Ménière's disease

Question 1

What is meniere’s disease?

Answer 1

A rare disorder of the inner ear that causes episodes of vertigo, the sensation of spinning. It also leads to hearing problems

Question 2

What is the prevalence of this disease?

Answer 2

1 in 1000

Question 3

What age does this disease most commonly affect?

Answer 3

between the ages of 40 and 60 but can occur at any age

Question 4

Is the condition usually unilateral or bilateral?

Answer 4

Unilateral however the other ear is also affected at some stage in about 4 in 10 cases.

Question 5

Where does the name Ménière’s disease come from?

Answer 5

Ménière’s disease is named after a French doctor called Prosper Ménière who first described the disease in the 1860s

Question 6

What is the cause of Menieres disease?

Answer 6

it is unknown

Question 7

What is the most consistent histologic abnormality of menieres disease?

Answer 7

Endolymphatic hydrops

Question 8

What is endolymphatic hydrops?

Answer 8

a progressive swelling of the membranous labyrinth in the inner ear. (However, not everyone with documented hydrops develops Ménière’s disease.)

Question 9

What happens during an acute attack of Meniere’s disease?

Answer 9

1. the excessive endolymphatic fluid pressure causes distension and rupture of the Reissner’s membrane.
   2.This results in the release of endolymph into the perilymphatic space and injury to the sensory and neural elements of the inner ear
2. manifest as the classic symptoms of vertigo, sensorineural hearing loss, tinnitus, and aural fullness

Question 10

What happens between acute attacks?

Answer 10

Between attacks, the ruptured membrane heals, chemical balance is restored, and symptoms remit.
It is though that associated scars might explain the nature of sudden attacks and fluctuation of symptoms

Question 11

What are some suspected causes/risk factors for Meniere’s disease?

Answer 11

allergic responses (especially to food).
Autoimmunity (usually presents with bilateral symptoms).
Genetic susceptibility.
Stenosis of the internal auditory canal.
Trauma (acoustic or physical).
Metabolic disturbances involving the balance of sodium and potassium in the fluid of the inner ear.
Vascular factors (there is an association between migraine and Ménière’s disease).
Viral infection.
Congenital or acquired syphilis.
Lyme disease.
Hypothyroidism.

Question 12

What are 4 complications of Meniere’s disease?

Answer 12

1. )alls
2. Hearing loss
3. Psychological effects ( anxiety depression and agoraphobia)
   4.Social effects — for example, work-related issues, effect on the ability to drive, and limitations on shopping and household activities

Question 13

What is the prognosis?

Answer 13

ymptoms of Ménière’s disease tend to get worse over time, regardless of medical intervention
Later in the course of the disease, hearing loss progresses and tinnitus becomes persistent. The frequency of episodes of vertigo often decreases

Question 14

What is the prognosis for meniere’s disease after 5-15 years?

Answer 14

After 5–15 years, vertigo is no longer experienced when the condition ‘burns out’, but tinnitus, unilateral hearing loss, sensations of aural pressure, and a sense of general imbalance or disequilibrium may persist despite treatment

Question 15

Are there any specific diagnostic tests for Meniere’s disease?

Answer 15

There are no specific diagnostic tests for Ménière’s disease. Diagnosis is based on the presence of key clinical features.

Question 16

When should Meniere’s disease be suspected?

Answer 16

1. Episodes of spontaneous vertigo attacks (described as spinning or rocking) with or without nausea and vomiting. Unsteadiness can persist for several days after the acute attack of vertigo.
2. Tinnitus, usually described as ‘roaring’.
3. Fluctuating sensorineural hearing loss, initially in low frequencies (usually unilateral).
4. Aural fullness (a sensation of pressure in the ear, or ear discomfort), which often occurs in advance of a vertigo attack but may also be present during the episode.

Question 17

How long do acute meniere’s disease attacks last?

Answer 17

Are present for at least 20 minutes, but typically last a few hours (no more than 24 hours)

Question 18

How often are these attacks?

Answer 18

Can occur in clusters over a few weeks, although months or years of remission can also occur

Question 19

What can be an indication of an upcoming attack?

Answer 19

May be preceded by a change in tinnitus, increased hearing loss, or a sensation of aural fullness shortly before the onset of vertigo.

Question 20

What other symptoms can happen during an acute attack?

Answer 20

Drop attacks without loss of consciousness that occur without warning (Otholitic crises of Tumarkin). Normal activities can be resumed immediately afterwards. They affect fewer than 1 in 10 people with Ménière’s disease.
Balance or gait problems, particularly during attacks of vertigo.
Postural instability.

Question 21

What is looked out forduring a physical exam for meniere’s disease?

Answer 21

Head and neck examination findings are usually normal.
Horizontal and/or rotatory nystagmus that can be suppressed by visual fixation may be present.
The person may be unable to stand with their feet together and eyes closed (Romberg’s test) or walk heel-to-toe (tandem) in a straight line.
If asked to march on the spot with their eyes closed (Unterberger’s test), the person may be unable to maintain their position and will turn to the affected side

Question 22

What red flag symptoms should result in immediate hospital admission?

Answer 22

1. New unilateral hearing loss.
2. Focal neurological signs (facial weakness, diplopia, or limb weakness).
3. New-onset headache.
4. Normal head thrust test.

Question 23

What are the requirements for a definite diagnosis of Meniere’s disease?

Answer 23

1.Two or more spontaneous episodes of vertigo, each lasting 20 minutes to 12 hours.
2. Audiometrically documented low-to-medium frequency sensorineural hearing loss in one ear, defining and locating to the affected ear on at least one occasion before, during, or after an episode of vertigo.
3. Fluctuating aural symptoms (hearing loss, tinnitus, or fullness) in the affected ear.
4. Not better accounted for by an alternative vestibular diagnosis.

Question 24

What are the requirements for a probable diagnosis of Meniere’s disease?

Answer 24

1. Two or more episodes of vertigo or dizziness, each lasting 20 minutes to 24 hours.
2. Fluctuating aural symptoms (hearing loss, tinnitus, or fullness) in the affected ear.
3. Not better accounted for by an alternative vestibular diagnosis

Question 25

What conditions need to be ruled out before confirming a diagnosis of meniere’s disease?

Answer 25

Tumours (for example acoustic neuroma).

Otosyphilis.

Multiple sclerosis.

Perilymph fistula.

Vascular events (for example transient ischaemic attack).

Migraine.

Benign paroxysmal
positional vertigo.

Vestibular neuronitis.

Acute labyrinthitis

Question 26

What advice should you give to people experiencing sudden attacks of Virgo?

Answer 26

1. Keep their medication readily accessible.
2. Consider the risks before undertaking activities such as driving, operating dangerous machinery, using ladders or scaffolding, or going swimming.

Question 27

What medication can be prescribed to help alleviate nausea, vomiting and vertigo?

Answer 27

Consider prescribing a short course (up to 7 days) of prochlorperazine or an antihistamine (such as cinnarizine, cyclizine, or promethazine teoclate)

Question 28

what medication can be prescribed for rapid relief in a person with (severe) nausea or vomiting?

Answer 28

Consider buccal prochlorperazine or a deep intramuscular injection of prochlorperazine or cyclizine.

If symptoms are very severe, hospital admission may be required for intravenous (IV) labyrinthine sedatives and fluids to maintain hydration and nutrition

Question 29

What can be prescribed to prevent recurrent attacks of Meniere’s disease?

Answer 29

Consider prescribing a trial of betahistine to reduce the frequency and severity of attacks of hearing loss, tinnitus, and vertigo.