Meniere's Disease Flashcards
What causes Ménière’s disease?
Not fully known, but thought to be characterised by excessive pressure (too much fluid) and progressive dilation of the endolymphatic system is the membranous labyrinth
What age does it typically present?
Can affect anyone but typically 40-60
Does it affect men or women more?
Equal
What symptoms are associated?
Vertigo - sudden attacks lasting 2-4 hours
Tinnitus
Sensation of aural fullness or pressure
Sensorineural hearing loss
Other features: nystagmus, positive Romberg test
How long do the symptoms typically last?
Minutes to hours = episodic
Are symptoms bilateral or unilateral?
Typically unilateral but bilateral symptoms may develop over a number of years
In terms of the hearing loss is it permanent?
No but repeated attacks may result in loss that worsens over time and may become permanent
What is vertigo?
The sensation that you or the world around you is moving or spinning
What can vertigo cause?
Nausea and vomiting
What is found on audiometry?
Sensorineural hearing loss
How is it managed?
Acute: prochlorperazine - a vestibular sedative (buccal or IM)
Prevention: betahistine
Thiazide diuretics
Diet: reduce salt, chocolate, alcohol, caffeine, Chinese food
Surgery:
Grommet insertion
Dexamethasone middle ear injection
Endolymphatic sac decompression
Vestibular destruction using middle ear injection of gentamicin
Labrinthectomy - effective at curing vertigo but causes total ipsilateral deafness
How frequent are attacks?
May be regular or occur only every few months
Can appear in clusters
What is tinnitus?
Perception of ringing or buzzing noise
Should the patient stop driving?
The DVLA should be informed
Cease driving until satisfactory control of symptoms achieved
Before a diagnosis is made, investigations may be required to exclude other causes of vertigo such as…
Acoustic neuroma
Cerebellopontine angle or endolymphatic sac tumour
MS
Chiari malformation
- May require an MRI