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MS 2 > MENIERE'S DISEASE > Flashcards

MENIERE'S DISEASE Flashcards

1
Q

Idiopathic Endolymphatic Hydrops

A

Meniere’s Disease

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2
Q

is a condition of increased hydrostatic pressure within the inner ear endolymphatic system

A

Endolymphatic hydrops

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3
Q

involves fluid that is contain in our inner ear

A

Endolymphatic hydrops

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4
Q

It pertains to water

A

Hydrostatic Pressure

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5
Q

Pertaining to inner ear

A

Labyrinth

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6
Q

Protective layer of all the inner ear structure

A

Bony Labyrinth

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7
Q

Contains a fluid perilymph

A

Perilymphatic Space

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8
Q

Contains more potassium

A

Perilymph

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9
Q

Contains less potassium

A

Endolymph

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10
Q

What are the 2 lymphatic fluids of the inner ear

A
  1. Perilymph
  2. Endolymph
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11
Q

Fluid inside the bony labyrinth

A

Perilymph

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12
Q

Fluid inside the membranous labyrinth

A

Endolymph

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13
Q

A form of endolymphatic hydrops of unknown etiology

A

Meniere Disease

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14
Q

A form of endolymphatic hydrops occurring secondary to abnormalities in endolymph production and absorption

A

Meniere Syndrome

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15
Q

Exact Cause of Meniere Disease

A

Unknown

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16
Q

Where does the Endolymphatic Fluid accumulates?

A

Endolymphatic fluid accumulates within the endolymphatic space

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17
Q

Pathophysiology of Meniere’s Disease

A
  1. Endolymphatic fluid accumulates within the endolymphatic space
  2. Dilatation of endolymphatic space (Endolymphatic Hydrops)
  3. Elevation of endolymphatic pressure

2 types of elevation of endolymphatic pressure

  1. Elevation of endolymphatic pressure
    -break in the membranous labyrinth
    - endolymph and perilymph mixes
    - mixture blocks impulse transmission and transient loss of function of vestibular nerve
    -May cause vertigo
  2. Elevation of Endolymphatic Pressure
    -Mechanical damage to the organ of corti
    - Sensorineural Hearing Loss
    - Tinnitus
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18
Q

What happens once endolymph and perilymph mixes?

A

Mixture of endolymph and perilymph may blocks impulse transmission and transient loss of function of vestibular nerve which leads to VERTIGO

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19
Q

Risk Factors of Meniere’s Disease

A

-Genetics
- Autoimmune Disorders
- Trauma
- Allergies
- Syphilis (Stage 4)

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20
Q

The world is turning around you

A

Vertigo

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21
Q

What is most common complication of elevated hypertension?

A

SMOKE

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22
Q

Clinical Manifestations of Meniere Disease 7

A

Based on Meniere’s Triad
1. Vertigo
2. Sensorineural Hearing Loss
3. Tinnitus

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23
Q

Subjective sensation of motion while motionless

A

Vertigo

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24
Q

Usually accompanied by nausea and vomiting, and nystagmus

A

Vertigo

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25
Q

Sudden falls without loss of consciousness during acute attacks

A

Crises of Tumarkin

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26
Q

Diagnostic Criterion of Crises of Tumarkin

A

At least 2 attacks lasting at least 20 minutes each

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27
Q

-Must be documented audiometrically at least once
- Primarily affects low frequency sounds

A

Sensorineural Hearing Loss

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28
Q

Ringing in the ears

A

Tinnitus

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29
Q

Non-pulsatile and often described as whistling

A

Tinnitus

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30
Q

Corresponds to the hearing loss during the attack

A

Tinnitus

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31
Q

Involuntary and rhythmic in eyeball

A

Nystagmus

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32
Q

What’s the movement of eyeball in horizontal nystagmus?

A

Movement of eyeball is side to side

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33
Q

Goal of Care of Meniere’s Disease

A
  1. To treat symptoms during acute attacks
  2. To control recurrence through prophylactic interventions
34
Q

Management of Acute Attacks

A
  1. Diazepam
  2. Corticosteroids IM
  3. IV fluids
35
Q

Used for vestibular suppressant and for its antinausea effects

A

Diazepam (Valium) IV/IM

36
Q

Used for its anti-inflammatory effects

A

Corticosteroids IM

37
Q

Shifted to PO for dose tapering

A

Corticosteroids IM

38
Q

To prevent dehydration and electrolyte imbalances from N&V

A

IV Fluids

39
Q

Safety Alert During Acute Attacks

A

Patient is at HIGH RISK FOR FALLS during ACUTE ATTACKS

40
Q

First line drug of Acute Attacks

A

Diazepam

41
Q

Medical Management During Quiscent Phase

A

-Salt restricted (usually 1.5 grams/day)
-Avoid triggers substances
(Caffeine, nicotine, chocolate, tobacco, red wine and beer, high-cholesterol foods, high-carbohydrate foods)
-Diuretics, as ordered

42
Q

Prevents build-up of inner ear fluid

A

Salt- restricted

43
Q

Food that are high in sodium content

A

Smoked, processed, preserved

44
Q

Used only to prevent attacks

A

Diuretics

45
Q

Diuretics

A

-Hydrochlorothiazide with Triamterene (Dyazide)
-Furosemide

46
Q

Need to watch out for in Hydrochlorothiazide with Triamterene (Dyazide)

A

Hypotension and Hyperkalemia

47
Q

Need to watch out for in Furosemide

A

Ototoxicity

48
Q

A very important interventions

A

Salt-restricted Diet

49
Q

First- line surgical treatment

A

Endolymphatic Sac Decompression

50
Q

Equalizes the pressure in the endolymphatic space by removing some of the mastoid tone

A

Endolymphatic Sac Decompression

51
Q

Incision of Endolymphatic Sac Decompression

A

Post-auricular

52
Q

Mastoid Shunting of Endolymphatic Sac Decompression

A

A shunt or drain is inserted in the endolymphatic sac to allow drainage of fluid into the subarachnoid space

53
Q

The success rate in Endolymphatic Sac Decompression

A

Success rate (in terms of controlling vertigo and stabilizing the hearing acuity) is 60% to 80%

54
Q

Surgical Management of Meniere’s Disease

A

-Endolymphatic Sac Decompression
- Decompression Procedure
- Shunting Procedure
-Vastibular Nerve Suctioning
- Labyrinthectomy
-Intra-tympanic Aminoglycoside Therapy

55
Q

Landmarks for the endolymphatic sac are identified

A

Decompression Procedure

56
Q

A small portion of mastoid bone over the sac is removed

A

Decompression Procedure

57
Q

Shunt is placed on the sac which drains into the subarachnoid space

A

Shunting Procedures

58
Q

Used as the ultimate solution for patients with useful hearing in the affected ear

A

Vestibular Nerve Suctioning

59
Q

Vestibular branch of CN VII is cut

A

Vestibular Nerve Suctioning

60
Q

Cutting the nerve prevents the brain from receiving input from the semicircular

A

Vestibular Nerve Suctioning

61
Q

Has 98% success rate in eliminating vertigo

A

Vestibular Nerve Suctioning

62
Q

Recommended if pt cannot tolerate vertigo

A

Vestibular Nerve Suctioning

63
Q

Involves ablation of the diseased inner ear organs

A

Labyrinthectomy

64
Q

Useful for patients whose hearing is already damaged by Meniere

A

Labyrinthectomy

65
Q

Uses either a transcanal or tansmastoid approach

A

Labyrinthectomy

66
Q

Rationale of using either a transcanal or transmastoid approach

A

Low risk for CSF leak and meningitis

67
Q

Has >95% cure rate

A

Labyrinthectomy

68
Q

Essential Post-Operative Care for Labyrinthectomy

A

-Position: Low fowlers position when lying down x at least 2 weeks
- Maintain pressure dressing x 24 hours, sutures are removed on surgical day 7
- Operated ear should not be exposed to water until complete healing
- Facilitate walker use post-op to facilitate ambulation and independence
- Laxatives, as ordered - To prevent straining stool

69
Q

Appropriate Position when Lying down in patients undergoing Post-Operative for Labyrinthectomy

A

Low-Fowlers Position when lying down x 2 weeks

70
Q

How many days does the suture need to remove?

A

Day 7

71
Q

Hours to maintain pressure dressing

A

24 hours

72
Q

Are toxic to the vestibular hair cells

A

Aminoglycosides (Gentamycin)

73
Q

Intra-Tympanic Aminoglycoside Therapy

A

-Aminoglycoside (Gentamycin) are preferentially toxic to the vestibular hair cells
-Destruction of the vestibular hair cells renders the brain insensitive to fluctuations in inner ear pressure brought on by Meniere Disease

74
Q

Reserve for end-stage intractable cases

A

Intra-tympanic Aminoglycoside Therapy

75
Q

Has useful effects on aural fullness and tinnitus of patients as well.

A

One-shot low dosage of Gentamycin

76
Q

Was effective in controlling vertigo attacks in Meniere Disease

A

One-Shot Low Dosage of Gentamycin

77
Q

These tests only have adjunctive role for monitoring therapeutic responses in intratympanic gentamycin-therapy

A

Postural and vestibular tests

78
Q

Facilitates recalibration of a patient’s balance

A

Vestibular Rehabilitation

79
Q

This should not be used as primary treatment cause it may be risk for injury

A

Vestibular Rehabilitation

80
Q

Strongly recommended for patient S/P Vestibular Nerve Resection, Labyrinthectomy, and Intratympanic Aminoglycoside Therapy

A

Vestibular Rehabilitation

MS 2 (27 decks)

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