menieres-pic.ppt

7/29/2019 menieres-pic.ppt

1/39

Menieres Disease

Samuel Ross Patton, MD

Tomoko Makishima, MD, PhD

Dayton Young, MD

The University of Texas Medical Branch

(UTMB Health)

Department of OtolaryngologyGrand Rounds Presentation

May 29, 2012


2/39

Introduction

hydrops

normal


3/39

Prosper Meniere

1861

History


4/39

Demographics

Incidence: 17/100,000 (Japan)- 5/1000 (Denmark)

Peak Onset: 4th and 5th decade


5/39

Presentation


6/39

Presentation


7/39

Presentation


8/39

Presentation


9/39

Pathophysiology


10/39

Pathophysiology


11/39

Possible Mechanisms

Auto-immune

virus

ischemic


12/39

Schuknecht theory


13/39

Problems with Theory

Merchant Study:

-25 of idiopathic hydrops with no symptoms


14/39


15/39

Natural History

Silverstein Study

8 years

71%

+

10% well controlled


16/39

Diagnosis

History Physical Exam

Audiogram

VEMPs

ECoG

VNG

Blood tests

MRI


17/39

ECoG


18/39

ECoG


19/39

ECoG


20/39

ECoG


21/39

ECoG


22/39

VEMPs


23/39

Classification


24/39

Classification


25/39

Treatments


26/39

Labyrinthectomy

-Selective nerve sectioning

-Intra-tympanic gentimicin

-Endolympatic sac decompression

-Diuretics

-Low Na Diet

-steroids(oral or IT)

Conservative/Medical Treatment

Non-ablative procedures

Non-surgical ablative procedures

Ablative Surgical Procedures


27/39

Medical Therapy


28/39

Diuretics

Cochrane

Review:


29/39

Medical Therapy

Steroids

90%


30/39

Labyrinthectomy




-Diuretics

-Low Na Diet







31/39

Endolymphatic Sac Surgery


32/39

Labyrinthectomy




-Diuretics

-Low Na Diet







33/39

Intratympanic Gentamicin


34/39

Labyrinthectomy




-Diuretics

-Low Na Diet







35/39

Vestibular Nerve Section


36/39

Labyrinthectomy




-Diuretics

-Low Na Diet







37/39

Labyrinthectomy

References


38/39

e e e ces

1Baloh RW. Prosper Meniere and His Disease. Arch Neurol. 2001;58:1151-11562. Boleas-Aguirre MS, Lin FR, Della Santina CC, et al. Longitudinal results with intratympanic dexamethasone in the treatment of Menieres disease.

Otol Neurotol 2008;29:33

3. Burgess A, Kundu S. Diuretics for Mnires disease or syndrome. Cochrane Database of Systematic Reviews. 2006;3:CD003599.

4. Chia SH. Gamst AC. Anderson JP. Harris JP. Intratympanic Gentamicin Therapy for Menieres Disease: A Meta-analysis. Otology &Neurotology. 2004;25:544-552.

5. Crane BT. Schessel DA. Nedzelski J. Minor LB. Peripheral Vestibular Disorders. Otolaryngology Head & Neck Surgery. 5th Edition. 2328-

2345.

6. Diaz RC. LaRouere MJ. Bojrab DI. Zappia JJ. Sargent EW. Shaia WT. Quality-of-Life Assessment of Menieres Disease Patients After

Surgical

Labyrinthectomy. Otology & Neurotology. 2006;28:74-76

7. Merchant SN. Adams JC. Nadol JB. Pathophysiology of Menieres Syndrome: Are Symptoms Caused by Endolymphatic Hydrops? Otology &

Neurotology. 2005;26:74-81.8. . Ferraro JA. Arenberg IK. Hassanein RS. Electrocochleography and Symptoms of Inner Ear Dysfunction. Arch Otolaryngology. 1985;111:71-

74.

9. Ferraro JA. Durrant JD. Electrocochleography in the Evaluation of Patients with Menieres Disease/Endolymphatic Hydrops. J Am Acad Audiol

17:4568 (2006).

10. Nguyen CD. Brackmann DE. Crane RT. Linthicum FH. Hitselberger WE. Retrolabyrinthine Vestibular Nerve Section: Evaluation of Technical

Modification in 143 Cases. American Journal of Otology: 1992;13;4:328-332

11. Pou AM. Hirsch BE, Durrant JD, Gold SR, Kamerer DB. The Efficacy of Tympanic Electrocochleography in the Diagnosis of Endolymphatic

Hydrops. The American Journal of Otology. 1996;16:607-611

12. Quaranta A. Marini F. Sallustio V. Long-term Outcome of Menieres Disease: Endolymphatic Mastoid Shunt vs Natural History. AudiolNeurootol.

1998;3:54-60.

13. Rauch SD. Zhou G. Kujawa SG. Guinan JJ. Herrmann BS. Vestibular Evoked Myogenic Potentials Show Altered Tuning in Patients with

Menieres Disease. Otology & Neurotology. 2004;25:333-338.

14. Rosenberg SI. Silverstein H. Hoffer ME. Thaler E. Hearing Results After Posterior Fossa Vestibular Neurectomy. Otolaryngology Head Neck

Surg. 1996;114:32-7


39/39

References

15. Semaan MT, Megerian CA. Menieres Disease: A Challenging and Relentless Disorder.

Otolaryngol Clin N Am 44 (2011) 383403.

16. Silverstein, H. Smouha E. Jones R. Natural History vs Surgery for Menieres Disease. Otolaryngol Head Neck Surg. 1989100;6.

17. Telischi FF. Luxford WM. Long-Term efficacy of Endolymphatic Sac Surgery for Vertigo in Menieres Disease. Otolaryngology- Head and Neck

Surgery. 1993:109;1:83-7.

18. Timmer FCA. Zhou G. Guinan JJ. Kujawa SG. Herrmann BS. Rauch SD. Vestibular Evoked Myogenic Potential in Patients with Menieres

Disease with Drop Attacks. The Laryngoscope. 2006;116;776-779.

Documents

menieres-pic.ppt