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Wednesday, February 16, 2011

MENIERE'S DISEASE

This is a disorder of the inner ear in which there is excessive pressure and dilatation of the endolymphatic system. This results in damage to both the vestibular and cochlear sense organs. The cause is unknown, although there is some overlap with other functional vasospastic disorders such as migraine.


Clinical symptoms
Symptoms rarely start before middle age; the patient suffers from recurrent bouts of profound vertigo, nausea and vomiting associated with deafness (especially for middle and low frequencies) and tinnitus. Acute attacks may be preceded by discomfort in one ear, and increasing tinnitus and deafness. The attack usually lasts several hours or a day, and is accompanied by prostration, pallor, vomiting, nystagmus and occasionally by syncope. Deafness and tinnitus tend to persist between attacks and sensorineural mid-low frequency hearing loss with loudness recruitment may be found on audiometry. Caloric tests show impaired vestibular function on the affected side.

Management
Bed rest and administration of vestibular sedatives are required during acute attacks. Cinnarizine (15-30 mg t.i.d) or prochlorperazine 5-10 mg t.i.d) or prochlorperazine (5-10 mg t.i.d) suppress vertigo and vomiting. In more severe attacks, intramuscular injection of prochlorperazine 12.5 mg or cyclizine 50 mg may be required. Some authorities also give intravenous diuretics (frusemide 40 mg i.v.) to try to reduce the endolymphatic pressure. Prophylaxis from recurrent episodes is sometimes effective with vasodilators such as betahistine (8mg t.i.d.), but if disabling attacks continue or hearing deteriorates progressively, surgical endolymph drainage may be necessary.

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