meniers disease

MENIERS DISEASE.MENIERS DISEASE.

PROF SHAHIDIN. PROF SHAHIDIN.

DEPARTMENT OF ENT KTH.DEPARTMENT OF ENT KTH.

Wednesday, April 19, 2023Wednesday, April 19, 2023 11

MENIERS DISEASEMENIERS DISEASE

Wednesday, April 19, 2023 2

CENTRAL LEISIONS CAUSING CENTRAL LEISIONS CAUSING VERTIGO.VERTIGO.

INFLAMMATORYINFLAMMATORY..Meningitis.Meningitis.Brain abscess.Brain abscess.Encephalitis.Encephalitis.SPACE OCCUPYINGSPACE OCCUPYING..Neoplasms of CNS.Neoplasms of CNS.Arachnoid cysts.Arachnoid cysts.VASCULAR.VASCULAR.Internal auditory artery lesion.Internal auditory artery lesion.Inferior posterior cerebellar artery lesion.Inferior posterior cerebellar artery lesion.Vertebral basilar insufficiency.Vertebral basilar insufficiency...


CENTRAL LESIONS CAUSING CENTRAL LESIONS CAUSING VERTIGO.VERTIGO.

SYSTEMIC.SYSTEMIC.Toxins Toxins Genetics.Genetics.Multiple sclerosisMultiple sclerosisTRAUMATIC.TRAUMATIC.Brain concussion.Brain concussion.AUTONOMIC NERVOUSAUTONOMIC NERVOUS..NEONATAL.NEONATAL.Developmental anomalies.Developmental anomalies.Anoxia,neonatal jaundice, prematurity.Anoxia,neonatal jaundice, prematurity.


PERIPHERAL LESIONS CAUSING PERIPHERAL LESIONS CAUSING VERTIGO.VERTIGO.

MIDDLE EARMIDDLE EAR..Inflammatory.Inflammatory.Otitis media.Otitis media.Atmospheric.Atmospheric.Tubal obstruction.Tubal obstruction.Aerotitis.Aerotitis.LABRYNTH.LABRYNTH.Labrynthitis.Labrynthitis.Vestibular neuronitis.Vestibular neuronitis.Haemorrhage.Haemorrhage.Ischemia.Ischemia.Allergy.Allergy.Hydrops. Otosclerosis.Hydrops. Otosclerosis.

SYSTEMIC DISEASESSYSTEMIC DISEASES..Bacterial.Bacterial.Viral.Viral.Metabolic.Metabolic.Hematogenous.Hematogenous.Drugs.Drugs.NEOPLASTIC LESIONSNEOPLASTIC LESIONS..Malignant tumours.Malignant tumours.Benign tumours.Benign tumours.

(Glomous,Acoustic)(Glomous,Acoustic)TRAUMA.TRAUMA.Fracture temporal bone.Fracture temporal bone.Labrynthine concussion.Labrynthine concussion.Acoustic trauma.Acoustic trauma.


1985 CRITERIA FOR THE 1985 CRITERIA FOR THE DIAGNOSIS OF MENIERS DIAGNOSIS OF MENIERS

DISEASE.DISEASE.1.1. Fluctuating, progressive, sensorineural hearing Fluctuating, progressive, sensorineural hearing

loss associated with tinnitus-the deficit is loss associated with tinnitus-the deficit is characteristically of low frequency or flat type.characteristically of low frequency or flat type.

2.2. Vertigo-Spontaneously occurring sensation of Vertigo-Spontaneously occurring sensation of movement hat is accompanied by unsteadiness movement hat is accompanied by unsteadiness and lasts from minutes to hours. More than one and lasts from minutes to hours. More than one attack is needed to establish the diagnosis.attack is needed to establish the diagnosis.

Definite spell- often prostrating, often Definite spell- often prostrating, often accompanied by nausea and vomiting. Patient accompanied by nausea and vomiting. Patient oriented and conscious, no neurological oriented and conscious, no neurological sequelae. Horizontal or horizontal rotatory sequelae. Horizontal or horizontal rotatory nystagmus is always present during definite nystagmus is always present during definite spell.spell.



DISEASE.DISEASE.1.1. Recurrent spontaneous episodic vertigo.Recurrent spontaneous episodic vertigo.Definite spell-Spontaneous rotational vertigo Definite spell-Spontaneous rotational vertigo

lasting at least 20 minutes (commonly lasting at least 20 minutes (commonly several hours),often several hours),often prostrating ,accompanied by disequilibrium prostrating ,accompanied by disequilibrium that may last several days; usually nausea that may last several days; usually nausea (commonly vomitting or retching); no loss (commonly vomitting or retching); no loss of consciousness.Horizontal or horizontal of consciousness.Horizontal or horizontal rotatory nystagmus is always present.rotatory nystagmus is always present.

2. Hearing loss (not necessarily fluctuating).2. Hearing loss (not necessarily fluctuating).3. Either aural fullness or tinnitus or (both).3. Either aural fullness or tinnitus or (both).Wednesday, April 19, 2023 8


DISEASE.DISEASE.Certain meniers disease is Definite, disease Certain meniers disease is Definite, disease

with histopathological confirmation.with histopathological confirmation.Definite,Definite, Meniers disease requires two or more Meniers disease requires two or more

definite episodes of vertigo with hearing loss definite episodes of vertigo with hearing loss plus tinnitus and or aural fullness.plus tinnitus and or aural fullness.

Probable,Probable, Meniers disease needs only one Meniers disease needs only one definite episode of vertigo and the other definite episode of vertigo and the other symptoms and signs.symptoms and signs.

Possible,Possible, Meniers disease is defined as definite Meniers disease is defined as definite vertigo with no associated hearing loss or vertigo with no associated hearing loss or hearing loss with non definite disequilibrium. hearing loss with non definite disequilibrium.


MEDICAL TREATMRNT OF ACUTE MEDICAL TREATMRNT OF ACUTE ATTACK OF MENIERS DISEASE.ATTACK OF MENIERS DISEASE.

DRUG.DRUG. DOSAGE.DOSAGE. ACTION.ACTION.Anticholenergics 0.6 mg qid Anticholenergics 0.6 mg qid muscarine antagonist muscarine antagonist

Scopolomine.Scopolomine.

Antihistamines.Antihistamines. 50mg tds 50mg tds H1 Antagonist H1 Antagonist

Dimenhydramine. I.M, 4-6 hoursDimenhydramine. I.M, 4-6 hours muscrine antagonist muscrine antagonist

Meclizine.Meclizine. 25mg tds25mg tds H1 Antagonist H1 Antagonist

Promethazine.Promethazine. 15 or 50mg tds 15 or 50mg tds H1 anagonist H1 anagonist

Phenothiazine.Phenothiazine. 5 or 10 mg tds muscarine antagonist 5 or 10 mg tds muscarine antagonist

Butyrophenone.Butyrophenone. 2.5 or 5 mg IM Bd Dopamine antagonist 2.5 or 5 mg IM Bd Dopamine antagonist

Diazepam.Diazepam. 5 or 10 mg qid5 or 10 mg qid GABA A GABA A antagonistantagonist

ClonazepamClonazepam 0.5 mg tds0.5 mg tds GABA A antagonist GABA A antagonist


SURGICAL PROCEDURES TO SURGICAL PROCEDURES TO TREAT MENIERS DISEASE.TREAT MENIERS DISEASE.

CONSERVATIVE PROCEDURESCONSERVATIVE PROCEDURES..A.A. Extra labrynthineExtra labrynthine..► Endolymphatic sac enhancement.Endolymphatic sac enhancement.► Endolymphatic sac revision.Endolymphatic sac revision.► Symphethectomy.Symphethectomy.B. B. Invasive of the labyrinth.Invasive of the labyrinth.► Sacculotomy.Sacculotomy.► Cochleosacculotomy.Cochleosacculotomy.► Stapedectomy-Sacculotomy.Stapedectomy-Sacculotomy.



PARTIALLY DESTRUCTIVE PROCEDURESPARTIALLY DESTRUCTIVE PROCEDURES..

A. A. VESTIBULAR NERVE SECTIONVESTIBULAR NERVE SECTION. . Through the middle fossaThrough the middle fossa

► Retrolabrynthine approach.Retrolabrynthine approach.► Retrosigmoid approach.Retrosigmoid approach.► Combined retrolabrynthine_ retrosigmoid Combined retrolabrynthine_ retrosigmoid

vestibular neurectomy.vestibular neurectomy.

B. B. SINGULAR NEURECTOMYSINGULAR NEURECTOMY..

C. C. ULTRASONIC IRRADIATION OF THE LABYRINTH.ULTRASONIC IRRADIATION OF THE LABYRINTH.

D. D. CRYOSURGERYCRYOSURGERY..

E. E. MEDICAL ABBLATION WITH/WITHOUT MEDICAL ABBLATION WITH/WITHOUT EXPLORATORY TYMPANOTOMY.EXPLORATORY TYMPANOTOMY.



DESTRUCTIVE LABYRINTHECTOMIESDESTRUCTIVE LABYRINTHECTOMIES..A.A. Transtympanic.Transtympanic.► Labyrinthectomy extended to the oval window.Labyrinthectomy extended to the oval window.► Trans canal labyrinthectomy.Trans canal labyrinthectomy.► Trans meatal labyrinthectomy.Trans meatal labyrinthectomy.B.B. Transmastoid.Transmastoid.► Trans mastoid labyrinthectomy.Trans mastoid labyrinthectomy.► Trans labyrinthine section of the vestibular nerve.Trans labyrinthine section of the vestibular nerve.► Labryinthotomy throug the horizontal canal.Labryinthotomy throug the horizontal canal.► Labyrinthectomy through the middle fossa.Labyrinthectomy through the middle fossa.


meniers disease

Documents