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Meniere’s disease
1.
Meniere’s Disease
2.
DEFINITION Disease of inner
ear Distention of endolymphatic system Vertigo Sensorineural hearing loss Tinnitus
3.
History 1861 – Prosper
Meniere describes classic symptoms 1938 – Hallpike and Portman confirm endolymphatic hydrops
4.
AGE DISTRIBUTION AND
INCIDENCE 35-60 yrs Females : Male 3:2 Familial Unilateral / bilateral
5.
PATHOPHYSIOLOGY
6.
Dilated membranous labyrinth Normal
membranous labyrinth in Meniere's disease (Hydrops)
7.
Pathophysiology Theories behind endolymphatic
hydrops Obstruction of endolymphatic duct/sac Hypoplasia of endolymphatic duct/sac Alteration of absorption of endolymph Alteration in production of endolymph Autoimmune insult Vascular origin Viral etiology
8.
AETIOLOGY (primary causes) Genetic Anatomical
(small vestibular aqueduct) Traumatic (physical, acoustic) Viral infection (HSV type 1) Allergy Autoimmunity
9.
AETIOLOGY (secondary causes)
Developmental insult Metabolic states (DM, hypothyroidism, hyperlipidaemia) Syphilis CSOM Otosclerosis Abnormal fluid balance
10.
CLINICAL FEATURES Vertigo
Episodic Nystagmus Hearing loss Sensorineural Progressive Tinnitus Continuous / intermittent Aural fullness
11.
DIFFERENTIAL DIAGNOSIS Vestibular neuronitis Benign
paroxysmal positional vertigo Vestibular schwannoma Vertibrobasilar insufficiency
12.
EXAMINATION Otoscopy: Normal Nystagmus: During
acute attacks Tuning fork tests: Rinnie Positive Weber Lateralized to better ear ABC Reduced in affected ear Complete neurological examination
13.
INVESTIGATIONS Assessment of cochlear
function PTA Rising Flat Falling
14.
INVESTIGATIONS Speial audiometric tests Evoked
response audiometry Transtympanic electrocochleography
15.
INVESTIGATIONS Assessment of vestibular
function Metabolic screening CBC-ESR UREA / ELETROLYTES VDRL / TPHA BSR GTT CHOLESTEROL / TG TFT
16.
TREATMENT
17.
MEDICAL TREATMENT
Acute Therapy
18.
Medical Treatment Symptomatic relief
Salt restriction Avoid caffeine, nicotine, alcohol, high- carbohydrate substances, high- cholesterol/triglyceride foods Vestibular suppressants Diuretics Vasodilators (Betahistine) Steroids Hearing aids
19.
Chemical ablation of
vestibular function Intratympanic gentamicin / streptomycin
20.
Surgical Therapy
21.
Endolymphatic Sac Surgery
Decompression: Removal of bone overlying the sac Shunting: Placement of synthetic shunt to drain endolymph into mastoid Drainage: Incision of the sac to allow drainage Removal of sac: Excision of the sac
22.
Endolymphatic Sac Surgery
23.
Vestibular Nerve Section Approaches:
Middle Fossa Retrolabyrinthine/Retrosigmoid Transcanal Complications Damage to facial nerve Damage to cochlear nerve CSF leak (about 13%)
24.
Ultrasonic destruction of
vestibular labyrinth
25.
Labyrinthectomy Approaches:
Transcanal Transmastoid
26.
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