meniers disease
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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Meniers DiseaseMeniers 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.
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.
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• 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
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• Pathology:
• Endolymphatic Sac / Stria Vascularis/ Longitudinal flow
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Anatomical-abnormalitiesAnatomical-abnormalities Genetic-autosomal dominant Genetic-autosomal dominant Immunological-immune complex depositionImmunological-immune complex deposition Viral-serum IgE to herpes simples virus types I and II, Viral-serum IgE to herpes simples virus types I and II,
Epstein-Barr virus and CMVEpstein-Barr virus and CMV Vascular-associated with migrainesVascular-associated with migraines Metabolic-potassium intoxicationMetabolic-potassium intoxication
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• Clinical Features:
• 1/Vertigo episodic, duration >20minutes, <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.
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• Contd
• 2/ Hearing Loss.
• SN hearing loss, lower frequencies. fluctuating ,may be normal in remissions?
• 3/Diplacusis, distortion of sound . tuning fork pitch
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• Contd
• 4/Hyperacusis. intolerance to loud sounds
• 5/ Tinnitus. low pitch
• 6/ fullness in ears
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• Diagnosis:
The diagnosis of Meniere disease is made based The diagnosis of Meniere disease is made based on a careful history and physical exam.on a careful history and physical exam.
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• 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
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• examine all cranial nerves
• Finger nose test
• Unterberger test
• Hallpike test (BPPV)
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• Investigations
• Pure tone audiometry
• Imaging: MRI to Exclude CP angle leision
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• Investigation not done routinely
• 1/ Electrochochleography:Its measurement of electrical output of the cochlea and 8th 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
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• Cont..
• Summating potentials, basilar membrane and outer hair cells?
• Action potential 8th nerve
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• In Meniers disease there is negative summating potential and SP to AP ratio is >30% (n 20%)
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•Caloric test:irrigation of ear with warm and cold water(70degree above and below body temp) and duration of nystagmus noted .
• Direction of nystagmus (COWS) temperature gradiend across scc and movement of endolymph.
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• In Meniers disease: canal paresis or reduced response on the affected side or directional preponderance.
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• Glycerol test; diagnostic
• Glycerol 1.5ml/kg orally
• hrs after ingestion ,PTA will show 10db improvement in hearing in adjacent frequencies.
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• Variants of Meniers disease
• Cochlear hydrop, Vestibular hydrop
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• Treatment
• Acute attack. 1/ Admit 2/ Vestibular Sedatives
• 3/ Vasodilators Carbogen 5% co2 with 95% O2
• Histamine drip 2.75mg in 500ml glucose i/v slowly(rarely used because of cardiac complications
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• Treatment when Acute phase is over:
• Betahistine(serc)16mg tds
• Diureic
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• 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
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• Patient with intractable Vertigo and no hearing
• Labrynthectomy
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• Differential diagnosis
• central causes of vertigo
• infections spreading from middle ear
• BPPV,
• Sudden vestibular failure
• Acoustic Neuroma
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• Question: 30 yrs. old lady with acute giddy spells lasting more than 20minutes 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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•/www.authorstream.com
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