Ménière's disease (Vestibular disease)

Question 1

Background

Answer 1

A disorder of inner ear characterised by eps of vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness in the affected ear.
Its cause is unknown.
Can cause vertigo, tinnitus, hearing loss, and a feeling of pressure deep inside the ear.
Risk factors
- Family Hx of condition
- Chemical imbalance of fluid in inner ear

Question 2

Signs and Symptoms

Answer 2

Usually experience some or all symptoms during attack lasts 2-3hrs
- Takes a day or 2 for symptoms to completely disappear
Acute attacks mostly unilateral but can be BI

Symptoms:
- Vertigo and dizziness.
- Imbalance & spatial disorientation
- Vision disturbance.
- Hearing changes.
- Cognitive and/or psychological changes.
- Sensitivity to sound (hyperacusis) or distorted sound

Question 3

Diagnosis

Answer 3

NO specific tests usually based on clinical features.

Take history: sus if -
- Eps of vertigo attacks
- Tinnitus
- Hearing changes
- Fullness in ear

Examine person - Ear, Head, Neck
Rule out cerebrovascular event
Refer to ENT if sus of Meniere
- Manage symptoms whilst waiting

Question 4

Treatment

Answer 4

NON pharmacological
Balance training, relaxing techniques, other self care stuff

Pharmacological
Procholperazine/ANTIHISTAMINES - Severe use IV/IM

Treat N, V, Vertigo:
- Consider Short course (up to 7 days) of prochlorperazine or antihistamine (cinnarizine, cyclizine, or promethazine)
- IF had previous attacks and they responded to 1 of the above try that 1 1st.
Rapid relief with severe N, V:
- Consider Buccal prochlorperazine or Deep IM injection - prochlorperazine or cyclizine
- More severe require hospital
Symptoms dont improve on 5-7 days = reassess diagnosis

Recurrent attacks:
Consider trial of Betahistine (reduce the frequency and severity of attacks of hearing loss, tinnitus, and vertigo)
FAIL = REFER ENT

DOSES: (Extra info)
Betahistine 16mg TDS with food - maintenance 24-28mg/day
Oral cinnarizine - 30mg TDS
Oral cyclizine 50mg up to TDS
IM Cyclizine 50mg up to TDS
Oral Prochlorperazine 5mg TDS - can go to 30mg but after few week reduce to 5-10mg.
Buccal Prochlorperazine 3-6mg BD
IM Prochlorperazine 12.5mg then oral after 6 hours
Oral Promethazine 25mg ON MAX 100mg