Menieres disease Flashcards
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
4 - 13 per 100,000 person
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?
- women
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?
- older adults
Typically 40-50 years old
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?
- endolymph
Endolymph = inside membranous labyrinths
Perilymph = bony labyrinth
Causes increased pressure, affecting sensory signals
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
4 - facial muscle weakness
Vertigo is typically the prominent symptom
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
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
Vertigo is a common symptom of Menieres disease. Is vertigo constant?
Vertigo is the sensation of moving when you are not (medical definition)
- 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
Vertigo is a common symptom of Menieres disease. Is vertigo triggered by movement and postural changes in Menieres disease?
- no
Good for distinguishing this from other conditions
Hearing loss is a common symptom of Menieres disease. Is this a sensorineural or conductive hearing loss?
- sensorineural hearing loss
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%
3 - 50%
Typically occurs in first 3 years of presentation
Dizziness improves, but hearing loss worsens over time called ‘Burn Out’
Hearing loss and tinnitus are common symptoms of Menieres disease. Is the hearing loss always present?
- no
Initially fluctuates with vertigo symptoms, but becomes permanent in chronic disease
In Menieres disease is this a clinical or diagnostic test diagnosis?
- Typically a clinical diagnosis based on the triad of tinnitus, vertigo and hearing loss
Audiology will be performed to assess hearing loss
Are patients with Menieres disease ok to drive if they have symptoms?
- no
Must inform the DVLA and cease driving until satisfactory control of symptoms is achieved
Which 2 diets have been linked with improving Menieres disease?
1 - vegan
2 - high protein
3 - low caffeine
4 - low salt
3 - low caffeine
4 - low salt
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
1 - metoclopramide
All others are H1 receptor blockers
Patients with acute attacks of Menieres disease can be treated with which of the following?
1 - Haloperidol
2 - Chlorpromazine,
3 - Prochlorperazine
4 - Olanzapine,
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.
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
4 - Betahistine dihydrochloride
H1-receptors and antagonist
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
1 - bendroflumethiazide
Less fluid reduces the risk of endolymph build up
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
4 - Transtympanic gentamicin
This can be ototoxic
Transtympanic steroids - steroids injected through the tympanic membrane reducing inflammation of the inner ear
Is Menieres diseases always permanent?
- No
Typically resolves after 5-10 years, BUT most patients will have some form of hearing loss and psychological distress
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 able to maintain a fixed gaze, without a corrective saccade, is this a central or peripheral problem?
- central
- indicates that the vestibulocochlear nerve is NOT damaged
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?
- peripheral
Suggests that there is an issue with vestibulocochlear
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?
- unilateral only
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
4 - all of the above
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?
- peripheral
Indicates vestibulocochlear issue
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?
- central cause
bidirectional nystagmus, is highly specific for stroke
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?
- peripheral
Most likely vestibular neuritis and patient can be discharged
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?
- central
More serious issue and needs more investigations
