It usually accompanies vertigo or may precede it . Hearing improves after the attack and may be normal during the periods of remission . Some complain of distorted hearing and intolerance to loud sounds.

3)Tinnitus : It is aggravated during acute attacks may persist during periods of remission . Change in intensity and pitch of tinnitus may be the warning symptom of attack.

4) Sense of fullness or pressure: It may accompany or precede an attack of vertigo.

5)Other features : patient may show emotional upset due to repetition of attacks.

Examination:Otoscopy normalNystagmus seen only during acute attack.Tuning fork test indicate the SNHL.

Investigation:

1)Pure tone audiomerty : There is SNHL.inearly stages, lower frequencies and later on higher frequencies are affected.

2)Caloric test : It shows reduced response on the affected side in 75% of cases . often it reveals a canal paresis on the affected side.

3)Glycerol test : It is a dehydrating agent when given orally it reduces endolymph pressure and thus causes an improvement in hearing.

Treatment: A) General measures: ReassuranceCessation of smokingLow salt dietAvoid excessive intake of waterAvoid over intake of coffee , tea and alchol.Avoid stress and bring a change in life style.Avoid activities requiring good body balance.

B) Management of acute attack:

ReassuranceBed restVestibular sedativesVasodilators –inhalation of carbogen ,histamine drip.

C)Management of chronic phase: vestibula sedativesVasodilatorsDiureticsPropantheline bromideElimination of allergenHormones Intra tympanic gentamicin therapy

D)Surgical Treatment: Decompression of endolymphatic sac.Endolymphatic shunt operation.SacculotomySection of vestibular nerveUltrasonic destruction of vestibular labyrinth.Labyrinthectomy.