Meniers Disease Periodic episodes of rotary vertigo or

Meniers Disease Periodic episodes of rotary vertigo or dizziness. ■Fluctuating, progressive, unilateral (in one ear) or bilateral (in both ears) hearing loss, usually in lower frequencies. [4] ■Unilateral or bilateral tinnitus. ■A sensation of fullness or pressure in one or both ears.

• Prosper Ménière Born June 18, 1799 Angers, France Died February 7, 1862 (aged 62) Nationality France Known for Ménière's disease • 1938 Hallpike described the pathology Hydrous. etiology still obscure

• Pathology: • Endolymphatic Sac / Stria Vascularis/ Longitudinal flow

n n n Anatomical-abnormalities Genetic-autosomal dominant Immunological-immune complex deposition Viral-serum Ig. E to herpes simples virus types I and II, Epstein. Barr virus and CMV Vascular-associated with migraines Metabolic-potassium intoxication

• Clinical Features: • 1/Vertigo episodic, duration >20 minutes, <12 hours, clusters of vertigo and then remissions • frequency of vertigo • other symptoms of vagal disturbance • warning of impeding attack fullness in ear and change in character of tinitus.

• Contd • 2/ Hearing Loss. • SN hearing loss, lower frequencies. fluctuating , may be normal in remissions? • 3/Diplacusis, distortion of sound. tuning fork pitch

• Contd • 4/Hyperacusis. intolerance to loud sounds • 5/ Tinnitus. low pitch • 6/ fullness in ears

• Diagnosis: n The diagnosis of Meniere disease is made based on a careful history and physical exam.

• Examination{this is how I examine patient with giddy spells or vertigo. • Ear: RT/Lt> Normal • Eyes, Nystagmus in Acute attack towards the unaffected ear WRONG WAY, +eye movements+Corneal reflex • Tuning fork test, And diplacusis

• examine all cranial nerves • Finger nose test • Unterberger test • Hallpike test (BPPV)

• Investigations • Pure tone audiometry • Imaging: MRI to Exclude CP angle leision

• Investigation not done routinely • 1/ Electrochochleography: Its measurement of electrical output of the cochlea and 8 th nerve in response to an auditory stimulus. • a/ cochlear microphonics; wave form, deflection up and down, sourse is hair cells. • inference; if CM present hair cells of cochlea intact

• Cont. . • Summating potentials, basilar membrane and outer hair cells? • Action potential 8 th nerve

• In Meniers disease there is negative summating potential and SP to AP ratio is >30% (n 20%)

• Caloric test: irrigation of ear with warm and cold water(70 degree above and below body temp) and duration of nystagmus noted. • Direction of nystagmus (COWS) temperature gradiend across scc and movement of endolymph.

• In Meniers disease: canal paresis or reduced response on the affected side or directional preponderance.

• Glycerol test; diagnostic • Glycerol 1. 5 ml/kg orally • hrs after ingestion , PTA will show 10 db improvement in hearing in adjacent frequencies.

• Variants of Meniers disease • Cochlear hydrop, Vestibular hydrop

• Treatment • Acute attack. 1/ Admit 2/ Vestibular Sedatives • 3/ Vasodilators Carbogen 5% co 2 with 95% O 2 • Histamine drip 2. 75 mg in 500 ml glucose i/v slowly(rarely used because of cardiac complications

• Treatment when Acute phase is over: • Betahistine(serc)16 mg tds • Diureic

• Surgery: 1/ Preserving Hearing • Decompression Endolympatic sac • Grommet insertion • vestibular Nerve section • Outcome of Retro-labyrinthine Vestibular Nerve Section Surgery (Original Article), Javed I. Shah & Gerald B. Brookes, Journal of Medical Sciences, Vol. 13, No. 2 Jul 2005

• Patient with intractable Vertigo and no hearing • Labrynthectomy

• Differential diagnosis • central causes of vertigo • infections spreading from middle ear • BPPV, • Sudden vestibular failure • Acoustic Neuroma

• Question: 30 yrs. old lady with acute giddy spells lasting more than 20 minutes with nausea and sickness, fluctuating hearing loss, low pitch tinnitus and fullness in ear, • whats diagnosis • Name investigations • Describe Medical Treatment.

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