Meniere

Question 1

what is the typical presentation of Meniere?

Answer 1

Intermittent vertigo, tinnitus, sensorineural hearing loss (low frequencies - can last up to an hour) (+ N+V)

Question 2

define meniere’s disease?

Answer 2

Recurrent episodes of tinnitus, paroxysmal vertigo and unilateral fluctuating hearing loss- can last up to an hour

Question 3

outline the aetiology of meniere’s disease

Answer 3

Disturbed homeostasis of endolymph (fluid in the inner ear) - impaired absorption/ overproduction

POSSIBLE THEORY: During acute attach the XS fluid pressure causes distention and rupture of Reissner’s membrane which can cause release of endolymph into perilymphatic spaces causing a sudden hearing loss, vertigo and tinnitus. Between attacks the Reissner’s membrane may reattach itseld restoring chemical balance

Disease = idiopathic; syndrome = secondary to a number of known inner-ear disorders

Question 4

what are the presenting symptoms of meniere’s disease?

Answer 4

Vertigo(WORLD AROUND YOU IS SPINNING)

Loss of hearing in affected ear (@ start it is during vertigo spells but later stages it may become constant) - occurs in affected ear and starts at low frequencies

Tinnitus– occurs in affected ear

sensation of fullness

Loss of balance

Headaches

Nausea/vomiting

Question 5

what is seen on examination in Meniere’s disease?

Answer 5

positive Romberg’s test and Fakuda’s stepping test(turning towards affected side when asked to march in place with eyes closed)

Positive romberg’s test (feeling unsteady when eyes closed) indicated a proprioceptive issue

Question 6

what are the appropriate investigation for Meniere’s disease?M

Answer 6

Positive Romberg

Fukuda/Unterbergertest ( marching on spot) -> Cant hold position and turns to affected side

Reinnes and Webers test: unilateral sensorineural loss

Poor tandem walking

Exclusion MRI- MRI is done for any patient with asymmetrical hearing loss, primarily to exclude acoustic neuroma.

If the patient has bilateral symptoms and a poor response to treatment, AI testing may be conducted e.g.ANA antibodies, Rh factor.

Question 7

Outline the management of Menniere’s disease?

Answer 7

Question 8

compare BPPV and Menniere’s disease?

Answer 8