Meniere’s disease &

labyrinthitis

Presented by:Jessica Faye G. Manansala

Anatomy of the inner ear The inner ear is house deep within the

temporal bone. The organs of hearing (cochlea) and balance (semicircular canals), as well as the cranial nerves VII (facial nerve) and VIII (vestibulocochlear nerve)

Cochlea and semicircular canals – are housed in the bony of labyrinth.

Bony labyrinth – surrounds and protect the membranous labyrinth, which is bathed in a fluid called perilymph

Membranous labyrinth – it contains a fluid called endolymph(posterior,superior , inferior & lateral).

- Contains sensory receptor organs, arrange to detect rotational movement.

- These receptor end organs are stimulated by changes in the rate or direction of an individual movement.

Organ of orti

Snale shape bony tube about 3.5 cm long with 2 and one half spiral turns

The organ of orti called the end organ of hearing, transform mechanical energy into neural activity and seperates sound into diff frequencies. This electrochemical impulse travels through the acoustic nerve to the temporal cortex of the brain.

Vertigo Vertigo is defined as misperception or

illusion of motion of the person or the surroundings.

Most person with vertigo describe a spinning sensation or say they feel as though objects are moving around them

Signs and symptoms Nausea or vomiting Sweating and/or  Abnormal eye movements.

Meniere’s disease Meniere’s disease is an abnormal inner

ear fluid balance caused by malabsorption in the endolymphatic sac

People with meniere’s disease may have blockage in the endolymphatic duct.

CauseIncrease pressure in the system or

rupture of the inner ear membranes that producing meniere’s symptoms.

Clinical manifestations Fluctuating Progressive sensorineural hearing

loss Tinnitus Feeling of pressure or fullness in the

ear Episodic Incapsulating vertigo with nausea

and vomiting

2 subsets of Meniere’s Disease1. Cochlear Meniere’s Disease

Is recognized as fluctuating, progressive sensory neural hearingloss, tinnitus and aural pressure.

2. Vestibular Meniere’s Disease Occurrence of episodic vertigo

associate with aural pressure but no cochlear symptoms.

Normal labyrinth Dilated labyrinth

Diagnostic test Weber test- sound from a tuning fork

(may lateralize to the ear opposite the hearing loss, the one affected with meniere’s disease)

Audiogram – reveals a sensorineural hearing loss in the affected ear. In the form of “Pike’s Peak” pattern.

Medical management Low sodium diet – sodium and fluid retention

disrupts the delicate balance btw endolymph and perilymph in the inner ear.

Pharmacologic theraphy Antihistamine meclizane (antivert) – supresses

the vestibular system Tranquilizer (diapezam) valium – used acute

instances to help control vertigo. Antiemetic (promethazine/phenergan) –

suppositories help control nausea and vomiting and vertigo because of antihistamine effect.

Diuretic theraphy (hydrochlorothiazide) – reduce symptoms by lowering the pressure in the endolymphatic system.

Surgical management Endolymphatic sac decompression (shunting) –

equalizes the pressure in the endolyphatic space

- A shunt or drain is inserted ion the endolymphatic sac through a postauricular incision.

middle ear perfusion – ototoxic medication (streptomycin or gentamicin) can be given to pt. by infusion into the middle and inner ear.

-this meds used to decrease vestibular function and decrease vertigo. It requires overnight stay because imbalance that last several weeks.

Intraotologic catheter- to provide a conduit from the outer ear to the inner ear. It is used to treat sudden hearing loss and various disorder causing intractable vertigo.

Vestibular nerve section

labyrinthistis Inflammation of the inner ear can be

bacterial or viral in origin. Infection can enter the inner ear by

penetrating the membranes of the oval or round windows (membrane).

Cause of labyrinthitis are viral diseases like:

mumps Rubella Rubeola influenza

Clinical manifestations Sudden incapacitating vertigo Nausea and vomiting Various degrees of hearing loss Possible tinnitus

Management Bacterial - IV antibiotic theraphy, fluid

replacement and administration of vestibular suppresant (meclizine and antiemetic).

The end!