Menieres disease

Question 1

Menieres This is a disorder of the inner ear caused by a change in fluid volume in the labyrinth. What is the incidence of this?

1 - 13,000 per 100,000 person
2 - 1300 per 100,000 person
3 - 130 per 100,000 person
4 - 13 per 100,000 person

Answer 1

4 - 13 per 100,000 person

Question 2

Menieres disease is a disorder of the inner ear caused by a change in fluid volume in the labyrinth. Is this more common in men or women?

Answer 2

• women

Question 3

Menieres disease is a disorder of the inner ear caused by a change in fluid volume in the labyrinth. It can affect any age, but is it more common in young children or older adults?

Answer 3

• older adults

Typically 40-50 years old

Question 4

Menieres disease is a disorder of the inner ear caused by a change in fluid volume in the labyrinth. This is due to a build of fluid, is this perilymph or endolymph?

Answer 4

• endolymph

Endolymph = inside membranous labyrinths
Perilymph = bony labyrinth

Causes increased pressure, affecting sensory signals

Question 5

Menieres is characterised by a triad, which of the following is NOT part of this triad?

1 - hearing loss
2 - tinnitus
3 - vertigo
4 - facial muscle weakness

Answer 5

4 - facial muscle weakness

Vertigo is typically the prominent symptom

Question 6

The classical triad of Menieres is hearing loss, tinnitus and vertigo. But all of the following can also occur, but which is least likely to occur?

1 - sensation of aural fullness or increased pressure
2 - nystagmus
3 - positive Romberg test
4 - bilateral symptoms
5 - increased falls

Answer 6

4 - bilateral symptoms

Typically symptoms are unilateral, but long term disease can result in bilateral disease

Nystagmus typically occurs during vertigo attacks and is only in one direction

Question 7

Vertigo is a common symptom of Menieres disease. Is vertigo constant?

Vertigo is the sensation of moving when you are not (medical definition)

Answer 7

• no

Typically occurs in episodes of 20 mins up to hours.

Can come in clusters and then have none for months, but the more attacks can lead to hair damage and subsequent hearing loss

Question 8

Vertigo is a common symptom of Menieres disease. Is vertigo triggered by movement and postural changes in Menieres disease?

Answer 8

• no

Good for distinguishing this from other conditions

Question 9

Hearing loss is a common symptom of Menieres disease. Is this a sensorineural or conductive hearing loss?

Answer 9

• sensorineural hearing loss

Question 10

Sensorineural hearing loss is a common symptom of Menieres disease, which fluctuates mainly affecting low frequencies. However, hearing loss can progress to bilateral, but what % of patients experience this?

1 - 5%
2 - 25%
3 - 50%
4 - 75%

Answer 10

3 - 50%
Typically occurs in first 3 years of presentation

Dizziness improves, but hearing loss worsens over time called ‘Burn Out’

Question 11

Hearing loss and tinnitus are common symptoms of Menieres disease. Is the hearing loss always present?

Answer 11

• no

Initially fluctuates with vertigo symptoms, but becomes permanent in chronic disease

Question 12

In Menieres disease is this a clinical or diagnostic test diagnosis?

Answer 12

• Typically a clinical diagnosis based on the triad of tinnitus, vertigo and hearing loss

Audiology will be performed to assess hearing loss

Question 13

Are patients with Menieres disease ok to drive if they have symptoms?

Answer 13

• no

Must inform the DVLA and cease driving until satisfactory control of symptoms is achieved

Question 14

Which 2 diets have been linked with improving Menieres disease?

1 - vegan
2 - high protein
3 - low caffeine
4 - low salt

Answer 14

3 - low caffeine
4 - low salt

Question 15

Patients with acute attacks of Menieres disease can be treated with all of the following, EXCEPT which one?

1 - metoclopramide
2 - cyclizine
3 - cinnarizine
4 - promethazine

Answer 15

1 - metoclopramide

All others are H1 receptor blockers

Question 16

Patients with acute attacks of Menieres disease can be treated with which of the following?

1 - Haloperidol
2 - Chlorpromazine,
3 - Prochlorperazine
4 - Olanzapine,

Answer 16

3 - Prochlorperazine

Prescribes for 7 days only

This is a vestibular depressant, depressing the chemoreceptor trigger zone and blocking D2 dopamine receptors in the brain.

Question 17

Patients with Menieres disease can be treated prophylactically to reduce symptoms using which of the following?

1 - Metoclopramide
2 - Haloperidol
3 - Cyclizine
4 - Betahistine dihydrochloride

Answer 17

4 - Betahistine dihydrochloride

H1-receptors and antagonist

Question 18

Patients with Menieres disease can be treated prophylactically to reduce symptoms using an antiemetic called betahistine dihydrochloride. Which of the following can also be useful in reducing fluid retention?
of the following?

1 - bendroflumethiazide
2 - glyceryl trinitrate
3 - flecainide
4 - furosemide

Answer 18

1 - bendroflumethiazide

Less fluid reduces the risk of endolymph build up

Question 19

Menieres disease can be treated with surgical approaches. Which of the following has the highest risk of hearing loss following its use?

1 - Transtympanic steroids
2 - Vestibular nerve section
3 - Endolymphatic sac decompression
4 - Transtympanic gentamicin

Answer 19

4 - Transtympanic gentamicin
This can be ototoxic

Transtympanic steroids - steroids injected through the tympanic membrane reducing inflammation of the inner ear

Question 20

Is Menieres diseases always permanent?

Answer 20

• No

Typically resolves after 5-10 years, BUT most patients will have some form of hearing loss and psychological distress

Question 21

The head impulse, nystagmus and test of skew (HINTS) is used to distinguish between a central or peripheral cause of ongoing vertigo. The 1st test is the head impulse test (HIT):

1 - patient fixes their eyes on your nose 2 - head is rapidly rotated 30 degrees to left and then back to midlife
3 - patient either maintains gaze on nose or fails to do so.
4 - repeat and rotate head to right

If they are unable to maintain a fixed gaze, this is called a corrective saccade. If the patient is able to maintain their gaze on your nose is this a central or peripheral problem?

Answer 21

• central
• indicates that the vestibulocochlear nerve is NOT damaged

Question 22

The head impulse, nystagmus and test of skew (HINTS) is used to distinguish between a central or peripheral cause of ongoing vertigo. The 1st test is the head impulse test (HIT):

1 - patient fixes their eyes on your nose 2 - head is rapidly rotated 30 degrees to left and then back to midlife
3 - patient either maintains gaze on nose or fails to do so.
4 - repeat and rotate head to right

If they are unable to maintain a fixed gaze, this is called a corrective saccade. Is this a central or peripheral problem?

Answer 22

• peripheral

Suggests that there is an issue with vestibulocochlear

Question 23

The 1st part of head impulse, nystagmus and test of skew (HINTS) is the head impulse test (HIT). If the patient is unable to maintain a fixed gaze, this is called a corrective saccade. suggesting a peripheral problem. Does this occur in both directions or just one?

Answer 23

• unilateral only

Question 24

The nystagmus test is the 2nd part of the head impulse, nystagmus and test of skew (HINTS). Which of the following are true about the nystagmus aspect of the HINTS examination?

1 - unidirectional nystagmus is more likely to be of peripheral origin
2 - change in nystagmus direction is likely to be associated with central pathologies
3 - bidirectional nystagmus, is highly specific for stroke
4 - all of the above

Answer 24

4 - all of the above

Question 25

The nystagmus test is the 2nd part of the head impulse, nystagmus and test of skew (HINTS). If a patient has a unidirectional nystagmus, and its always in the same direction, is this due to a peripheral or central cause?

Answer 25

• peripheral

Indicates vestibulocochlear issue

Question 26

The nystagmus test is the 2nd part of the head impulse, nystagmus and test of skew (HINTS). If a patient has a bidirectional or vertical nystagmus, and its always in the same direction, is this due to a peripheral or central cause?

Answer 26

• central cause

bidirectional nystagmus, is highly specific for stroke

Question 27

If you perform the 3 parts of the head impulse, nystagmus and test of skew (HINTS) exam and have the following:

1st part = corrective saccade
2nd part = unidirectional nystagmus
3rd part = normal test of skew

Is this a central or peripheral issue?

Answer 27

• peripheral

Most likely vestibular neuritis and patient can be discharged

Question 28

If you perform the 3 parts of the head impulse, nystagmus and test of skew (HINTS) exam and have the following:

1st part = normal reflex
2nd part = vertical/bidirectional nystagmus
3rd part = abnormal test of skew

Is this a central or peripheral issue?

Answer 28

• central

More serious issue and needs more investigations