Upload
saurabh-gupta
View
520
Download
4
Tags:
Embed Size (px)
Citation preview
MENIERE’S DISEASE
Saurabh GuptaProf. (Dr.) S. K. Jaiswal unit
IntroductionMeniere's disease (idiopathic endolymphatic
hydrops) is a disorder of the inner ear associated with a symptoms consisting of spontaneous, episodic attacks of vertigo; sensorineural hearing loss which usually fluctuates; tinnitus; and often a sensation of aural fullness.
dramatic variability is the hallmark of this disease.
Introduction : HistoryFirst described by
Prosper Meniere in 1861.
In 1902, Parry performed a CN VIII division for vertigo in a patient with suspected Meniere’s disease.
Portman did endolymphatic sac decompression via a transmastoid approach in 1926.
In 1931,McKenzie performed a selective vestibular neurectomy.
Pathology Distortion of the membranous labyrinth.This condition reflects the changes in the
anatomy of the membranous labyrinth as a consequence of the over-accumulation of endolymph.
Mainly affects scala media and sacculeBulging of reissner’s membrane Saccule may come to lie against the stapes
footplate.
EtiologyA. Defective absorption by endolymphatic sac-• Poor vascularity of sac• Less absorptive tubular epithelium• increased perisaccular fibrosisB. Rupture of reissner’s membreane leading to
mixing of perilymph & endolymph- Schuknecht
• allow leakage of the potassium-rich endolymph into the perilymph, bathing the eighth cranial nerve and lateral sides of the hair cells
EtiologySpasm of int. auditory artery – Sym.
OveractivityAllergy – inner ear is shock organSodium & water retentionHypothyroidismAutoimmuneViral
Clinical featuresAffects in 4th -5th decade of lifeMale:Female 1:1Prevalence more in whites.VERTIGO : episodic attacks , asso. with nystagmus,
nausea & vomiting , vagal disturbanceTullio phenomenon may be seen
Clinical featuresHEARING LOSS 1. Fluctuating2. SNHL3. Progressive 4. Unilateral5. Distortion of sound6. Intolerance to loud sound
Clinical featuresTINNITUS1. Low pitched roaring2. Subjective3. Unilateral AURAL FULLNESS1. Fluctuates , in prodromal phase
Diagnosis
InvestigationsTuning forks tests :
SNHLPTA Speech audiometryRecruitment test
+veSISI >70%Tone decay <20 dB
Investigations Caloric testing – canal paresisENGHead Thurst testECoG – SP is larger & more negativeSP/AP ratio increases > 30%Glycerol testVEMP – elevated threshold
VEMPs
StagingSTAGE PURE TONE AVERAGE IN dB IN PREVIOUS 6
MONTHS
1 = < 25
2 26-40
3 41-70
4 >70
Variants Cochlear hydrops – no vertigoVestibular hydrops – no heaing lossDrop attacksLermoyez syndrome- hearing loss followed by
vertigo
Treatment Medical management –ACUTE stage : labyrinth sedatives + anti-
emeticsCarbogen, Histamine dripFrustenberg Regimen -1. Low salt diet2. Diuretics + Pot. chlor3. High protein Beta histine – to relieve vascular ischemia Stop caffeine, nicotine, alcohol & tobacco
Non ablative proceduresPortman -1926Endolymphatic sac surgery1. Subarachnoid shunt2. Mastoid shunt
Non ablative proceduresIntratympanic steroids May benefit in autoimmune causes of
meniere’s syndrome.Sacculotomy Cochleosacculotomy
Ablative proceduresIntratympanic gentamicin – Schuknecht
(1957)
Ablative proceduresSelective Vestibular nerve sectioning
Ablative proceduresUltrasonic destruction of vest. Labyrinth CryodestructionLabyrinthectomy - when cochlear function
has been totally deteoriated ,higher rate of vertigo control seen than that typical for vestibular neurectomy
Recent advancesdecrease hydrops by pulsing pressure in the
middle earMeniett device - handheld air pressure
generator that the patient self-administersThe pressure is delivered in complex pulses
of up to 20 cm of water, over a 5 minute period.
The device requires a ventilation tube to be placed in the tympanic membrane before initiation of therapy
Pressure at the RW passes to perilypmh and decreases pressure in endolymph by redistributing it.
THANK YOU