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Z Year3 Neuro Conditions > Meniere's Disease > Flashcards

Meniere's Disease Flashcards

1
Q

What is Meniere’s disease?

A

episodic auditory and vestibular disease characterised by sudden onset of vertigo, hearing loss, tinnitus, and sensation of fullness in the affected ear

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2
Q

What is the cause of Meniere’s disease?

A

Endoylymphatic hydrops (excess fluid in inner ear) due to impaired endolymph resorption

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3
Q

What happens in Meniere’s disease?

A
  • overproduction or impaired absorption of endolymph in inner ear
  • so increased pressure of endolymphatic system of inner ear
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4
Q

What are RF for Meniere’s idsease?

A
  1. Positive FHx
  2. Recent viral illness
  3. Autoimmune disorders
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5
Q

What are the symptoms of Meniere’s?

A
  1. recurrent attacks of vertigo lasting >20mins
  2. fluctuating or permanent sensorineural hearing loss
  3. tinnitus (with a sense of aural fullness and falling on one side)
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6
Q

What tests may be positive in Meniere’s disease?

A
  1. Romberg’s test

2. Fukuda’s stepping test

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7
Q

What is Romberg’s test?

A

swaying or falling when asked to stand with feet together and eyes closed

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8
Q

What is Fukuda’s stepping test?

A

Turning towards the affected side when asked to march in place with eyes closed

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9
Q

What are possible DDx for Meniere’s disease?

A
  1. Acoustic neuroma
  2. Vestibular migraine
  3. Vestibular neuronitis
  4. Viral Labyrinthitis
  5. BPPV
  6. Vertebrobasilar insufficiency
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10
Q

What investigations may be used for meniere’s disease?

A
  • 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
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11
Q

What would pure tone air and bone conduction with masking show in Meniere’s?

A

unilateral sensorineural hearing loss (low freq if early and mid-high when MD progress)

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12
Q

What is 1st line treatment for meniere’s?

A

dietary changes and lifestyle modification + diuretic

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13
Q

What can be added to treatment of Meniere’?

A
  • vestibular suppressant, anti-emetic or corticosteroid

- intratympanic injection (of steroid)

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14
Q

What is the 1st line treatment of menieres if persistent hearing loss?

A

amplification (hearing aid) or assistive listening device

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15
Q

What is 1st line treatment for menieres with failure of medical devices with hearing adequate?

A

endolymphatic sac surgery + vestibular nerve section

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16
Q

What is the 1st line treatment for failure of medical therapies with hearing impaired in Menieres?

A

labyrinthectomy

17
Q

What else can you give for menieres?

A

antihistamine e.g. cinnarizine if prolonged or buccal prochlorperazine if severe up to 7days

18
Q

What are complications of menieres?

A
  1. Falls

2. Profound hearing loss; incidence of bilateral, severe to profound hearing loss is estimated at 1% to 6%

19
Q

What is the prognosis of meniere’s disease?

A
  • 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
20
Q

What is epid for menieres?

A

30-60year

Women more than men

21
Q

What is Menieres?

A

Disorder of inner ear caused by a change in fluid volume in the labyrinth, causing tinnitus and vertigo

22
Q

What are possible aetiological agents on menieres?

A
  1. Allergy
  2. Viral infection
  3. Syphiliis
  4. Lyme disease
  5. Hypothyroidism
23
Q

What is the difference between Meiere’s syndrome and disease?

A
  1. Meniere’s disease: idiopathic unknown cause

2. Meniere’s syndrome: if symptoms are secondary to another condition

24
Q

What are key symptoms to distinguish menieres from BPPV?

A
  1. Vertigo
  2. Minuetes to hours
  3. Hearing loss in affected ear
25
Q

What is sensorineural hearing loss on audiometry?

A
  • 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
26
Q

How are sounds different in sensorineural hearing loss?

A
  • Soft sounds may be hard to hear

- Even louder sounds may be unclear or may sound muffled

27
Q

How do you treat an acute vertigo attack?

A

vestibular suppressant drugs

28
Q

What are examples of vestibular suppresant drugs?

A
  1. benzodiazepines

2. antihistamines

29
Q

How do vestibular suppressant drugs works?

A

suppress the effects of vestibular dysfunction, such as vertigo, nystagmus, and nausea

30
Q

How do you prevent reccurence of menieres?

A
  • Lifestyle changes: limit salt, caffeine and alcohol consumption, stop smoking, manage stress
  • Exercises to improve balance
31
Q

What maintenace therapy is used?

A

diuretics (thiazides): reduce the volume of the endolymph

32
Q

Why is a restricted salt diet helpful?

A

thought to prevent sodium related water retention and re-distribution into endolymphatic system

Z Year3 Neuro Conditions (34 decks)

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