Menieres disease

Question 1

What?

Answer 1

Rare condition characterised by recurring episodic, rotatory vertigo lasting 30 minutes to a few hours

Question 2

Do attacks recur?

Answer 2

Recurrent over months or years

Question 3

Pathophysiology?

Answer 3

Endolymphatic hydrops

• High pressure within endolymph system of inner ear
• Build up of end-lymphatic fluid in inner ear

Question 4

Clinical features?

Answer 4

History of recurrent, spontaneous, rotational vertigo with at least two episodes >20mins (often lasting hours)
New tinnitus (or worsening) on the affected side
Aural fullness on the affected side
Low frequency sensorineural hearing loss
Loss of balance
vomiting

Question 5

Management?

Answer 5

Self care
Vestibular sedatives (acute phase)
Preventative measures
If uncontrolled - labyrinthectomy  (perfusing round window orifice with ototoxic drugs (gentamicin))
Surgical decompression

Question 6

What vestibular sedative can be used in acute phase?

Answer 6

Cinnarizine

Question 7

Preventative measures?

Answer 7

Low salt diet

Avoid caffeine, alcohol, stress

Question 8

What happens when labyrinthectomy performed?

Answer 8

Patient has severe vertigo for 2 weeks until body compensates