Treatments for Meniere’s Disease

Treatments for Meniere’s Disease
Presentation lecture by:Alan L. Cowan, MD

Tomoko Makishima, MD, Ph.D
Definition:Meniere’s Disease is a disorder of the inner ear that can affect hearing and balance.

History
Physiology
* Perilymph
o Located in the Scala Vestibuli / Tympani
o Similar in composition to CSF
o High Na+, Low K+
* Endolymph
o Located in the Scala Media
o Similar in compostion to ICF
o Low Na+ High K+
o Site of production in Stria Vascularis
* Membranous Labyrinth separates the compartments
o No difference in pressure

Pathophysiology
* Endolymphatic hydrops leads to distortion of membranous labyrinth
* Reisner’s membrane can be seen bulging into the scala vestibuli in some histologic studies
* Microruptures may lead to episodic attacks which resolve when the tears heal
* Theories behind endolymphatic hydrops
o Obstruction of endolymphatic duct/sac
o Hypoplasia of endolymphatic duct/sac
o Alteration of absorption of endolymph
o Alteration in production of endolymph
o Autoimmune insult
o Vascular origin
o Viral etiology

Diagnosis
* Meniere’s is diagnosed by
o Vertigo
+ Spontaneous, lasting minutes to hours
+ Recurrent, must have more than 1 episode
+ Associated with nystagmus
o Hearing loss
+ Fluctuating sensorineural
+ Low-frequency or flat
o Tinnitus
* Vertigo treatment reporting standard
* Hearing treatment reporting standard

* Meniere’s is diagnosed by
o Vertigo
+ Spontaneous, lasting minutes to hours
+ Recurrent, must have 2 episodes > 20 min.
+ Nystagmus during episodes
o Hearing loss
+ Avg (250, 500, 1000) 15 dB < Avg (1000, 2000, 3000) or
+ Avg (500, 1000, 2000, 3000) 20 dB > than other ear
+ For bilateral disease Avg (500, 1000, 2000, 3000) > 25 dB in the studied ear
o Tinnitus
+ No guidelines
o Aural pressure
+ No guidelines

* Possible Meniere's
* Probable Meniere's disease
* Definite Meniere's disease
* Certain Meniere's disease
* Functional Level Scale

Reporting Results of Treatment
Placebo Effect
Medical Therapy
Acute Therapy
Vasodilators
Diuretics and Salt restriction
Diuretics
Water Therapy
Meniett Device
Intratympanic Therapy
Intratympanic Steroids
Intratympanic Ablation
Intratympanic Gentamicin
Low dose therapy
Multiple Daily Dosing
Titration Therapy
Intratympanic Gent
Surgical Therapy
Endolymphatic Sac Surgery
* Types of procedures
o Decompression: removal of bone overlying the sac
o Shunting: placement of synthetic shunt to drain endolymph into mastoid
o Drainage: incision of the sac to allow drainage
o Removal of sac: excision of the sac. Some believe the sac may play a role in endolymph production

Endolymphatic Sac Surgery
Vestibular Nerve Section
Labyrinthectomy
Vestibular Suppressants
Diuretics Salt Restriction
Vasodilators ? Water Therapy
Alternative Therapies Meniett
Herbal
Hypnosis
Intratympanic Steroid Therapy
Intratympanic Gentamicin Therapy
Surgical Ablation
Nerve Section
Labyrinthectomy
Mastoid Shunt
Final Thought
Bibliography

Treatments for Meniere’s Disease.ppt