Meniere’s Disease

Question 1

What are the other names of Ménière’s disease ?

Answer 1

Endolymphatic hydrops ( since the endolymphatic system is dilated with endolymph )

Has two variants

Cochlear hydrops - main feature hearing loss
Vestibular hydrops - main feature is vertigo

Question 2

What is the main pathology of meniere’s?

Answer 2

Distension of endolymphatic sac and bulging of Reissner membrane which many herniate through the helicotremma into the apical part of scala tympani

Question 3

Most common gender and age group affected?

Answer 3

Male

35-60 years ; usually unilateral but other ear is affected after few years

Question 4

What is the main aetiology?

Answer 4

Either increased production ( due to Na and water retention ) or decreased absorption

Question 5

Production and absorption of endolymph?

Answer 5

Production - stria vascularis
Absorption - endolymphatic sac

Question 6

Cardinal symptoms of Ménière’s disease

Answer 6

Episodic vertigo

Fluctuating hearing loss ( SNHL)

Tinnitus ( ringing sensation in the ear without any external stimuli )

Fullness of the involved ear

Question 7

Intolerance to loud sounds called as?

Answer 7

Recruitment phenomenon ( feature of all cochlear pathologies )

Question 8

Diplacusis

Answer 8

Single auditory stimulus is heard as different pitch in both the ears

Question 9

Tullio’s phenomenon

Answer 9

Loud sounds or noise stimulates vertigo since saccule is distended and is easily stimulated

Question 10

Investigations for Ménière’s disease

Answer 10

Tuning fork tests
PTA
Special audiometry tests
Electrocochleography
Caloric test
Glycerol test

Question 11

Explain glycerol test

Answer 11

Glycerol is a dehydrating agent . When given orally it reduces endolymph pressure and thus improves hearing

Amount of glycerol given=1.5ml/kg with equal amount of water and little flavouring agent or lemon juice

Question 12

What is lermoyez syndrome ?

Answer 12

Symptoms of Ménière’s disease appear in reverse order

First hearing loss followed by vertiginous episode

Question 13

What is tumarkin otolith crisis / drop attack ?

Answer 13

Patient develop sudden drop attack without loss of consciousness

Due to destruction of macula found in vestibule which is responsible for linear acceleration as a result of pressure exerted towards inside

Question 14

PTA in Ménière’s disease

Answer 14

SNHL

Early stages - curve is of rising type ( since low frequencies affected )
Late stages - flat curve ( low + high frequencies affected )

Question 15

Short increment sensitivity index test (SISI TEST)

Answer 15

Score > 70% indicates Ménière’s disease

Normal - 15%

Question 16

What is confirmatory test for Ménière’s disease ?

Answer 16

Electrocochleography

Normal summating potential/action potential = 30%

> 30% suggests Ménière’s
45% confirms Ménière’s

Question 17

MRI in Ménière’s

Answer 17

MRI with contrast ( gadolinium )

Injected into scala tympani ( peri lymph ) and it mixes with endolymph then contrast can be seen

Question 18

What is Donaldsons line?

Answer 18

An imaginary line from the lateral semicircular canal bisecting the posterior semicircular canal below which is the endolymphatic sac

Question 19

What is hennebert sign?

Answer 19

Vertigo is caused due to pressure changes since enlarged saccule is stimulated by the foot plate of stapes easily