meniere's disease

Question 1

definition of meniere’s

Answer 1

Recurrent episodes of tinnitus, paroxysmal vertigo and unilateral fluctuating hearing loss

Question 2

aetiology of meniere’s

Answer 2

Disturbed homoeostasis of endolymph (fluid within the inner ear).

increased pressure in the endolymphatic system of the inner ear

RF

• recent viral infection
• genetic predisposition
• autoimmune disease

Question 3

meniere’s epi

Answer 3

The true incidence and prevalence of MD is not known

MD is primarily a disease of adulthood, although several cases have been reported in children.

Question 4

sx meniere’s

Answer 4

recurrent attacks of vertigo >20min,

fluctuating or permanent sensineural hearing loss

tinnitus (with a sense of aural fullness ± falling to one side).

drop attacks - sudden loss of balance w/o loss of consciousness or other autonomic neurological symptoms - more common in older people but can happen at any age, occur in later stages

Question 5

signs meniere’s

Answer 5

+ve romberg’s test - Swaying or falling when asked to stand with feet together and eyes closed.

+ve Fukuda’s stepping test - Turning towards the affected side when asked to march in place with eyes closed.

tandem walk

nystagmus

bilateral symptoms

Question 6

ix meniere’s

Answer 6

no specific test will confirm diagnosis

audiogram, electronystagmography, electrocochleography, vestibular evoked myogenic potential, MRI to rule out other causes

Question 7

mx of meniere’s

Answer 7

advise
* long term condition, vertigo improves with rx
* acute vertigo settle in 24 hrs
* consider risks of swimming/climbing/driving

involve MDT including psychologist
nausea, vomiting, vertigo: short course (up to 7 days) of buccal/IM prochlorperazine or an antihistamine
may need admission for IV labyrinthine sedatives
audiology assessment
trial of betahistine to reduce freq and severity of attacks

Question 8

px of meniere

Answer 8

lasts 5-10 yrs
likely to have some hearing loss