Meneieres disease

24

Transcript of Meneieres disease

Page 1: Meneieres disease
Page 2: Meneieres disease

MENIERES DISAESE(ENDOLYMPATIC HYDROPS)

Page 3: Meneieres disease

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

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

Page 4: Meneieres disease
Page 5: Meneieres disease

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

•Increased production of endolymph •Decreased drainage of the endolymph

Page 6: Meneieres disease

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

Page 7: Meneieres disease

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

Page 8: Meneieres disease

examination

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

loss

Page 9: Meneieres disease
Page 10: Meneieres disease

1.Pure tone audiometry

Page 11: Meneieres disease

2.Speech audiometry

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

Page 12: Meneieres disease

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

Page 13: Meneieres disease

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

Page 14: Meneieres disease

Variants of menieres disease

Page 15: Meneieres disease

1.Cochlear hydrops

Page 16: Meneieres disease

2. Vestibular hydrops

Page 17: Meneieres disease

•Drop attacks (tumarkins otolithic crisis)

•Lermoyez synrome

Page 18: Meneieres disease

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

Page 19: Meneieres disease

Treatment:-

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

Page 20: Meneieres disease

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

Page 21: Meneieres disease

Management of acute attack

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

•Vasodilators(inhalation of carbogen and histamine drip)

Page 22: Meneieres disease

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

Page 23: Meneieres disease

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)

Page 24: Meneieres disease

Thank you