1. 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.

2. 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

3. Pathology:
Endolymphatic Sac / Stria Vascularis/ Longitudinal flow

4. 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

5. 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.

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

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

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

9. 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

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

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

12. 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

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

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

15. 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.

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

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

18. Variants of Meniers disease
Cochlear hydrop, Vestibular hydrop

19. 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

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

21. 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

22. Patient with intractable Vertigo and no hearing
Labrynthectomy

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

24. 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.

25. /