EAR -MENIERE’S DISEASE

What is Meniere's disease?

In 1861 Prosper Meniere described a condition characterized by sudden recurring episodes of vertigo, nausea, vomiting and fluctuating hearing loss.
This is called Meniere’s Disease

 What are the Aetiology of Meniere's disease?

1. Age: Before age of 50 Years, Peak Incidence is between 31-40 Years of age.
2. Sex: Common in females than males. M:F=1:2
3. Bilateral involvement: Only 10% of the patients have bilateral involvement
4. Vascular insufficiency
5. Idiopathic

What is the pathology of Meniere's disease?

There is dysfunction of the endolymphatic duct and sac system causing distension of the endolymphatic spaces
Vascular insufficiency may play a role in endolymphatic dysfunction.

What are the Clinical features of Meniere's disease?

1. Hearing Loss : It has 3 Phases
(a) Early reversible hearing loss
(b) Established Fluctuating hearing loss
(c) Late non-fluctuating hearing loss
2. Vagal Stimulation may occur. Patient complains of sweating and pallor. This is seen is acute attacks.
3. Tinnitus: It is roaring in nature and prominent before an attack
4. Sensation of heaviness and fullness in the ear
5. Server anxiety
6. Nystagmus is always present during an attack

What Investigations are required for the diagnosis of Meniere's disease?

1. Pure tone audiometry: Suggestive of sensorineural hearing loss in the affected ear. It is fluctuating in the early stages.
2. Vestibular function test: Electronystagmography shows presence of spontaneous or abnormal nystagmus.
3. Glycerol test: Strongly diagnostic of Meniere’s diseas
4. General Examination of the patient with neurological examination
5. BERA is used to differentiate unilateral acoustic tumours. Normal in Meniere’s disease.
6. Electrocochleography

What is the treatment of Meniere's disease?

1. General
a. Stop alcohol, Smoking
b. Monitor blood pressure
c. Sound Sleep

2. Medical line:
a) Reduce sodium intake
b) Diuretics Furosemide 10-70 mg/day
c) Vestibular ablation by injection streptomycin
d) Vasodilators: Betahistine
e) Calcium channel blockers: Useful in some patients not responding to the above treatment
f) Sedatives to relieve anxiety
g) Labyrinthine sedatives with antiemetics used in acute period
h) Anti-histaminics : Act as vestibular suppressants

Surgical:
1. Chemical Labyrinthectomy of inner ear by injection Gentamycin
Ultrasonic ablation of the inner ear
Endolymphatic Sac decompression. Helps to prevent the accumulation of the endolymph
Vestibular neurectomy
Labyrinthectomy: It comprises of destruction of the labyrinth to relieve the symptoms.




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