Recommandé
Contenu connexe
Tendances
Tendances (20)
Similaire à Menieres disease
Similaire à Menieres disease (20)
Dernier
Dernier (20)
Menieres disease
- 3. Endolymphatic hydrops Disorder of inner ear where the endolymphatic system is distended
- 4. Episodic Vertigo low frequency SNHL Low pitched Tinnitus Aural Fullness
- 5. Distention of endolymphatic system Affecting the cochlear duct and the saccule , and to some extent utricle and saccule
- 16. Distention of endolymphatic system Increased production or decreased absorption
- 17. Postulates are 1.defective absorption Ishemia of the endolymphatic sac poor vascularity and poor absorption 2. vasomotor disturbances Sympathetic over activity - spasm of the of internal auditory artery – cochlear and vestibular neuroendothelial dysfunction (deafness and vertigo )
- 18. Anoxia of stria vascularis- causes transudation and increased production of endolymph 3 . Allergy :food stuff or inhalant – inner ear produces excess endolymph 50% of MD suffering from allergy (food or inhalational ) 4. Sodium and water retention : increased production of endolymph 5.Auto immune and viral etiologies
- 19. Vertigo episodic vertigo accopmpanied by nausea and vomiting with nystagmus Sudden onset, comes in clusters with spontaneous remission and for weeks months or years Vagal disturbances abd. Cramps ,diarrhoea cold sweats . Pal;lor and bradycardia Tullio phenomenon
- 20. Usually accompanies vertigo or may precede it fluctuating hearing loss- Normal hearing after the attack and during remission Recurrent attacks leading to slow and permanent deterioration of hearing Intolerance to loud sound
- 21. Low pitched roaring or hissing type Aggravated during attack May persists during remission Change in the character of the tinnitus may be a warning symptom of a new attack
- 22. It may accompany or precedes the vertigo
- 23. Otoscopy normal Nystagmus only during acute attack TFT: SNHL
- 24. PTA low frequency SNHL
- 25. SPEECH AUDIOMETRY 55-85% is normally during remissions and much impaired during and immediately following attack
- 26. Recruitment positive SISI better than 70% Tone decay less than 20 db Shows cochlear nature of the disease than retro cochlear
- 27. Dehydrating agent ,when given orally will reduce endolymph 1.5mg /kg with water PTA and speech discrimination recorded before and after 1-2 hours 10 db improvement in PTA 10 % gain in speech discrimination No improvement for tinnitus and sense of fullness Diagnostic and prognostic value
- 28. General measures Cessation of smoking Low salt diet Avoid excessive intake of water Avoid coffee tea and alcohol Stress releving methods Avoid activities requiring body balance Flying , underwater diving.heights
- 29. Reassurance Bed rest Vestibular sedatives Prochlorperazine / promethazine Diazepam
- 30. Carbogen inhalation 5% co2 +95%o2 Histamine drip - histamine diphosphate 2.75mg dissolved in 500 ml glucose given IV
- 31. Vestibular sedatives Prochoperazine 10 mg Vasodilators Diuretics Propantheline bromide Elimination of allergen Hormonal replacement Intratympanic gentamycin therapy
- 32. 1. COSERVATIVE PROCEDURES 2. DESTRUCTIVE PROCEDURES
- 38. Labyrinthectomy 1.Through LSCC By transmastoid approach 2. Oval window through trans canal approach