Meniere's Disease Flashcards

1
Q

What causes Ménière’s disease?

A

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

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2
Q

What age does it typically present?

A

Can affect anyone but typically 40-60

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3
Q

Does it affect men or women more?

A

Equal

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4
Q

What symptoms are associated?

A

Vertigo - sudden attacks lasting 2-4 hours
Tinnitus
Sensation of aural fullness or pressure
Sensorineural hearing loss

Other features: nystagmus, positive Romberg test

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5
Q

How long do the symptoms typically last?

A

Minutes to hours = episodic

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6
Q

Are symptoms bilateral or unilateral?

A

Typically unilateral but bilateral symptoms may develop over a number of years

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7
Q

In terms of the hearing loss is it permanent?

A

No but repeated attacks may result in loss that worsens over time and may become permanent

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8
Q

What is vertigo?

A

The sensation that you or the world around you is moving or spinning

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9
Q

What can vertigo cause?

A

Nausea and vomiting

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10
Q

What is found on audiometry?

A

Sensorineural hearing loss

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11
Q

How is it managed?

A

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

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12
Q

How frequent are attacks?

A

May be regular or occur only every few months

Can appear in clusters

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13
Q

What is tinnitus?

A

Perception of ringing or buzzing noise

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14
Q

Should the patient stop driving?

A

The DVLA should be informed

Cease driving until satisfactory control of symptoms achieved

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15
Q

Before a diagnosis is made, investigations may be required to exclude other causes of vertigo such as…

A

Acoustic neuroma
Cerebellopontine angle or endolymphatic sac tumour
MS
Chiari malformation

  • May require an MRI
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16
Q

Initially patients are well between attacks but as the disease progresses what can happen?

A

May feel unsteady between attacks as they start to develop reduced vestibular function on the side of the disease and a progressive sensorineural hearing loss.

Over time, disease often burns itself out, so patient will not suffer acute vertigo but will have reduced hearing and maybe generally unbalanced.