Ménière’s disease MCQ

Introduction

• Ménière’s disease is a chronic disorder of the inner ear that affects balance and hearing.
• It is characterized by episodes of vertigo, tinnitus, hearing loss, and a feeling of fullness in the ear.
• The exact cause is unknown, but it is thought to involve abnormal fluid (endolymph) buildup in the inner ear.

Anatomy and Physiology

• The inner ear contains the cochlea (for hearing) and the vestibular system (for balance).
• Both structures are filled with fluid: perilymph and endolymph.
• Proper fluid regulation is essential for normal auditory and vestibular function.

Pathophysiology

• Ménière’s disease involves an increase in endolymphatic fluid, leading to increased pressure in the inner ear.
• This pressure affects the hair cells responsible for hearing and balance, leading to the symptoms of the disease.
• Potential contributing factors include genetics, autoimmune responses, allergies, and viral infections.

Definite” and “probable” Meniere’s disease are classifications used to help diagnose and describe the condition based on the presence and pattern of symptoms.

1. Definite Meniere’s Disease:

• Diagnostic Criteria:
• At least two episodes of vertigo, each lasting 20 minutes to 12 hours.
• Audiometrically confirmed sensorineural hearing loss on at least one occasion, in the affected ear.
• Tinnitus (ringing in the ear) or a feeling of fullness in the affected ear.
• Symptoms cannot be better explained by another vestibular diagnosis.

2. Probable Meniere’s Disease:

• Diagnostic Criteria:
• At least two episodes of vertigo or dizziness, each lasting 20 minutes to 24 hours.
• Symptoms of fluctuating hearing, tinnitus, or aural fullness in the affected ear, but without confirmed hearing loss as seen in definitive cases.
• Symptoms cannot be better explained by another diagnosis.

Symptoms

1. Vertigo: Sudden, severe spinning sensation lasting minutes to hours; associated with nausea and vomiting.
2. Hearing Loss: Fluctuating, often low-frequency hearing loss in the early stages; can become permanent and progressive.
3. Tinnitus: Ringing, buzzing, or roaring noise in the affected ear.
4. Aural Fullness: A feeling of pressure or fullness in the ear.

Diagnosis

• Diagnosis is clinical, based on patient history and symptom patterns.
• Audiometric testing shows fluctuating hearing loss, primarily affecting lower frequencies.
• Vestibular testing (e.g., electronystagmography) may demonstrate balance dysfunction.
• MRI can be used to rule out other conditions, such as acoustic neuroma.

Management

• There is no cure, but symptoms can be managed to improve quality of life.

Non-Surgical Treatments

1. Dietary Modifications: Low-sodium diet to reduce fluid retention; avoiding caffeine and alcohol.
2. Medications:
• Diuretics to reduce fluid buildup.
• Anti-vertigo medications (e.g., meclizine, diazepam) to control vertigo symptoms.
• Antiemetics for nausea.
• Corticosteroids (oral or intratympanic) to reduce inflammation.
3. Vestibular Rehabilitation: Physical therapy to improve balance and reduce dizziness.
4. Hearing Aids: For hearing loss management.
5. Lifestyle Changes: Stress management and avoidance of known triggers.

Surgical and Invasive Treatments

1. Intratympanic Injections: Gentamicin to reduce vertigo (can cause further hearing loss) or corticosteroids.
2. Endolymphatic Sac Surgery: Decompression or shunt to reduce fluid pressure.
3. Labyrinthectomy: Removal of the balance organ (in cases with severe, intractable vertigo and hearing loss).
4. Vestibular Nerve Section: Cutting the nerve to the balance organ to stop vertigo while preserving hearing.

Prognosis

• The disease has a variable course, with periods of remission and flare-ups.
• Over time, many patients experience a reduction in vertigo but may have persistent hearing loss or balance issues.

Recent Advances and Research

• Research is ongoing into the pathophysiology of Ménière’s, including genetic and immunological factors.
• Potential future treatments include gene therapy and advanced inner ear drug delivery systems.

Conclusion

• Ménière’s disease is a challenging condition that affects quality of life but can be managed with a combination of lifestyle changes, medications, and in some cases, surgical intervention.
• Multidisciplinary management involving otolaryngologists, audiologists, and physical therapists can provide the best outcomes for patients.

Key Takeaways

• Early diagnosis and management are crucial to preserving hearing and balance function.
• A tailored approach, considering individual symptom patterns and response to treatment, is essential in managing Ménière’s disease.

This concludes the lecture on Ménière’s disease. If there are any questions or specific areas you would like to explore further, feel free to ask!