Lecture 8- Meniere Disease Flashcards Preview

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What is Meneiere Disease?

Multifactorial disorder probably initiated by a combination of genetic and environmental factors

Associated with accumulation of endolymph in the cochlear duct and vestibular organs


What is Meneiere Disease characterized by?

- Episodic, spontaneous vertigo, usually accompanied by fluctuating SNHL, tinnitus, and aural fullness
- Cochlear symptoms may occur between episodes of vertigo
- Vertigo crises are more frequent during early ears of disease


What are the diagnostic criteria for Meneiere Disease?

- 2 or more episodes of spontaneous vertigo lasting between 20 minutes and 12 hours
- Low frequency SNHL in 1 ear, defined at least one occasion before, during, or after one of the episodes of vertigo
- Fluctuating hearing symptoms (HL, tinnitus, aural fullness) in affected ear
- There is no other diagnosis that better explains the vestibular symptoms


What is vertigo?

Sensation of movement in the absence of movement, or an altered sensation of movement during normal movement of the head


What are some triggers for vertigo attacks?

Dietary: caffeine, sodium

Sound: Tullio phenomenon

Pressure: Hennebert symptom/sign


What is a vertiginous episode?

Defined by the time the patient has to be immobile and cannot move

- Can be <20 minutes or >12 hours, but these are not common findings; other vestibular disorders should be considered


How is the affected ear determined?

Thresholds shift to at least 35 dB HL at 2 consecutive frequencies below 2 kHz (or 30 dB shift compared to contralateral ear)


Do SNHL and vertigo have to occur at the same time?


- SNHL may precede the onset of vertigo by months or years

- Recurrent vertigo may occur before the SNHL in weeks or months, but tinnitus or aural fullness are usually associated with the first episode of vertigo


When is Meniere Disease considered likely?

- 2 or more episodes of vertigo or dizziness, lasting between 20 minutes and 24 hours each
- Fluctuating hearing symptoms (SNHL, tinnitus, or aural fullness) in the affected ear
- There is no other diagnosis that better explains vestibular symptoms


What is the differential diagnosis for Meniere Disease?

- DFNA9, COCH mutation
- Autoimmune inner ear disease
- Stroke
- Cogan syndrome
- CPA mass
- Susac syndrome
- Infectious causes (e.g., otosyphilis)
- 3rd window syndromes
- Vestibular migraine
- Vestibular schwannoma
- Vogt-Koyanagi-Harada syndrome


When should Familial Meniere Disease be considered?

- At least one first or second relative has definitive or probably Meniere
- May occur in 8-9% of cases of MD in European populations, but has been described in nearly all ethnic groups
- Typically fits AD inheritance, although mitochondrial recessive has been described