Meniere’S Disease

(Meniere’s disease; Endolymphatic hydrops)

Meniere’s disease is localized in the inner ear disorder that causes dizziness, fluctuating sensorineural hearing loss and tinnitus. A safe diagnostic test does not exist. Dizziness and nausea are treated symptomatically for acute attacks with anticholinergics or benzodiazepines. Frequency and severity of episodes of illness can be reduced as the first choice by diuretics and a low-salt diet. In severe or refractory cases can be carried out (with gentamicin injections by a previously pickled tympanostomy tubes), or surgical ablation of the vestibular a chemical.

When Meniere’s disease is pressure and volume fluctuations in the endolymph act in the labyrinth of the inner ear functions. Etiology of endolymphatic fluid retention is not clear. Possible risk factors, in addition to a family history of Meniere’s disease and autoimmune diseases, allergies, head or ear trauma as well – be syphilis – very rare. The peak incidence is found among 20 to 50 year olds.

Meniere’s disease is localized in the inner ear disorder that causes dizziness, fluctuating sensorineural hearing loss and tinnitus. A safe diagnostic test does not exist. Dizziness and nausea are treated symptomatically for acute attacks with anticholinergics or benzodiazepines. Frequency and severity of episodes of illness can be reduced as the first choice by diuretics and a low-salt diet. In severe or refractory cases can be carried out (with gentamicin injections by a previously pickled tympanostomy tubes), or surgical ablation of the vestibular a chemical. When Meniere’s disease is pressure and volume fluctuations in the endolymph act in the labyrinth of the inner ear functions. Etiology of endolymphatic fluid retention is not clear. Possible risk factors, in addition to a family history of Meniere’s disease and autoimmune diseases, allergies, head or ear trauma as well – be syphilis – very rare. The peak incidence is found among 20 to 50 year olds. Symptoms and complaints Meniere’s patients have sudden dizziness that h usually for 1-6, but up to 24 can stop in rare cases h and associated with nausea and vomiting. Accompanying symptoms sweats may be added (diaphoresis), diarrhea, and unsteadiness. An occurring regardless of position or movement continuous or intermittent tinnitus (buzzing or roaring) in the affected ear, a typical hearing loss – have the consequence – low-pitched sound. Shortly before and during an episode, many patients feel a fullness or pressure in the affected ear. In the majority of patients, only one ear is ill. In early stages, the symptoms always sound again, and the symptom-free intervals between individual disease episodes can last for> 1 year. but persisted with the disease progresses and the hearing loss worsens gradually, even the tinnitus can become chronic. Diagnosis Clinical evaluation audiogram and gadolinium-enhanced MRI to rule out other causes The diagnosis of Meniere disease is provided as a diagnosis of exclusion clinically and primarily because similar symptoms can also at a vestibular migraine, viral labyrinthitis or neuritis, a cerebellopontine angle tumor (z. B. acoustic neuroma) or myocardial infarction (occur in the brain stem area). Although Meniere’s disease can also occur on both sides to increase bilateral symptoms, the probability of an alternative diagnosis (z. B. vestibular migraine). When suspicious symptoms an audiogram and a cranial MRI should be performed (with gadolinium contrast enhancement), and to rule out other causes of this particular attention to the inner ear canals. The audiogram is facing a Niedertonschwerhörigkeit than typical sensorineural hearing loss of the affected ear, which fluctuates between tests. Rinne trial and Weber test (tuning fork test) can also indicate a sensorineural hearing loss. In acute attack a falling tendency of patients seen beside the nystagmus to the affected side. Between attacks, the investigation may turn out normal. For many years or refractory cases with associated labyrinth underactive Fukuda stepping test causes (with eyes closed marching in place) the patient but to devote herself to the side of the affected ear, which is consistent with a unilateral Labyrinthläsion. The Halmagyi-head impulse maneuver is another technique that is used to detect a unilateral labyrinth dysfunction. In this test, the examiner causes the patient to fix a straight befindliches target (for. Example, the nose of the examiner) visually. The examiner then turns as quickly as possible the patient’s head by 15-30 ° to the side while viewing the patient’s eyes. When the vestibular function on the side to which the head was turned, is normal, the patient’s eyes remain fixed on the goal. When the vestibular function on the side to which the head was turned, is disturbed, the vestibulookuläre reflex and the patient’s eyes failed not remain at the target fixed, but instead follow the rotation of the head and then return quickly and voluntarily return to target back (so-called delayed catch-up saccades). Therapy symptom relief with anti-emetics, antihistamines or benzodiazepines diuretics and low-salt diet rare vestibular ablation by medication or surgery Ménière’s disease is self-limiting. Treatment of an acute attack has carried out a relief of symptoms to the goal and, after a specified method. The least invasive measures are tried first, ablative procedures sometimes are used when other measures fail. With anticholinergic antiemetics (. For example prochlorperazine or promethazine, every 6-8 h 25 mg rectally, or 10 mg p.o.) can be attenuated vagally-transmitted gastrointestinal symptoms; Ondansetron is an antiemetic the second choice. Antihistamines (e.g., diphenhydramine, meclizine or cyclizine, 50 mg p.o. every 6 h) can be used or benzodiazepines (5 mg p.o. z. B. diazepam every 6-8 h) for sedation of the vestibular system. Neither antihistamines nor benzodiazepines are suitable for prophylactic treatment. Some doctors treat acute episodes of illness with an oral corticosteroid pulse therapy (eg. As prednisone, po 1 week 60 mg 1 time a day, then one week tapering off) or intratympanischen Dexamethasoninjektionen. A low-salt diet (<1.5 g / day), abstaining from alcohol and caffeine, and taking diuretics (eg., 25 mg hydrochlorothiazide 1 times daily po or 250 mg acetazolamide 2 times daily po) can help advent of vertigo attacks to prevent or reduce and be first applied in general. However, there are no well-designed studies that clearly demonstrate the effectiveness of these measures for Meniere's disease. Although invasive, performs a depressurization of the endolymphatic sac in the majority of patients for correction of fraud and involves just one small (Hörverlust-) risk. Therefore, this method is still classified as one of the vestibular apparatus gentle treatment. If the saving the vestibular treatment attempts fail, an ablative procedure is contemplated. Intratympanisches gentamicin (chemical labyrinthectomy - typically 0.5 ml at a concentration of 40 mg / ml) is injected through the tympanic membrane. To follow a series audiometric examination is recommended to define hearing loss and inner ear toxicity of each other. If there is still a vertigo without hearing loss, the injection after 4 weeks may be repeated. Ablative surgery should be reserved for patients whose common and severely debilitating disease episodes do not respond to less invasive treatment modalities. After an intracranial intervention (neurectomy of the vestibular nerve) of vertigo in 95% of patients decreases and also their hearing usually remains preserved. Only when already there was a high degree of hearing loss, a surgical labyrinthectomy is performed. As the natural progression of hearing loss itself could stop them, unfortunately, is not known. In most patients adapts had a moderate to severe sensorineural hearing of the affected ear within 10-15 years. Summary Meniere's disease usually causes vertigo with nausea and vomiting, unilateral tinnitus and chronic, progressive hearing loss. To rule out other conditions, an audiogram and an MRI are performed. Antiemetics and antihistamines can relieve symptoms. Some doctors also use oral or transtympanische corticosteroids. Invasive treatments for refractory cases comprise a decompression of endolymphatic sac, a labyrinthectomy with gentamicin and neurectomy of N. vestibulars. Diuretics, a low-salt diet and avoiding alcohol and caffeine can prevent seizures.

Health Life Media Team

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