Copy of Meniere Disease

7/25/2019 Copy of Meniere Disease

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MeniereMenieres Diseases Disease


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What is MeniereWhat is Menieress

Disease?Disease? In 1861 Prosper Meniere described aIn 1861 Prosper Meniere described asyndrome characterized by deafness,syndrome characterized by deafness,

tinnitus, and episodic vertigo !e "in#edtinnitus, and episodic vertigo !e "in#ed

this condition to a disorder of the innerthis condition to a disorder of the innerearear

In 1$%8 !a""pi#e and &airns described theIn 1$%8 !a""pi#e and &airns described the

under"ying patho"ogy of Meniereunder"ying patho"ogy of Meniere s diseases disease

as being endo"ymphatic hydrops but theas being endo"ymphatic hydrops but the

precise etio"ogy sti"" remains e"usiveprecise etio"ogy sti"" remains e"usive


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Normal membranous labyrinthDilated membranous labyrinthin Meniere's disease (Hydrops)


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'ge'ge DistributionDistributionandand

Incidence of the DiseaseIncidence of the Disease

Women(MenWomen(Men

In the US: 50% of patients have a positive family history.

The estimated prevalene is !50 ases per !00"000 population

#0$s and 50$s


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)ymptoms)ymptoms

Periodic episodesPeriodic episodes

of rotatory vertigoof rotatory vertigo

or dizzinessor dizziness

*"uctuating,*"uctuating,progressive, "o+progressive, "o+

fre-uency hearingfre-uency hearing

"oss"oss

.innitus.innitus

*u""ness/pressure*u""ness/pressure


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DiagnosisDiagnosis

The diagnosis of Meniere disease is madeThe diagnosis of Meniere disease is made

based on a careful history and physical exam.based on a careful history and physical exam.

If the work-up is normal and the classicIf the work-up is normal and the classic

symptoms continue, the diagnosis of Menieresymptoms continue, the diagnosis of Menieredisease is made.disease is made.


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!istory!istory

Most important part of the diagnosisMost important part of the diagnosis

Pattern of symptomsPattern of symptoms

ssociation between hearing loss, tinnitus,ssociation between hearing loss, tinnitus,and !ertigoand !ertigo


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Physica" 0aminationPhysica" 0amination

"xamination results !ary, depending upon the phase"xamination results !ary, depending upon the phaseof disease. #uring remission, physical examinationof disease. #uring remission, physical examinationfindings may be completely normal, particularly if thefindings may be completely normal, particularly if thepatient is symptom free.patient is symptom free.

#uring an acute attack, the patient has se!ere#uring an acute attack, the patient has se!ere

!ertigo.!ertigo. Patients are sometimes diaphoretic and pale.Patients are sometimes diaphoretic and pale. $ital signs may show ele!ated blood pressure, pulse,$ital signs may show ele!ated blood pressure, pulse,

and respirationand respiration..

%pontaneous nystagmus directed toward affected ear%pontaneous nystagmus directed toward affected earis typical during an acute attack.is typical during an acute attack.


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Physica" 0amination 2conPhysica" 0amination 2cont3t3

The &omberg test generally shows significant instabilityThe &omberg test generally shows significant instability

and worsening when the eyes are closed.and worsening when the eyes are closed.

The 'eber tuning fork test usually laterali(es away fromThe 'eber tuning fork test usually laterali(es away from

the affected ear.the affected ear.

The &inne test usually indicates that air conductionThe &inne test usually indicates that air conduction

remains better than bone conduction.remains better than bone conduction.

)omplete neurologic e!aluation is important. *ew-onset)omplete neurologic e!aluation is important. *ew-onset

!ertigo might be an early sign of stroke, migraine, or!ertigo might be an early sign of stroke, migraine, or

brainstem compression that may re+uire emergentbrainstem compression that may re+uire emergent

e!aluation and care.e!aluation and care.


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Imaging )tudiesImaging )tudies

Magnetic resonance imagingMagnetic resonance imaging

)T scans)T scans


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4ther tests4ther tests

AudiometryAudiometry Transtympanic electrocochleographyTranstympanic electrocochleography

"lectronystagmography"lectronystagmography


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.reatment.reatment

Medical therapy is both symptomaticMedical therapy is both symptomaticie, acute attacks and prophylactic.ie, acute attacks and prophylactic.

$estibulosuppressants eg, mecli(ine$estibulosuppressants eg, mecli(inedecrease symptoms, but generallydecrease symptoms, but generallyonly mask the !ertigo by decreasingonly mask the !ertigo by decreasingthe brains response to !estibularthe brains response to !estibular

input.input. #iuretic or diuretic-like medication#iuretic or diuretic-like medication


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.reatment.reatment &ont&ontdd

nti-inflammatory properties of steroidsnti-inflammatory properties of steroids

/ifestyle and dietary/ifestyle and dietary

#ia(epam#ia(epam


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.reatment.reatment &ont&ontdd

Surgical Care:Surgical Care:

0 %urgical therapy for M1ni2re disease is%urgical therapy for M1ni2re disease is

reser!ed for medical treatment failures and isreser!ed for medical treatment failures and is

otherwise contro!ersial.otherwise contro!ersial.

0 %urgical procedures are di!ided into 3 ma4or%urgical procedures are di!ided into 3 ma4or

classifications as follows5classifications as follows5

#estructi!e surgical procedures#estructi!e surgical procedures

*ondestructi!e surgical procedures*ondestructi!e surgical procedures


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PrognosisPrognosis

Prognosis is !ariable, since the disease patternPrognosis is !ariable, since the disease pattern

of exacerbation and remission makes e!aluationof exacerbation and remission makes e!aluation

of treatment and prognosis difficult to predict.of treatment and prognosis difficult to predict.

Copy of Meniere Disease

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