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Meniere's disease

Meniere's disease is a clinical disorder defined as the idiopathic syndrome of endolymphatic hydrops. The underlying pathophysiologic state in Meniere's disease is endolymphatic hydrops, which can only be demonstrated with certainty after death by histopathologic study of the temporal bones. The presence of endolymphatic hydrops can be inferred.

VERTIGO

Vertigo is the sensation of motion when no motion is occurring relative to earth's gravity. Conversely, motion intolerance is a feeling of dysequilibrium, spatial disorientation, or malaise during active illness.

HEARING LOSS

It is a common clinical observation that patients with aural fullness or tinnitus may perceive that they have a loss of hearing when pure-tone sensitivity and word recognition (speech discrimination) are Meniere disease, .

Although hearing usually fluctuates early in Meniere's disease, fluctuation is not universally present.

TINNITUS AND AURAL FULLNESS

Ttinnitus and aural fullness are difficult to quantify independent of results for hearing and for control of vertigo.

OTHER DIAGNOSTIC CONSIDERATIONS

It is important to state what Meniere's disease is not. Episodic vertigo without hearing loss, tinnitus.

Otosyphilis is a disorder that includes episodic vertigo of the Meniere type, hearing loss.

Treatment of Meniere's Disease

Medical Therapy

Medical therapy is aimed at (1) reducing the inner ear fluid overpressure (endolymphatic hydrops) and (2) controlling vertigo.

Treatment of Endolymphatic Hydrops

A sodium-restricted diet forms the basis of dietary management of Meniere's disease. Salt intake is restricted.

Body fluid management is augmented by diuretic therapy. Thiazides in combination with potassium-sparing agents are popular (Dyazide, Maxzide).

Dietary compliance and diuretic therapy alone are often adequate for control.

Symptomatic Vestibular Suppression

Vestibular suppressants are used in conjunction with dietary and diuretic therapy.

Diazepam (Valium) is the single most effective outpatient vestibular suppressant. It is thought to diminish resting activity.

The excitatory neurotransmitter of the vestibular system is thought to be acetylcholine. Anticholinergics diminish neuron excitability in the vestibular nuclei and, in combination with diazepam, are useful in therapy for Meniere's disease. Glycopyrrolate (Robinul), 2 mg orally twice daily.

Similar agents suffice (e.g., propantheline [Pro-Banthine], atropine). Dry mouth, blurred vision.

The antihistamines, including meclizine (Antivert), are not useful in Meniere's disease.

managing the acute episode (droperidol [Inapsine]).

Streptomycin Therapy

Streptomycin is an ototoxin that selectively destroys first the balance and then, in higher dosages.

Intratympanic Injections

The intratympanic injection of steroids* or aminoglycosides,* which are thought to access the labyrinth.

Surgical Therapy

Surgery for Meniere's disease is reserved for those who have medically refractory disease.

Labyrinthectomy

Removing the balance contents of the inner ear is a destructive procedure in which hearing.

Endolymphatic System Surgery

A conservation procedure in which hearing is preserved, endolymphatic system surgery (ELSS).

Vestibular Nerve Section

Selective vestibular nerve section (VNS), while preserving hearing, is the only surgical modality.