This document discusses Meniere's disease, a disorder of the inner ear that causes spontaneous episodes of vertigo, hearing loss, and tinnitus. It outlines the potential causes, clinical features, diagnostic tests, treatment options including medications, intratympanic injections, and surgical procedures like endolymphatic sac decompression or vestibular nerve sectioning. Surgical intervention is considered for patients with severe, treatment-resistant vertigo. The goal of treatment is to control vertigo attacks while preserving hearing if possible.
10. Investigation
Electrocochleography
SP/AP ratio > 30%
Caloric test
Reduced response on affected
side
Glycerol test
1.5 ml/kg flavoured diluted glycerol ..PTA done after 1-
2 hrs …10dB gain on PTA…10% gain SDT … improve
ECoG
28. Low dose gentamycin in OPD
40mg/dl 0.2-0.5 ml via insulin syringe
30 minutes wait in position / no swallowing
Seen after 7 days and evaluated
33. Selection criteria
Failed medical treatment
Debilitating vertigo
For both primary and secondary meniere
Improvement in 76-95%
Hearing preserving ---cochlear implantation can be
done
Donot operate in meniere variants!
42. Selection criteria
Severe vertigo
Tumarkin crisis
BEST for Old patients unable to tolerate GA
EASYTO PERFORM
ALMOST FREE FROM MORBIDITY
NO POST OPERATIVEVERTIGO
Hearing preserving
54. Counsel patient!!!
Meniere’s disease can remit spontaneously in
70% within 08 years!!
10-40% chance of involvement of second
ear!!
Tinnitus may or may not resolve after
surgery!!
55. Why do it?
Destroying the end organ can lead to better
and early compensation by the brain
Breaking the connection between the
preganglionic and postganglionic fibres leads
to better takeover by the brain as it consider
it as a complete lesion
56. In whom to do it?
Failed /exhausted medical and conservative
approaches for 1 year
Vertigo severe and debilitating
Dead ear
Having NON SERVICEABLE HEARING
> 50 db HL pure tone av
SRT < 50%
57. What is the trade off?
Taking away the intolerable vertigo and
giving tolerable feeling of imbalance or
motion tolerance in sensory deprived
situations like darkness or walking on cushion
Younger the patient better the tolerance
58.
59.
60.
61.
62.
63.
64.
65.
66. Postop care
Mastoid bandage /head elevation
ITC care
Neuroobservation 24 hrs
24 hrs pt sits up /dangle feet
Vestibular suppressants
Ambulant when static compensation occurs
ALEXANDER LAW guide us!
When nystagmus in opposite gaze 1 degree then
discharge pt
No driving till full compensation
76. complications
CSF leak
Failure to find utricle
Injury to facial nerve
Incomplete labyrinthectomy
Persistent vertigo(neuroepithelial remnant)
Perform caloric test post op to find out
Revision surgery
77. New research
Mostly focused on improving diagnosis via
imaging and other test battery
No major break through in management
Intratympanic steriod has variable success!