Mernier's disease

Question 1

disease vs syndrome

Answer 1

disease = idopathic
syndrome = known cause

Question 2

what is it + symptoms

Answer 2

rare disorder that affects inner ear
can affect balance and hearing
can cause vertigo (spinning sensation), losing balance, feeling sick, tinnitus (ringing ears), hearing loss, feeling or pressure in ear

Question 3

what is vertigo

Answer 3

spinning sensation

Question 4

complications

Answer 4

falls
adverse psychosocial and social impacts

Question 5

if pt is suspected of having it, what to do

Answer 5

refer to ENT specialist to confirm diagnosis

Question 6

cure?

Answer 6

no

Question 7

advice people who have frequent, sudden attacks to

Answer 7

keep meds readily accessible and to consider risk before starting potentially dangerous activities e.g. driving, swimming, operating machinery

Question 8

to help alleviate n, v, vertigo in pt with acute Mernier’s disease a short course of this can be considered

Answer 8

prochlorperazine or antihistamine

Question 9

what to do if severe symptoms

Answer 9

pt may require hospital admission for IV labyrinthine sedatives and fluids to maintain hydration and nutrition

Question 10

4 drugs used to alleviate n/v and vertigo in acute attacks

Answer 10

Antihistamines : cinnarizine, cyclizine, promethazine teoclate
Phenothiazines: prochlorperazine

Question 11

drugs used to rapidly relieve n/v in severe acute attacks

Answer 11

Buccal prochlorperazine
Deep IM injection of prochlorperazine or cyclizine

Question 12

betahistine is an analogue of

Answer 12

histamine

Question 13

use of betahistine + dose

Answer 13

Can be trialled to reduce freq and severity of hearing loss, tinnitus and vertigo in pt with recurrent attacks
Dose, adult, PO: initially 16mg TDS, dose pref taken with food
Maintenance dose 24-48mg daily

Question 14

contraindications and cautions for betahistine

Answer 14

Contradicted in phaeochromocytoma
Cautions: asthma, history of peptic ulcer

Question 15

common SE betahistine

Answer 15

GI discomfort.
Headache
Nausea

Question 16

self care advice for Mernier’s disease

• how long do acute attacks of vertigo last for
• what to do if no improvement

Answer 16

Although long term condition, vertigo usually significantly improves with treatment
Acute attack vertigo will normally settle within 24h in most people
If no improvement after 5-7 days, or deterioration in symptoms, exclude alternative diagnoses

Question 17

Driving in people who experience sudden attacks or vertigo

Answer 17

people with liability to sudden and unprovoked or unprecipitated episodes of disabling dizziness should stop driving and inform DVLA

Question 18

preventing recurrent attacks

Answer 18

Consider prescribing trial of betahistine to reduce freq and severity of attacks or hearing loss, tinnitus and vertigo
If betahistine does not provide clinical benefit required and there are recurrent attacks of Meniere’s disease despite its use, refer to ENT specialist

Question 19

symtomatic treatment depends on type and severity of symptoms experienced. to alleviate n/v, vertigo:

Answer 19

Short course (up to 7 days) prochlorperazine or antihistamine (e..g cinnarizine, cyclizine, promethazine teoclate)
If the pt has had previous attacks of Menier’s disease and responded well to one of these treatment, consider trying that one 1st line

Question 20

If rapid relieve required in pt with severe n/v consider the following

Answer 20

Consider buccal prochlorperazine or a deep IM injection of prochlorperazine or cyclizine
If symptoms severe, hospital admission may be required for IV labyrinthine sedatives and fluids to maintain hydration and nutrition