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MENIERE'S DISEASE Flashcards

(80 cards)

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1
Q

Idiopathic Endolymphatic Hydrops

A

Meniere’s Disease

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2
Q

is a condition of increased hydrostatic pressure within the inner ear endolymphatic system

A

Endolymphatic hydrops

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3
Q

involves fluid that is contain in our inner ear

A

Endolymphatic hydrops

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4
Q

It pertains to water

A

Hydrostatic Pressure

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5
Q

Pertaining to inner ear

A

Labyrinth

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6
Q

Protective layer of all the inner ear structure

A

Bony Labyrinth

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7
Q

Contains a fluid perilymph

A

Perilymphatic Space

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8
Q

Contains more potassium

A

Perilymph

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9
Q

Contains less potassium

A

Endolymph

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10
Q

What are the 2 lymphatic fluids of the inner ear

A
  1. Perilymph
  2. Endolymph
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11
Q

Fluid inside the bony labyrinth

A

Perilymph

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12
Q

Fluid inside the membranous labyrinth

A

Endolymph

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13
Q

A form of endolymphatic hydrops of unknown etiology

A

Meniere Disease

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14
Q

A form of endolymphatic hydrops occurring secondary to abnormalities in endolymph production and absorption

A

Meniere Syndrome

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15
Q

Exact Cause of Meniere Disease

A

Unknown

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16
Q

Where does the Endolymphatic Fluid accumulates?

A

Endolymphatic fluid accumulates within the endolymphatic space

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17
Q

Pathophysiology of Meniere’s Disease

A
  1. Endolymphatic fluid accumulates within the endolymphatic space
  2. Dilatation of endolymphatic space (Endolymphatic Hydrops)
  3. Elevation of endolymphatic pressure

2 types of elevation of endolymphatic pressure

  1. Elevation of endolymphatic pressure
    -break in the membranous labyrinth
    - endolymph and perilymph mixes
    - mixture blocks impulse transmission and transient loss of function of vestibular nerve
    -May cause vertigo
  2. Elevation of Endolymphatic Pressure
    -Mechanical damage to the organ of corti
    - Sensorineural Hearing Loss
    - Tinnitus
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18
Q

What happens once endolymph and perilymph mixes?

A

Mixture of endolymph and perilymph may blocks impulse transmission and transient loss of function of vestibular nerve which leads to VERTIGO

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19
Q

Risk Factors of Meniere’s Disease

A

-Genetics
- Autoimmune Disorders
- Trauma
- Allergies
- Syphilis (Stage 4)

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20
Q

The world is turning around you

A

Vertigo

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21
Q

What is most common complication of elevated hypertension?

A

SMOKE

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22
Q

Clinical Manifestations of Meniere Disease 7

A

Based on Meniere’s Triad
1. Vertigo
2. Sensorineural Hearing Loss
3. Tinnitus

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23
Q

Subjective sensation of motion while motionless

A

Vertigo

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24
Q

Usually accompanied by nausea and vomiting, and nystagmus

A

Vertigo

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25
Sudden falls without loss of consciousness during acute attacks
Crises of Tumarkin
26
Diagnostic Criterion of Crises of Tumarkin
At least 2 attacks lasting at least 20 minutes each
27
-Must be documented audiometrically at least once - Primarily affects low frequency sounds
Sensorineural Hearing Loss
28
Ringing in the ears
Tinnitus
29
Non-pulsatile and often described as whistling
Tinnitus
30
Corresponds to the hearing loss during the attack
Tinnitus
31
Involuntary and rhythmic in eyeball
Nystagmus
32
What's the movement of eyeball in horizontal nystagmus?
Movement of eyeball is side to side
33
Goal of Care of Meniere's Disease
1. To treat symptoms during acute attacks 2. To control recurrence through prophylactic interventions
34
Management of Acute Attacks
1. Diazepam 2. Corticosteroids IM 3. IV fluids
35
Used for vestibular suppressant and for its antinausea effects
Diazepam (Valium) IV/IM
36
Used for its anti-inflammatory effects
Corticosteroids IM
37
Shifted to PO for dose tapering
Corticosteroids IM
38
To prevent dehydration and electrolyte imbalances from N&V
IV Fluids
39
Safety Alert During Acute Attacks
Patient is at HIGH RISK FOR FALLS during ACUTE ATTACKS
40
First line drug of Acute Attacks
Diazepam
41
Medical Management During Quiscent Phase
-Salt restricted (usually 1.5 grams/day) -Avoid triggers substances (Caffeine, nicotine, chocolate, tobacco, red wine and beer, high-cholesterol foods, high-carbohydrate foods) -Diuretics, as ordered
42
Prevents build-up of inner ear fluid
Salt- restricted
43
Food that are high in sodium content
Smoked, processed, preserved
44
Used only to prevent attacks
Diuretics
45
Diuretics
-Hydrochlorothiazide with Triamterene (Dyazide) -Furosemide
46
Need to watch out for in Hydrochlorothiazide with Triamterene (Dyazide)
Hypotension and Hyperkalemia
47
Need to watch out for in Furosemide
Ototoxicity
48
A very important interventions
Salt-restricted Diet
49
First- line surgical treatment
Endolymphatic Sac Decompression
50
Equalizes the pressure in the endolymphatic space by removing some of the mastoid tone
Endolymphatic Sac Decompression
51
Incision of Endolymphatic Sac Decompression
Post-auricular
52
Mastoid Shunting of Endolymphatic Sac Decompression
A shunt or drain is inserted in the endolymphatic sac to allow drainage of fluid into the subarachnoid space
53
The success rate in Endolymphatic Sac Decompression
Success rate (in terms of controlling vertigo and stabilizing the hearing acuity) is 60% to 80%
54
Surgical Management of Meniere's Disease
-Endolymphatic Sac Decompression - Decompression Procedure - Shunting Procedure -Vastibular Nerve Suctioning - Labyrinthectomy -Intra-tympanic Aminoglycoside Therapy
55
Landmarks for the endolymphatic sac are identified
Decompression Procedure
56
A small portion of mastoid bone over the sac is removed
Decompression Procedure
57
Shunt is placed on the sac which drains into the subarachnoid space
Shunting Procedures
58
Used as the ultimate solution for patients with useful hearing in the affected ear
Vestibular Nerve Suctioning
59
Vestibular branch of CN VII is cut
Vestibular Nerve Suctioning
60
Cutting the nerve prevents the brain from receiving input from the semicircular
Vestibular Nerve Suctioning
61
Has 98% success rate in eliminating vertigo
Vestibular Nerve Suctioning
62
Recommended if pt cannot tolerate vertigo
Vestibular Nerve Suctioning
63
Involves ablation of the diseased inner ear organs
Labyrinthectomy
64
Useful for patients whose hearing is already damaged by Meniere
Labyrinthectomy
65
Uses either a transcanal or tansmastoid approach
Labyrinthectomy
66
Rationale of using either a transcanal or transmastoid approach
Low risk for CSF leak and meningitis
67
Has >95% cure rate
Labyrinthectomy
68
Essential Post-Operative Care for Labyrinthectomy
-Position: Low fowlers position when lying down x at least 2 weeks - Maintain pressure dressing x 24 hours, sutures are removed on surgical day 7 - Operated ear should not be exposed to water until complete healing - Facilitate walker use post-op to facilitate ambulation and independence - Laxatives, as ordered - To prevent straining stool
69
Appropriate Position when Lying down in patients undergoing Post-Operative for Labyrinthectomy
Low-Fowlers Position when lying down x 2 weeks
70
How many days does the suture need to remove?
Day 7
71
Hours to maintain pressure dressing
24 hours
72
Are toxic to the vestibular hair cells
Aminoglycosides (Gentamycin)
73
Intra-Tympanic Aminoglycoside Therapy
-Aminoglycoside (Gentamycin) are preferentially toxic to the vestibular hair cells -Destruction of the vestibular hair cells renders the brain insensitive to fluctuations in inner ear pressure brought on by Meniere Disease
74
Reserve for end-stage intractable cases
Intra-tympanic Aminoglycoside Therapy
75
Has useful effects on aural fullness and tinnitus of patients as well.
One-shot low dosage of Gentamycin
76
Was effective in controlling vertigo attacks in Meniere Disease
One-Shot Low Dosage of Gentamycin
77
These tests only have adjunctive role for monitoring therapeutic responses in intratympanic gentamycin-therapy
Postural and vestibular tests
78
Facilitates recalibration of a patient's balance
Vestibular Rehabilitation
79
This should not be used as primary treatment cause it may be risk for injury
Vestibular Rehabilitation
80
Strongly recommended for patient S/P Vestibular Nerve Resection, Labyrinthectomy, and Intratympanic Aminoglycoside Therapy
Vestibular Rehabilitation

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