MENIERE’S DISEASE

Meniere's Disease,

• Also called endolymphatic hydrops,

• Disorder of the inner ear

• Endolymphatic system is distended with endolymph.

• Characterised by (i) vertigo, (ii) sensorineural hearing loss and (iii) tinnitus and (iv) aural fullness.

• Age and sex. commonly seen in between 35—60 years.

• Males >females. Usually,

• Unilateral, but the other ear may be affected after a few years.

• Cardinal, symptoms of Meniere's disease are:

• (1) Episodic vertigo,

• (2) Fluctuating hearing loss,

• (3) Tinnitus

• (4) Sense of fullness or pressure in the involved ear.

1. Vertigo• Sudden onset, feeling of rotation of himself or his environment.

• Attacks in clusters, with spontaneous remission lasting for weeks, months or years.

• Usually, accompanied by nausea and vomiting with ataxia and nystagmus.

• Severe attacks with vagal disturbances such as abdominal cramps, diarrhoea, cold sweats, pallor and bradycardia.

• Feeling of sense of fullness in the ear. Change in character of tinnitus or discomfort in the ear which herald an attack.

• Some cases associated with Tullio phenomenon (loud sounds or noise produce vertigo) due to the distended saccule lying against the stapes footplate.

2.Hearing loss • Accompanies vertigo or may precede it.

• Improves after the attack and may be normal during the periods of remission.

• Fluctuating nature, with recurrent attacks, improvement but not complete; some hearing loss slow and progressive ,which is permanent.

• diplacusis :Distortion of sound. A tone of a particular frequency may appear normal in one ear and of higher pitch in the other.

• Intolerance to loud sounds due to recruitment phenomenon.

• They are poor candidates for hearing aids

3. Tinnitus• low-pitched roaring/ hissing type, aggravated during acute attacks.

• Change in intensity and pitch may be the warning symptom of attack.

•4. Sense of fullness or pressure like symptoms.

• Fluctuates may accompany or precede an attack of vertigo.

Destructive procedures

• Totally destroy cochlear and vestibular function and are used only when cochlear function is not serviceable.

• LABYRINTHECTOMY. Membranous labyrinth is completely destroyed.

• TRANSMASTOID ROUTE: by opening through the lateral semicircular canal

• TRANSCANAL ROUTE: through the oval window. This gives relief from the attacks of vertigo.

Meniett device therapy• Intermittent low pressure pulse therapy: intermittent positive

pressure delivered to inner ear fluids brings relief from the symptoms.

• Myringotomy, insertion a ventilation tube is required to deliver pressure waves to the round window membrane via the ventilation tube.

• Pressure waves pass through the perilymph and cause reduction in endolymph pressure by redistributing it through various communication channels such as the endolymphatic sac or the blood vessels.

• Meniett device therapy recommended, who have failed medical treatment and the surgical options are being considered.