SEP 25th 2023

Ménière
disease
Group: 53 A
Jerin, Jemarin
Joshi, Keyuri Unmeshkumar
Mahesh, Krithik (Leader)
Mani, Arun Prakash
Group: 53 A

Thakkar Mosam Bharatkumar

Ray, Amit Kumar
Saravanan, Hemnath
Tamboli, Nikunj Suresh
 SEP 25th 2023
INTRODUCTION
Otolaryngology is a medical specialty which
is focused on the ears, nose, and throat. It is
also called otolaryngology-head and neck
surgery because specialists are trained in
both medicine and surgery. An
otolaryngologist is often called an ear, nose,
and throat doctor, or an ENT for short.
Group: 53 A
MENIERE’S DISEASE

Ménière disease is a disorder caused by build of fluid in the chambers in the inner ear. It causes symptoms such as
vertigo, nausea, vomiting, loss of hearing, ringing in the ears, headache, loss of balance, and sweating.

Ménière disease is a disorder of the inner ear that is also known as idiopathic endolymphatic hydrops. Endolymphatic
hydrops refers to a condition of increased hydraulic pressure within the inner ear endolymphatic system. Excess
pressure accumulation in the endolymph can cause a tetrad of symptoms: (1) fluctuating hearing loss, (2) occasional
episodic vertigo (usually a spinning sensation, sometimes violent), (3) tinnitus or ringing in the ears (usually low-tone
roaring), and (4) aural fullness (eg, pressure, discomfort, fullness sensation in the ears).
Physiology

SEP 25th 2023

Meniere's disease appears to involve overproduction
or decreased absorption of endolymph, with resultant
degeneration of vestibular and cochlear hair cells.
Recurrent attacks result in progressive sensorineural
hearing loss (especially low tones), usually unilateral
in nature
PATHOPHYSIOLOGY
MD is characterized during its active phase with the characteristic symptom triad, of episodic vertigo and tinnitus with
fluctuations in hearing, followed by a symptom‐free period, ultimately resulting in a more permanent dysfunction of the
above symptoms. Any theory attempting to explain the pathophysiology of MD has to account for processes that result in a
reversible dysfunction of both the cochlea and vestibule, with long ‐term chronic deficits. Examples of reversible causes
include noise, toxins such as salicylates, viral infections and immune ‐mediated mechanisms, most of which do not show
morphological changes unless they turn permanent.

This suggests a possibility of a final common pathway in a variety of conditions that could all result in fluctuating cochlear
and vestibular dysfunction. The exact mechanisms are not clearly elucidated, with noise ‐related damage being a notable
exception. In all cases, a persistence of the metabolic dysfunction results in permanence. Hence, it may be inferred that
MD is modeled on the pathophysiology of disorders wherein abnormalities of metabolic dysfunction result in a permanent
vestibulocochlear dysfunction.

The problem in MD is thought to be malabsorption of endolymph, mainly in the duct or sac. This outflow dysfunction is
usually a slow process, the inciting etiological event having occurred possibly years earlier.
 SEP 25th 2023
Causes and
Risks factors
Group: 53 A
SEP 25th 2023
Pathology
 Clinical Manifestations

SEP 25th 2023

Group: 53 A
Group: 53 A

Diagnosis
 Treatment

SEP 25th 2023

No cure exists for Meniere's disease. Some treatments can help lessen
how bad vertigo attacks are and how long they last. But there are no
treatments for permanent hearing loss. Your health care provider may be
able to suggest treatments that prevent your hearing loss from getting
worse.

Healthcare providers may start with treatments to reduce pressure on your inner ear
from high endolymph levels. They may also prescribe medications to help with vertigo,
including:

Diuretics: This medication reduces the amount of fluid in your body. Reducing fluid
overall may bring down inner ear fluid levels.
Motion sickness medications: These medications help control vertigo episodes.
Antihistamines: This medication may reduce vertigo attacks
Intratympanic steroid injection: A medical provider may inject steroids through your
eardrum as a means of controlling episodes of Ménière’s disease.
TREATMENT

If other treatments don’t reduce symptoms, healthcare providers may use surgery to treat very severe cases of Ménière’s
disease. Surgical options include redirecting or relieving the pressure from the inner ear fluid, such as:

Endolymphatic sac procedure: Your endolymphatic sac is a hollow pouch that drains inner ear fluid. In endolymphatic sac
procedures, providers release fluid by cutting into the sac. They may place a stent in the sac so fluid continues to drain
from the sac.

Vestibular nerve section: Your vestibular nerve helps regulate balance and hearing. Removing the nerve helps with vertigo
and reduces hearing loss.

Labyrinthectomy: This surgery removes your labyrinth, the part of your inner ear that controls balance. Providers typically
do this surgery only after you’ve lost hearing in your affected ear.
MANAGEMENT

Oral medication
- Short term: To relief symptoms during attacks
- Long term: To reduce the pressure in inner ear

• Steroid or gentamicin injection

• Pressure pulse treatment (more evidence needed)

• Surgery
- Endolymphatic sac decompression
- Vestibular nerve section
- Labyrinthectomy
 Management

SEP 25th 2023

Medicines such as meclizine (Antivert) or diazepam (Valium),
may lessen the spinning feeling and help control nausea and
vomiting. Anti-nausea medicines. Medicines such as
promethazine, might control nausea and vomiting during a
vertigo attack. Diuretics and betahistine
 SEP 25th 2023
Thank You
Doc!
Group: 53 A