Meniers Disease Periodic episodes of rotary vertigo or dizziness. Fluctuating, progressive, unilateral (in one ear) or bilateral (in both ears) hearing loss, usually in lower frequencies.[4] Unilateral or bilateral tinnitus. A sensation of fullness or pressure in one or both ears.

1938 Hallpike described the pathology Hydrous.etiology still obscure Prosper Ménière Born June 18, 1799 Angers, France Died February 7, 1862 (aged 62) Nationality France Known for Ménière's disease 1938 Hallpike described the pathology Hydrous.etiology still obscure

Pathology: Endolymphatic Sac / Stria Vascularis/ Longitudinal flow

Anatomical-abnormalities Genetic-autosomal dominant Immunological-immune complex deposition Viral-serum IgE to herpes simples virus types I and II, Epstein- Barr virus and CMV Vascular-associated with migraines Metabolic-potassium intoxication

Clinical Features: 1/Vertigo episodic, duration >20minutes, <12 hours, clusters of vertigo and then remissions frequency of vertigo other symptoms of vagal disturbance warning of impeding attack fullness in ear and change in character of tinitus.

Contd 2/ Hearing Loss. SN hearing loss, lower frequencies. fluctuating ,may be normal in remissions? 3/Diplacusis, distortion of sound . tuning fork pitch

Contd 4/Hyperacusis. intolerance to loud sounds 5/ Tinnitus. low pitch 6/ fullness in ears

Diagnosis: The diagnosis of Meniere disease is made based on a careful history and physical exam.

Examination{this is how I examine patient with giddy spells or vertigo. Ear:RT/Lt> Normal Eyes, Nystagmus in Acute attack towards the unaffected ear WRONG WAY, +eye movements+Corneal reflex Tuning fork test, And diplacusis

examine all cranial nerves Finger nose test Unterberger test Hallpike test (BPPV)

Investigations Pure tone audiometry Imaging: MRI to Exclude CP angle leision

Investigation not done routinely 1/ Electrochochleography:Its measurement of electrical output of the cochlea and 8th nerve in response to an auditory stimulus. a/ cochlear microphonics; wave form,deflection up and down,sourse is hair cells. inference; if CM present hair cells of cochlea intact

Cont.. Summating potentials, basilar membrane and outer hair cells? Action potential 8th nerve

In Meniers disease there is negative summating potential and SP to AP ratio is >30% (n 20%)

Caloric test:irrigation of ear with warm and cold water(70degree above and below body temp) and duration of nystagmus noted . Direction of nystagmus (COWS) temperature gradiend across scc and movement of endolymph.

In Meniers disease: canal paresis or reduced response on the affected side or directional preponderance.

Glycerol test; diagnostic Glycerol 1.5ml/kg orally hrs after ingestion ,PTA will show 10db improvement in hearing in adjacent frequencies.

Variants of Meniers disease Cochlear hydrop, Vestibular hydrop

Acute attack. 1/ Admit 2/ Vestibular Sedatives Treatment Acute attack. 1/ Admit 2/ Vestibular Sedatives 3/ Vasodilators Carbogen 5% co2 with 95% O2 Histamine drip 2.75mg in 500ml glucose i/v slowly(rarely used because of cardiac complications

Treatment when Acute phase is over: Betahistine(serc)16mg tds Diureic

Surgery: 1/ Preserving Hearing Decompression Endolympatic sac Grommet insertion vestibular Nerve section Outcome of Retro-labyrinthine Vestibular Nerve Section Surgery (Original Article), Javed I. Shah & Gerald B. Brookes, Journal of Medical Sciences, Vol. 13, No. 2 Jul 2005

Patient with intractable Vertigo and no hearing Labrynthectomy

Differential diagnosis central causes of vertigo infections spreading from middle ear BPPV, Sudden vestibular failure Acoustic Neuroma

Question: 30 yrs. old lady with acute giddy spells lasting more than 20minutes with nausea and sickness,fluctuating hearing loss, low pitch tinnitus and fullness in ear, whats diagnosis Name investigations Describe Medical Treatment.

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