Meniere Disease Flashcards
What is Meniere 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
Do endolymphatic hydrops explain all clinical features of Meniere?
- No
- EX: progressive HL, frequency of vertigo crisis
What are the clinical manifestations of Meniere?
- Episodic, spontaneous vertigo (usually accompanied by fluctuating SNHL, tinnitus, and AF)
- Cochlear symptoms may occur between episodes of vertigo
- Vertigo crises are more frequent during early years of disease
Why is it difficult establishing an accurate phenotype for Meniere?
- HL and vestibular hypofunction vary greatly among patients
- Nosologic confusion: easily confused with other conditions
What is the diagnostic criteria for Meniere Disease?
- 2+ episodes of spontaneous vertigo lasting between 20 min and 12 hours
- LF SNHL in one ear, defined at least one occasion before, during, or after one of the episodes of vertigo
- Fluctuating hearing symptoms (HL, T, AF) in the 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
Are dizziness/instability Dx criteria for MD?
- No
- But patients can describe dizziness and long-term instability
What are some triggers for patients’ MD?
- Dietary: caffeine, sodium
- Sound: Tullio phenomenon
- Pressure: Hennebert symptom/sign
- These episodes usually occur much later in the disease processes
- Possibly as a result of advanced hydrops that bring the membranous labyrinth closer to the stapes footplate
Describe duration of the vertiginous episodes.
- 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
- Duration can be challenging to quantify because residual symptoms can remain after the crisis
How do you determine the affected ear with MD?
- Thresholds shift to at least 35 dB HL at 2 consecutive frequencies below 2 kHz
- Or 30 dB shift compared to contralateral ear
- SNHL
- Bilateral is possible but less common (autoimmune inner ear disease should be considered)
Is slowly progressive HL indicative of MD?
- No
- Should consider the possibility of it being independent of vestibular symptoms
- EX: migraine, DNFA6/14
Do SNHL and vertigo have to occur at the same time?
- No
- SNHL may precede the onset of vertigo by months or years
- Recurrent vertigo may occur before the SNHL in weeks or months, but T or AF are usually associated with the first episode of vertigo
Could there be a temporal association between hearing symptoms and vertigo?
- Yes
- Including, SNHL fluctuations, T, and AF
When is MD considered LIKELY?
- 2+ episodes of vertigo/dizziness lasting between 20 min and 24 hours each
- Fluctuating hearing symptoms (SNHL, T, AF) in the affected ear
- No other diagnosis better explains the vestibular symptoms
What are some conditions that may present like MD?
- Autoimmune inner ear disease
- Stroke
- Cogan syndrome
- CPA mass
- Susac syndrome
- 3rd window syndromes
- Vestibular schwannoma
