Meniere's Disease Flashcards
What is Meniere’s disease?
episodic auditory and vestibular disease characterised by sudden onset of vertigo, hearing loss, tinnitus, and sensation of fullness in the affected ear
What is the cause of Meniere’s disease?
Endoylymphatic hydrops (excess fluid in inner ear) due to impaired endolymph resorption
What happens in Meniere’s disease?
- overproduction or impaired absorption of endolymph in inner ear
- so increased pressure of endolymphatic system of inner ear
What are RF for Meniere’s idsease?
- Positive FHx
- Recent viral illness
- Autoimmune disorders
What are the symptoms of Meniere’s?
- recurrent attacks of vertigo lasting >20mins
- fluctuating or permanent sensorineural hearing loss
- tinnitus (with a sense of aural fullness and falling on one side)
What tests may be positive in Meniere’s disease?
- Romberg’s test
2. Fukuda’s stepping test
What is Romberg’s test?
swaying or falling when asked to stand with feet together and eyes closed
What is Fukuda’s stepping test?
Turning towards the affected side when asked to march in place with eyes closed
What are possible DDx for Meniere’s disease?
- Acoustic neuroma
- Vestibular migraine
- Vestibular neuronitis
- Viral Labyrinthitis
- BPPV
- Vertebrobasilar insufficiency
What investigations may be used for meniere’s disease?
- Sensorinueral hearing loss on audiometry
1. Pure tone air and bone conduction with masking
2. Speech audiometry
3. Tympanometry/immittance/stapedial reflex levels
4. Oto-acoustic emissions
What would pure tone air and bone conduction with masking show in Meniere’s?
unilateral sensorineural hearing loss (low freq if early and mid-high when MD progress)
What is 1st line treatment for meniere’s?
dietary changes and lifestyle modification + diuretic
What can be added to treatment of Meniere’?
- vestibular suppressant, anti-emetic or corticosteroid
- intratympanic injection (of steroid)
What is the 1st line treatment of menieres if persistent hearing loss?
amplification (hearing aid) or assistive listening device
What is 1st line treatment for menieres with failure of medical devices with hearing adequate?
endolymphatic sac surgery + vestibular nerve section
What is the 1st line treatment for failure of medical therapies with hearing impaired in Menieres?
labyrinthectomy
What else can you give for menieres?
antihistamine e.g. cinnarizine if prolonged or buccal prochlorperazine if severe up to 7days
What are complications of menieres?
- Falls
2. Profound hearing loss; incidence of bilateral, severe to profound hearing loss is estimated at 1% to 6%
What is the prognosis of meniere’s disease?
- start with hearing loss and tinnitus
- patients may or may not then develop the complete clinical profile of MD
- symptoms can get worse and can go into remission
What is epid for menieres?
30-60year
Women more than men
What is Menieres?
Disorder of inner ear caused by a change in fluid volume in the labyrinth, causing tinnitus and vertigo
What are possible aetiological agents on menieres?
- Allergy
- Viral infection
- Syphiliis
- Lyme disease
- Hypothyroidism
What is the difference between Meiere’s syndrome and disease?
- Meniere’s disease: idiopathic unknown cause
2. Meniere’s syndrome: if symptoms are secondary to another condition
What are key symptoms to distinguish menieres from BPPV?
- Vertigo
- Minuetes to hours
- Hearing loss in affected ear
What is sensorineural hearing loss on audiometry?
- Happens after inner ear damage
- Problems with the nerve pathways from your inner ear to your brain can also cause SNHL
- Most common type of permenant hearing loss
How are sounds different in sensorineural hearing loss?
- Soft sounds may be hard to hear
- Even louder sounds may be unclear or may sound muffled
How do you treat an acute vertigo attack?
vestibular suppressant drugs
What are examples of vestibular suppresant drugs?
- benzodiazepines
2. antihistamines
How do vestibular suppressant drugs works?
suppress the effects of vestibular dysfunction, such as vertigo, nystagmus, and nausea
How do you prevent reccurence of menieres?
- Lifestyle changes: limit salt, caffeine and alcohol consumption, stop smoking, manage stress
- Exercises to improve balance
What maintenace therapy is used?
diuretics (thiazides): reduce the volume of the endolymph
Why is a restricted salt diet helpful?
thought to prevent sodium related water retention and re-distribution into endolymphatic system
