meniere's Flashcards
definition of meniere’s
affecting the inner ear which can affect balance and hearing
causes of meniere
Unknown – abnormal endolymph production and/or absorption is associated with meniere’s
- Volume of endolymph in the membranous labyrinth increases and the volume of perilymph filling the bony labyrinth decreases – does not give all the features (ENDOLYMPHATIC HYDROPS)
- Swelling of the membranous labyrinth
what is meniere syndrome
when the cause is identified - trauma, autoimmune and genetic
risk factors of meniere
- Autoimmunity (usually presents with bilateral symptoms).
- Genetic susceptibility.
- Metabolic disturbances involving the balance of circulating levels of sodium and potassium in the fluid of the inner ear.
- Vascular factors (there is an association between migraine and Meniere’s disease).
- Viral infection.
- Head trauma.
clinical features of meniers
- recurrent episodes of vertigo
- tinnitus
- hearing loss (sensorineural)
a sensation of aural fullness or pressure is now recognised as being common
other features include horizontal nystagmus and a positive Romberg test
episodes last minutes to hours
typically symptoms are unilateral but bilateral symptoms may develop after a number of years - low frequency
management for Meniere’s
ENT assessment is required to confirm the diagnosis
patients should inform the DVLA. The current advice is to cease driving until satisfactory control of symptoms is achieved
acute attacks: buccal or intramuscular prochlorperazine. Admission is sometimes required
prevention: betahistine and vestibular rehabilitation exercises may be of benefit
- otholitic crisis
acute severe attack
- cyclizine + IV betahistine + thiazide diuretics
Clincial features of viral labrynthitis
presents as sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting
vertigo.
Patients will typically present with symptoms such as a previous ear infection, tinnitus, or previous coryzal symptoms.
how to differentiate between vestibular neuritis and labrynthitis
vestibular neuritits only involves the vestibular nerve therefore no hearing impairment whereas the labyrinth consists both vertigo and hearing loss
Clincial features of viral labrynthitis
presents as sudden onset horizontal nystagmus, hearing disturbances, nausea, vomiting and vertigo. Patients will typically present with symptoms such as a previous ear infection, tinnitus, or previous coryzal symptoms.
what is labrynthitis
Labyrinthitis is an inflammatory disorder of the membranous labyrinth, affecting both the vestibular and cochlear end organs
how to differentiate between vestibular neuritis and labrynthitis
vestibular neuritits only involves the vestibular nerve therefore no hearing impairment whereas the labyrinth consists both vertigo and hearing loss
signs of labrynthitis
spontaneous unidirectional horizontal nystagmus towards the unaffected side
sensorineural hearing loss: shown by Rinne’s test and Weber test
abnormal head impulse test: signifies an impaired vestibulo-ocular reflex
gait disturbance: the patient may fall towards the affected side
normal skew test
abnormality on inspection of the external ear canal and the tympanic membrane e.g. vesicles in herpes simplex infection
ix to do if diagnosis is uncertain for labrynthitis
pure tone audiometry can be done to assess hearing loss
full blood count and blood culture: if systemic infection suspected
culture and sensitivity testing if any middle ear effusion
temporal bone CT scan: indicated if suspecting mastoiditis or cholesteatoma
MRI scan: helpful to rule out causes such as suppurative labyrinthitis or central causes of vertigo
vestibular function testing: may be helpful in difficult cases and/or determining prognosis
complications of meniere’s
- Falls
- Psychological effects – anxiety, depression, agoraphobia
- Social effects – work, daily activities
whats the name of drop attack seen in meniers
otholotic crisis of tumarkin
