Menieres Disease

Question 1

Misperceptions or illusion of motion of the person or the surroundings
• spinning sensation
• objects moving around them

Answer 1

Vertigo

Question 2

Involuntary rhythmic movement of the eyes

• watches rapidly logging object

Answer 2

Nystagmus

Question 3

Disturbance of equilibrium caused by constant motion

Answer 3

Motion sickness

Question 4

• sweating
• pallor
• nausea/vomiting  caused by vestibular over stimulation 
- Dramamine 
- meclizine 
- scopolamine patches

Answer 4

Motion sickness

Question 5

• An abnormal inner ear fluid balance cause by a malabsorption in the endolymphatic sac.
• Endolymphatic hydrops – dilation in the endolymphatic space develops
• Either increased pressure in the system or rupture of the inner ear membrane occurs
• Can be related to high sodium intake or excessive ETOH use

Answer 5

Ménière’s disease

Question 6

Fluctuating progressive hearing loss
• Tinnitus or a roaring sound
• Feeling of pressure or fullness in the ear
• Episodic, incapacitating vertigo accompanied by dizziness, nausea or vomiting
• Associated with aural pressure but no cochlear symptoms
• Examination is normal except for cranial nerve VIII
• “Pike’s Peak” pattern
• As the disease progresses, hearing loss increases
• Electronystagmogram (ENG) (measures involuntary rapid eye movements called nystagmus and evaluates the muscles controlling eye movements) may be norma

Answer 6

S&S Ménière’s disease

Question 7

Recognized as a fluctuating progressive sensorineural hearing loss associated with tinnitus and aural pressure in the absence of vestibular Symptoms

Answer 7

Cochlear Ménière’s

Question 8

Episodic vertigo associated with auroral pressure but no cochlear symptoms

Answer 8

Vestibular Ménière’s

Question 9

• Antihistamines such as Antivert, which suppress the vestibular system
• Lower sodium in diet to less than 2,000 mg/day & diuretics
• No ETOH
• Anxiety treatment
• Valium to help with vertigo
• Antiemetics (Phernergan) help the nausea and vomiting
• Diuretic therapy to help with water/sodium retention
• Take potassium because of diuretic
• Surgeries:
o Endolymphatic Sac Decompression
o Middle and Inner Ear Perfusion
o Introtologic Catheters
o Vestibular Nerve Section

Answer 9

Treatment of Ménière’s disease

Question 10

Looks like mountain or hill

• sensorineural loss in the low frequencies as the disease progresses

Answer 10

Pikes peak

Question 11

Physical examination findings are usually normal with the exception of those if cranial nerve VIII
• sounds from turning fork ( Weber test) may laterize to the ear opposite the hearing loss, the one affected with Ménière’s disease

Answer 11

Assessment of Ménière’s

Question 12

Sac decompression or shunting
• shunt or drain inserted through postauricular incision
• first line surgical approach
• outpatient

Answer 12

Endolymphatic sac decompression

Question 13

Provides greatest success in eliminating attacks of vertigo.

Answer 13

Vestibular nerve suctioning

Question 14

Inflammation of inner ear
• sudden onset of nausea, vomiting, degrees of hearing loss, possibly tinnitus
• bacterial IV Antibiotics
• meclizine

Answer 14

Labyrinthitis

Question 15

Keeps inner ear fluid at constant level

Answer 15

Endolymphatic sac

Question 16

• Slow growing benign tumor of cranial nerve VIII, usually arising from the Schwann cells of the vestibular portion of the nerve.
• S/S – unilateral tinnitus and hearing loss with or without vertigo or balance disturbance
• MRI with a paramagnetic contrast agent is the imaging study of choice.
• Surgical removal of acoustic tumors is the treatment of choice because these tumors do not respond well to radiation or chemotherap

Answer 16

Acoustic Neuroma

Question 17

• Surgical removal of acoustic tumors is the treatment of choice because these tumors do not respond well to radiation or chemotherapy
• try to preserve facial nerves
• translabyrinthine approach

Answer 17

Management of Acoustic tumor

Question 18

Risks – facial nerve paralysis, cerebrospinal fluid leak, meningitis and cerebral edema

Answer 18

Risk of acoustic tumor

Question 19

Altered sensation of orientation of space

Answer 19

Dizziness