Meniere's Disease Flashcards
Definition
Condition of inner ear = clinical syndrome
- vertigo
- fluctuating hearing loss
- tinnitus
- associated with feeling of fullness in the affected ear
Epidemiology
- 20-60
- Caucasian
- FHx
- Migraines
- Autoimmune disease: SLE, RA, Ankylosing spondylitis
- Head trauma
- Viral infection
Clinical features
- Vertigo - may be accompanied by N+V
- Tinnitus
- Fluctuating hearing loss
- Aural fullness: pressure in ears
- Unsteadiness on feet: persistent for several days after acute attack of vertigo
- Nystagmus: unidirectional, horizontal-torsional nystagmus
- Postive Romberg’s test
How do symptoms present?
Acute attacks result in symptoms that are present for at least 20 minutes , but typically last a few hours (no more than 24 hours).Attacks can occur in clusters over a few weeks, although months or years of remission can also occur.
Diagnosis
Clinical diagnosis
GOLD STANDARD: Meet Criteria
- Vertigo = lasts 20 mins to 12 hours
- Fluctuating hearing, tinnitus +/- perception of aural fullness in affected ear
- Hearing loss = sensorineural hearing loss on audiometry
- Not accounted for by alternative vestibular diagnosis
Consider:
- Otoscopy
- Pure-tone audiometry
- MRI head
- Lyme disease serology
- Syphilis serology
Treatment Acute
Severe, acute attacks: Prochlorperazine
= D2-receptor antagonist used to rapidly relieve nausea and vomiting in acute attacks, given either buccal or IM
Non-severe, acute attacks : consider a short course (e.g. 7 days) of the following to relieve nausea and vomiting
= Prochlorperazine
= Anti-histamine: e.g. cinnarizine, cyclizine or promethazine
Prophylaxis
Betahistine: considered to reduce the frequency and severity of attacks of hearing loss, tinnitus, and vertigo
Other treatment options
Counselling and relaxation therapy
Paitent must alert DVLA once diagnosed = DLVA will permit a licence again if Sx are in good control
Complications
Anxiety
Depression
Social impact
Falls
