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ENT
Ménière’s Disease
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
10 sections · 114 slides
Overview
- Definition of Ménière's disease
- Prevalence by age group
- Ménière's disease as a referral diagnosis
Aetiology and pathophysiology
- Proposed aetiologies
- Endolymphatic hydrops
- Temporal bone histopathology in Ménière's disease
- Hydrops as histological marker, not cause
- Endolymph production and normal handling
- Obstruction theories of hydrops
- Schuknecht's rupture theory
- Sequence from duct obstruction to vertigo
Clinical features
- The typical attack
- Evolution of the hearing loss
- Lermoyez syndrome and Tumarkin's attacks
- Long-term natural history
- Conversion to bilateral disease
Diagnosis
- Diagnosis is clinical
- 1995 AAO-HNS guidelines for diagnosis of Ménière’s disease
- Amended 2015 criteria for diagnosis of Ménière’s disease
- Clinical practice guidelines for Ménière's disease
- Scope of the differential diagnosis
- Differential diagnosis of Ménière’s disease
- Differential diagnosis of Ménière’s disease (continued)
- Vestibular migraine and migraine-associated vertigo
- Cochlear symptoms in vestibular migraine
- Overlap of vestibular migraine and Ménière's disease
Investigations
- Audiometry
- Caloric testing
- Video head impulse test
- Vestibular evoked myogenic potentials
- Electrocochleography
- Rotational chair testing
- Magnetic resonance imaging with gadolinium
- Time course of intratympanic gadolinium
- Computed tomography of the temporal bone
Conservative management
- Goals of treatment
- Acute vertigo management
- Limits of vestibular suppressants
- Diet and lifestyle modification
- Diuretic therapy
- Choice of diuretic and monitoring
- Betahistine: pharmacology
- Betahistine: vascular and central theories
- Betahistine: evidence and dosing
- Histamine in the authors' practice
- Allergy in Ménière's disease
- Indications for allergy testing
- Meniett device
- Evidence for positive pressure therapy
- Oral steroids
- Rationale for transtympanic steroids
- Evidence for transtympanic dexamethasone
- Transtympanic dexamethasone in practice
- Ménière’s disease management algorithm and outcomes: conservative
- Ménière’s disease management algorithm and outcomes: ablative
- Stepwise escalation of treatment
Endolymphatic sac surgery
- Evolution of endolymphatic sac surgery
- The sham surgery controversy
- Decompression versus mastoid shunt
- Steps of endolymphatic sac decompression
- Location of the endolymphatic sac at surgery
- Outcomes of sac surgery
Ablative therapy
- Principle of vestibular ablation
- Routes of vestibular ablation
- Vestibular compensation after ablation
- Transtympanic gentamicin: rationale and route
- Mechanism and drawbacks of gentamicin
- Prerequisites before gentamicin
- Fixed dose gentamicin protocol
- Outcomes of fixed and titrated regimens
- Meta-analysis of intratympanic gentamicin
- Streptomycin for bilateral disease
- Selective vestibular nerve section
- Nerve anatomy from root entry zone to fundus
- Approaches for vestibular nerve section
- Retrolabyrinthine and retrosigmoid technique
- Retrolabyrinthine vestibular nerve section, right ear
- Risks and efficacy of nerve section
- Indication for labyrinthectomy
- Transcanal labyrinthectomy
- Traumatic neuroma after transcanal labyrinthectomy
- Skeletonised right ear before labyrinthectomy
- Transmastoid labyrinthectomy
- Sequential labyrinthectomy of a right ear
- Outcomes of complete labyrinthine ablation
- Burn-out and the case for patience
Adjunctive and experimental options
- Cochlear implantation in Ménière's disease
- Simultaneous labyrinthectomy and implantation
- Vestibular implants: concept
- Vestibular implant surgery and results
Summary
- Key points on diagnosis
- Key points on management
- Counselling the patient
- References
- References (continued)
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- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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