Meniere's Disease

Question 1

what is it?

Answer 1

a rare condition with recurring, episodic, rotatory vertigo
lasts 30 minutes to a few hours
attacks are recurrent over months or years

Question 2

pathogenesis?

Answer 2

build up of endolymphatic fluid in the inner ear - why isn’t really understood

Question 3

what is the presentation?

Answer 3

30 minute to few hour long attacks of rotatory vertigo
associated with low-frequency hearing loss
- feeling of fullness in the affected ear
- loss of balance
- tinnitus
- vomiting

Question 4

preventative measures for Menieres disease?

Answer 4

low salt diet
betahistine
avoidance of caffeine

Question 5

how is it managed in the acute phase?

Answer 5

vestibular sedatives - cinnarizine

Question 6

how is it managed if it is hard to control?

Answer 6

chemical labrintectomy perfusing the round window orifice with ototoxic drugs e.g. gentamicin
surgical decompression of the endolymphatic compartment of the inner ear to relieve the endolymphatic hydrops

Question 7

how does gentamicin work?

Answer 7

It destroys the vestibular epithelium so the patient has severe vertigo for 2 weeks until the body compensates for the lack of vestibular input on that side
there is a trade of the occasional mild vertigo for the disabling attacks in Menieres disease
there is a risk of sensorineural hearing loss and complete vestibular failure if Menieres develops in the other side