MENIERES DISAESE(ENDOLYMPATIC HYDROPS)

The disease cause due to distension of endolymphatic system by endoymph and characterised by …….

•Vertigo•Sensor neural hearing loss•Tinnitus•Aural fullness

The main pathology in menieres disease is distension of endolymphatic system which results from :-

•Increased production of endolymph •Decreased drainage of the endolymph

Based on that there are 6 aetiology:-1. Defective absorption by endolymphatic sac

(ischemia of sac –defective absorption –distension—rupture--vertigo)

2.Vasomotor disturbance( anoxia of capallaries—incr permeability—

increased production)3.Allergy (50%)4.Sodium and water retention5.Hypothyroidism (3%)6.Autoimmune and viral aetiology

Clinical presentation:-

•Commonly seen in an age group of 35-60 years•Males are affected more than female

1.Vertigo + tullio phenomenon2.Sensory neural hearing loss3.Tinnitus4.Sense of fullness of head5.Other features

examination

1.Otoscopy:- normal2.Nystagmus :- during attacks3.Tuning fork test :- sensory neural hearing

loss

1.Pure tone audiometry

2.Speech audiometry

•Beetween attacks :- 55-85% are discriminated•During and following the attack:- impaired

3.Special audiometry testThey indicates the cochlear nature of the disease and helps to differentiate from retro cochlear pathology

•Recruitment test positive•SISI is better than 70% of the in two-third patients•Tone decay test:- normally there is decay of 20db

4.Electro cochleography

5.Caloric test

SP/AP normal is 30% but in this it is greater than 30%

• It shows reduced response on affected side in 75% of cases

•It reveals canal paresis on the affected side

Variants of menieres disease

1.Cochlear hydrops

2. Vestibular hydrops

•Drop attacks (tumarkins otolithic crisis)

•Lermoyez synrome

Menieres disease vs Menieres syndrome

(Secondary menieres disease)

•Menieres disease is idiopathic•Menieres syndrome:- similar features where the cause may be

•Head injury(ear surgery)•Viral infection(measles and mumps)•Otosclerosis•Cogans syndrome•Autoimmune disorders

Treatment:-

•General measures•Management of acute attack•Management of chronic phase•Surgical treatment

General measures•Reassurance•Cessation of smoking•Low salt intake•Avoid excessive water intake•Avoid over indulging in coffee, tea and alcohol•Avoiding activities requiring body balance

Management of acute attack

•Reassurance•Bed rest•Vestibular sedatives(dimenhydranate, diazepam, prochloroperazine)

•Vasodilators(inhalation of carbogen and histamine drip)

Management of chronic phase•Vestibular sedatives•Vasodilators•Diuretics•Elimination of allergens•Hormone replacement theraphy

Surgical treatment

•Conservative procedures(decompression of sac, endolymphatic shunt operations, sacculotomy, section of vestibular nerve)

•Destructive procedures(labrynthectomy)

•Intermittent low pressure pulse therapy (meniett device therapy)

Thank you