Meniere's

Question 1

Define

Answer 1

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

Define Meniere’s disease

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

Question 2

Causes

Answer 2

endolymph

Question 3

Symptoms

Answer 3

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

Loss of balance

Headaches

Nausea/vomiting

ON EXAMINATION: 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 4

Investigations

Answer 4

There is NO SPECIFIC TEST that will confirm the diagnosis:

• Reinnes and Webers test: unilateral sensorineural loss
• Speech recognition threshold (SRT) is negative (Meniere’s does not cause a SRT change)
• Normal tympanogram and stapedial reflex
• OAE (oto-acoustic emissions measures the electrophysiology of hair cell dysfunction) - Meniere’s and other middle ear disease will see an absence of measurable OAE in frequency range

Some other investigations (e.g. MRI, electrocochleography, electronystagmography) may be used to exclude other causes of such symptoms

Betahistane or steroid injections into the ear may be given to help with the symptoms