Meniere's disease

Meniere's disease
====================

Meniere's disease - idiopathic {mem tip "D"isease = i"D"iopathic)
Meniere's syndrome - secondary to a cause

Proposed pathogenesis
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endolymphic hydrops (hydrops: excessive accumulation of serous fluid in tissues or cavities of the body)


Symptoms
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-Hearing loss (Sensorineural hearing loss is fluctuating and progressive. Vertigo episodes last from 20 minutes to 24 hours, and

typically occur in clusters)
-Tinnitis
-Vertigo (episodic , sudden onset vertigo)
-Sensation of fullness in the affected ear.


-positive Romberg's test (common)
 (Swaying or falling when asked to stand with feet together and eyes closed.)
-positive Fukuda's stepping test (common)
 (Turning towards the affected side when asked to march in place with eyes closed.)
-inability to walk tandem (heel-to-toe) in a straight line (often)

-Sensorineural hearing loss

Dx
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Meniere's disease is a clinical diagnosis. Although not diagnostic, patients should undergo audiometry, vestibular testing, and MRI

to rule out other causes of symptoms


Rx:
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all pt
- low salt diet ( < 1500~2000  mg/day )
- triamterene/hydrochlorothiazide : 50/25 mg orally once daily
 or
 acetazolamide : 250 mg orally (regular-release) twice daily

symptomatic vetigo
- promethazine:  12.5 to 25 mg orally/rectally every 4-6 hours when required
- <adjunct> intratympanic injections (dexmethasone)
- <adjunct> Meniett device

tinnitis
- tinnitis masker (Tinnitus maskers (white noise generators) are devices similar to hearing aids that fit behind the ear.)
- hearing aids(Hearing aids may help in masking the tinnitus), etc
- if unresponsive to non-pharm Rx: amitriptyline : 25-75 mg/day orally given in 1-3 divided doses

sudden hearing loss
- prednisolone : 20 mg orally three times daily for 2-3 weeks, then gradually taper, or
- Intratympanic corticosteroids

onging symptoms -> surgery