1. Saurabh Gupta
Prof. (Dr.) S. K. Jaiswal unit

2. Introduction
 Meniere's disease (idiopathic endolymphatic hydrops)
is a disorder of the inner ear associated with a
symptoms consisting of spontaneous, episodic attacks
of vertigo; sensorineural hearing loss which usually
fluctuates; tinnitus; and often a sensation of aural
fullness.
 dramatic variability is the hallmark of this disease.

3. Introduction : History
 First described by Prosper
Meniere in 1861.
 In 1902, Parry performed a
CN VIII division for vertigo
in a patient with suspected
Meniere’s disease.
 Portman did
endolymphatic sac
decompression via a
transmastoid approach in
1926.
 In 1931,McKenzie
performed a selective
vestibular neurectomy.

4. Pathology
 Distortion of the membranous labyrinth.
 This condition reflects the changes in the anatomy of
the membranous labyrinth as a consequence of the
over-accumulation of endolymph.
 Mainly affects scala media and saccule
 Bulging of reissner’s membrane
 Saccule may come to lie against the stapes footplate.

6. Etiology
A. Defective absorption by endolymphatic sac-
• Poor vascularity of sac
• Less absorptive tubular epithelium
• increased perisaccular fibrosis
B. Rupture of reissner’s membreane leading to mixing of
perilymph & endolymph- Schuknecht
• allow leakage of the potassium-rich endolymph into
the perilymph, bathing the eighth cranial nerve and
lateral sides of the hair cells

8. Etiology
 Spasm of int. auditory artery – Sym. Overactivity
 Allergy – inner ear is shock organ
 Sodium & water retention
 Hypothyroidism
 Autoimmune
 Viral

10. Clinical features
 Affects in 4th -5th decade of life
 Male:Female 1:1
 Prevalence more in whites.
 VERTIGO : episodic attacks , asso. with nystagmus,
nausea & vomiting , vagal disturbance
 Tullio phenomenon may be seen

11. Clinical features
 HEARING LOSS
1. Fluctuating
2. SNHL
3. Progressive
4. Unilateral
5. Distortion of sound
6. Intolerance to loud sound

12. Clinical features
 TINNITUS
1. Low pitched roaring
2. Subjective
3. Unilateral
 AURAL FULLNESS
1. Fluctuates , in prodromal phase

13. Diagnosis

14. Investigations
 Tuning forks tests :
SNHL
 PTA
 Speech audiometry
 Recruitment test +ve
 SISI >70%
 Tone decay <20 dB

15. Investigations
 Caloric testing – canal paresis
 ENG
 Head Thurst test
 ECoG – SP is larger & more negative
 SP/AP ratio increases > 30%
 Glycerol test
 VEMP – elevated threshold

16. VEMPs

17. Staging
STAGE PURE TONE AVERAGE IN dB IN PREVIOUS 6 MONTHS
1 = < 25
2 26-40
3 41-70
4 >70

18. Variants
 Cochlear hydrops – no vertigo
 Vestibular hydrops – no heaing loss
 Drop attacks
 Lermoyez syndrome- hearing loss followed by vertigo

19. Treatment
 Medical management –
 ACUTE stage : labyrinth sedatives + anti-emetics
 Carbogen, Histamine drip
 Frustenberg Regimen -
1. Low salt diet
2. Diuretics + Pot. chlor
3. High protein
 Beta histine – to relieve vascular ischemia
 Stop caffeine, nicotine, alcohol & tobacco

20. Non ablative procedures
 Portman -1926
 Endolymphatic sac surgery
1. Subarachnoid shunt
2. Mastoid shunt

21. Non ablative procedures
 Intratympanic steroids
 May benefit in autoimmune causes of meniere’s
syndrome.
 Sacculotomy
 Cochleosacculotomy

22. Ablative procedures
 Intratympanic gentamicin – Schuknecht (1957)

23. Ablative procedures
 Selective Vestibular nerve sectioning

24. Ablative procedures
 Ultrasonic destruction of vest. Labyrinth
 Cryodestruction
 Labyrinthectomy - when cochlear function has been
totally deteoriated ,higher rate of vertigo control seen
than that typical for vestibular neurectomy

25. Recent advances
 decrease hydrops by pulsing pressure in the middle
ear
 Meniett device - handheld air pressure generator that
the patient self-administers
 The pressure is delivered in complex pulses of up to
20 cm of water, over a 5 minute period.
 The device requires a ventilation tube to be placed in
the tympanic membrane before initiation of therapy

26.  Pressure at the RW passes to perilypmh and decreases
pressure in endolymph by redistributing it.