Menieres disease

Question 1

Menieres This is a disorder of the inner ear caused by a change in fluid volume in the labyrinth. What is the incidence of this?

1 - 13,000 per 100,000 person
2 - 1300 per 100,000 person
3 - 130 per 100,000 person
4 - 13 per 100,000 person

Answer 1

4 - 13 per 100,000 person

Question 2

Menieres disease is a disorder of the inner ear caused by a change in fluid volume in the labyrinth. Is this more common in men or women?

Answer 2

• women

Question 3

Menieres disease is a disorder of the inner ear caused by a change in fluid volume in the labyrinth. It can affect any age, but is it more common in young children or older adults?

Answer 3

• older adults

Typically 40-50 years old

Question 4

Menieres disease is a disorder of the inner ear caused by a change in fluid volume in the labyrinth. This is due to a build of fluid, is this perilymph or endolymph?

Answer 4

• endolymph

Causes increased pressure, affecting sensory signals

Question 5

Menieres is characterised by a triad, which of the following is NOT part of this triad?

1 - hearing loss
2 - tinnitus
3 - vertigo
4 - facial muscle weakness

Answer 5

4 - facial muscle weakness

Vertigo is typically the prominent symptom

Question 6

The classical triad of Menieres is hearing loss, tinnitus and vertigo. But all of the following is least likely to occur?

1 - sensation of aural fullness or increased pressure
2 - nystagmus
3 - positive Romberg test
4 - bilateral symptoms
5 - increased falls

Answer 6

4 - bilateral symptoms

Typically symptoms are unilateral, but long term disease can result in bilateral disease

Nystagmus typically occurs during vertigo attacks and is only in one direction

Question 7

Vertigo is a common symptom of Menieres disease. Is vertigo constant?

Vertigo is the sensation of moving when you are not (medical definition)

Answer 7

• no

Typically occurs in episodes of 20 mins
Can come in clusters and then have none for months

Question 8

Vertigo is a common symptom of Menieres disease. Is vertigo triggered by movement and postural changes in Menieres disease?

Answer 8

• no

Good for distinguishing this from other conditions

Question 9

Hearing loss is a common symptom of Menieres disease. Is this a sensorineural or conductive hearing loss?

Answer 9

• sensorineural hearing loss

Question 10

Hearing loss and tinnitus are common symptoms of Menieres disease. Is the hearing loss always present?

Answer 10

• no

Initially fluctuates with vertigo symptoms, but becomes permanent in chronic disease

Question 11

In Menieres disease is this a clinical or diagnostic test diagnosis?

Answer 11

• Typically a clinical diagnosis based on the triad of tinnitus, vertigo and hearing loss

Audiology will be performed to assess hearing loss

Question 12

Are patients with Menieres disease ok to drive if they have symptoms?

Answer 12

• no

Must inform the DVLA and cease driving until satisfactory control of symptoms is achieved

Question 13

Patients with acute attacks of Menieres disease can be treated with all of the following, EXCEPT which one?

1 - metoclopramide
2 - cyclizine
3 - cinnarizine
4 - promethazine

Answer 13

1 - metoclopramide

All others are H1 receptor blockers

Question 14

Patients with acute attacks of Menieres disease can be treated with which of the following?

1 - Haloperidol
2 - Chlorpromazine,
3 - Prochlorperazine
4 - Olanzapine,

Answer 14

3 - Prochlorperazine

Question 15

Patients with Menieres disease can be treated prophylactically to reduce symptoms using which of the following?

1 - Metoclopramide
2 - Haloperidol
3 - Cyclizine
4 - Betahistine dihydrochloride

Answer 15

4 - Betahistine dihydrochloride

H1-receptors and antagonist

Question 16

Is Menieres diseases always permanent?

Answer 16

• No

Typically resolves after 5-10 years, BUT most patients will have some form of hearing loss and psychological distress

Question 17

The head impulse, nystagmus and test of skew (HINTS) is used to distinguish between a central or peripheral cause of ongoing vertigo. The 1st test is the head impulse test (HIT):

1 - patient fixes their eyes on your nose 2 - head is rapidly rotated 30 degrees to left and then back to midlife
3 - patient either maintains gaze on nose or fails to do so.
4 - repeat and rotate head to right

If they are unable to maintain a fixed gaze, this is called a corrective saccade. If the patient is able to maintain their gaze on your nose is this a central or peripheral problem?

Answer 17

• central
• indicates that the vestibulocochlear nerve is NOT damaged

Question 18

The head impulse, nystagmus and test of skew (HINTS) is used to distinguish between a central or peripheral cause of ongoing vertigo. The 1st test is the head impulse test (HIT):

1 - patient fixes their eyes on your nose 2 - head is rapidly rotated 30 degrees to left and then back to midlife
3 - patient either maintains gaze on nose or fails to do so.
4 - repeat and rotate head to right

If they are unable to maintain a fixed gaze, this is called a corrective saccade. Is this a central or peripheral problem?

Answer 18

• peripheral

Suggests that there is an issue with vestibulocochlear

Question 19

The 1st part of head impulse, nystagmus and test of skew (HINTS) is the head impulse test (HIT). If the patient is unable to maintain a fixed gaze, this is called a corrective saccade. suggesting a peripheral problem. Does this occur in both directions or just one?

Answer 19

• unilateral only

Question 20

The nystagmus test is the 2nd part of the head impulse, nystagmus and test of skew (HINTS). Which of the following are true about the nystagmus aspect of the HINTS examination?

1 - unidirectional nystagmus is more likely to be of peripheral origin
2 - change in nystagmus direction is likely to be associated with central pathologies
3 - bidirectional nystagmus, is highly specific for stroke
4 - all of the above

Answer 20

4 - all of the above

Question 21

The nystagmus test is the 2nd part of the head impulse, nystagmus and test of skew (HINTS). If a patient has a unidirectional nystagmus, and its always in the same direction, is this due to a peripheral or central cause?

Answer 21

• peripheral

Indicates vestibulocochlear issue

Question 22

The nystagmus test is the 2nd part of the head impulse, nystagmus and test of skew (HINTS). If a patient has a bidirectional or vertical nystagmus, and its always in the same direction, is this due to a peripheral or central cause?

Answer 22

• central cause

bidirectional nystagmus, is highly specific for stroke

Question 23

If you perform the 3 parts of the head impulse, nystagmus and test of skew (HINTS) exam and have the following:

1st part = corrective saccade
2nd part = unidirectional nystagmus
3rd part = normal test of skew

Is this a central or peripheral issue?

Answer 23

• peripheral

Most likely vestibular neuritis and patient can be discharged

Question 24

If you perform the 3 parts of the head impulse, nystagmus and test of skew (HINTS) exam and have the following:

1st part = normal reflex
2nd part = vertical/bidirectional nystagmus
3rd part = abnormal test of skew

Is this a central or peripheral issue?

Answer 24

• central

More serious issue and needs more investigations