MENIERES DISEASE BYDR SUDEEP K C Menieres disease

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 saccule completely fill the scala vestibuli distended 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 disturbance 3)Allergy 4)Sodium and water retention 5)Hypothyroidism 6)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 normal Nystagmus 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: Ø Reassurance ØCessation of smoking ØLow salt diet ØAvoid excessive intake of water ØAvoid over intake of coffee , tea and alchol. ØAvoid stress and bring a change in life style. ØAvoid activities requiring good body balance.

B) Management of acute attack: ØReassurance ØBed rest ØVestibular sedatives ØVasodilators –inhalation of carbogen , histamine drip.

C)Management of chronic phase: Ø vestibula sedatives ØVasodilators ØDiuretics ØPropantheline bromide ØElimination of allergen ØHormones ØIntra tympanic gentamicin therapy

D)Surgical Treatment: Ø Decompression of endolymphatic sac. ØEndolymphatic shunt operation. ØSacculotomy ØSection of vestibular nerve ØUltrasonic destruction of vestibular labyrinth. ØLabyrinthectomy.