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MENIERS DISEASE.

PROF SHAHIDIN. DEPARTMENT OF ENT KTH.

Monday, April 21, 2014

MENIERS DISEASE

Monday, April 21, 2014

Monday, April 21, 2014

CENTRAL LEISIONS CAUSING VERTIGO.


INFLAMMATORY. Meningitis. Brain abscess. Encephalitis. SPACE OCCUPYING. Neoplasms of CNS. Arachnoid cysts. VASCULAR. Internal auditory artery lesion. Inferior posterior cerebellar artery lesion. Vertebral basilar insufficiency. .
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CENTRAL LESIONS CAUSING VERTIGO.


SYSTEMIC. Toxins Genetics. Multiple sclerosis TRAUMATIC. Brain concussion. AUTONOMIC NERVOUS. NEONATAL. Developmental anomalies. Anoxia,neonatal jaundice, prematurity.
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PERIPHERAL LESIONS CAUSING VERTIGO.


MIDDLE EAR. Inflammatory. Otitis media. Atmospheric. Tubal obstruction. Aerotitis. LABRYNTH. Labrynthitis. Vestibular neuronitis. Haemorrhage. Ischemia. Allergy. Hydrops. Otosclerosis.
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SYSTEMIC DISEASES. Bacterial. Viral. Metabolic. Hematogenous. Drugs. NEOPLASTIC LESIONS. Malignant tumours. Benign tumours.(Glomous,Acoustic) TRAUMA. Fracture temporal bone. Labrynthine concussion. Acoustic trauma.
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1985 CRITERIA FOR THE DIAGNOSIS OF MENIERS DISEASE.


Fluctuating, progressive, sensorineural hearing loss associated with tinnitus-the deficit is characteristically of low frequency or flat type. 2. Vertigo-Spontaneously occurring sensation of movement hat is accompanied by unsteadiness and lasts from minutes to hours. More than one attack is needed to establish the diagnosis. Definite spell- often prostrating, often accompanied by nausea and vomiting. Patient oriented and conscious, no neurological sequelae. Horizontal or horizontal rotatory nystagmus is always present during definite spell.
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1995 CRITERIA FOR THE DIAGNOSIS OF MENIERS DISEASE.


Recurrent spontaneous episodic vertigo. Definite spell-Spontaneous rotational vertigo lasting at least 20 minutes (commonly several hours),often prostrating ,accompanied by disequilibrium that may last several days; usually nausea (commonly vomitting or retching); no loss of consciousness.Horizontal or horizontal rotatory nystagmus is always present. 2. Hearing loss (not necessarily fluctuating). 3. Either aural fullness or tinnitus or (both).
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1995 CRITERIA FOR THE DIAGNOSIS OF MENIERS DISEASE.


Certain meniers disease is Definite, disease with histopathological confirmation. Definite, Meniers disease requires two or more definite episodes of vertigo with hearing loss plus tinnitus and or aural fullness. Probable, Meniers disease needs only one definite episode of vertigo and the other symptoms and signs. Possible, Meniers disease is defined as definite vertigo with no associated hearing loss or hearing loss with non definite disequilibrium.
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MEDICAL TREATMRNT OF ACUTE ATTACK OF MENIERS DISEASE.


DRUG.
Anticholenergics Scopolomine. Antihistamines. Dimenhydramine. Meclizine. Promethazine. Phenothiazine. Butyrophenone. Diazepam. Clonazepam
Monday, April 21, 2014

DOSAGE.
0.6 mg qid
50mg tds I.M, 4-6 hours 25mg tds 15 or 50mg tds 5 or 10 mg tds 2.5 or 5 mg IM Bd 5 or 10 mg qid 0.5 mg tds

ACTION.
muscarine antagonist
H1 Antagonist muscrine antagonist H1 Antagonist H1 anagonist muscarine antagonist Dopamine antagonist GABA A antagonist GABA A antagonist
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SURGICAL PROCEDURES TO TREAT MENIERS DISEASE.


CONSERVATIVE PROCEDURES. A. Extra labrynthine. Endolymphatic sac enhancement. Endolymphatic sac revision. Symphethectomy. B. Invasive of the labyrinth. Sacculotomy. Cochleosacculotomy. Stapedectomy-Sacculotomy.
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SURGICAL PROCEDURES TO TREAT MENIERS DISEASE.


PARTIALLY DESTRUCTIVE PROCEDURES. A. VESTIBULAR NERVE SECTION. Through the middle fossa Retrolabrynthine approach. Retrosigmoid approach. Combined retrolabrynthine_ retrosigmoid vestibular neurectomy. B. SINGULAR NEURECTOMY. C. ULTRASONIC IRRADIATION OF THE LABYRINTH. D. CRYOSURGERY. E. MEDICAL ABBLATION WITH/WITHOUT EXPLORATORY TYMPANOTOMY.
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SURGICAL PROCEDURES TO TREAT MENIERS DISEASE.


DESTRUCTIVE LABYRINTHECTOMIES.
A.

Transtympanic.
Labyrinthectomy extended to the oval window. Trans canal labyrinthectomy. Trans meatal labyrinthectomy.

B.

Transmastoid.
Trans mastoid labyrinthectomy. Trans labyrinthine section of the vestibular nerve. Labryinthotomy throug the horizontal canal. Labyrinthectomy through the middle fossa.
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Monday, April 21, 2014