Meniere Disease W6 PDF

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 12: Altered Somatic and Special Sensory Function Module 4: Clinical Models Copyright © 2...

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 12: Altered Somatic and Special Sensory Function Module 4: Clinical Models Copyright © 2017 Wolters Kluwer Health | Lippincott Williams &Wilkins  Ménière disease Clinical Diagnostic Pathophysiology Treatment manifestations criteria  Ménière disease Pathophysiology Condition of altered vestibular function Incidence is 0.5-7.5/1000, depending on diagnostic criteria Onset is between 20-60, equally common between genders Etiology: trauma, infection, drugs, toxin Increased volume of endolymph (endolymph hydrops) leads to dilation of the membranous labyrinth of the inner ear Rupture of membranous labyrinth allows mixing of endolymph and perilymph Primary lesion location: endolymphatic sac Porth C. Pathophysiology : concepts of altered health states. 7th ed. Philadelphia, Lippincott Williams & Wilkins; 2005.  Ménière disease Clinical Manifestations Triad: Often unilateral vestibular dysfunction Vertigo Variable in severity from mild to disabling Tinnitus Hearing loss Vertigo, feeling of spinning Often with incapacitating nausea and vomiting Tinnitus and nystagmus Sensorineural hearing loss Pressure, pain in ear Symptoms can occur daily or infrequently Attack last less than 24 hours Weeks or months can go by before another episode In time, remissions become longer Hearing loss recovers between attacks but later may become permanent  Ménière disease Diagnostic Criteria History of symptoms Physical exam Auditory examination to identify hearing loss, audiograms Electrocochleography Recording sound induced electrical potentials in inner ear Electrode is in ear canal or tympanic membrane Videonystagmography to assess vestibular system Testing eye movements: abnormal result may be a sign of vestibular nerve damage Determines communication between balance-related sensors and head movement on eye control Glycerol test Oral ingestion of hyperosmolar solution (glycerol) Dehydration to reduce inner ear fluid volume Audiometric testing: acute temporary hearing improvement in Meniere disease  Ménière Disease Treatment No cure Management of symptoms (symptomatic) Nonpharmacologic Regulation of body fluid Reduction in salt intake (pharmacologic: diuretic therapy) Smoking cessation Stress reduction Pharmacologic Antiemetics to prevent nausea Diuretic therapy Drugs to reduce vertigo  Ménière Disease Treatment Surgical Ototoxicity Gentamicin: antibiotic used systemically in serious infections Side effect: ototoxicity Irreversible destruction of hair cells May damage hearing Vestibular neurectomy Severing the vestibular nerve No effect on hearing Labyrinthectomy May reduce vertigo Hearing loss