Menieres Disease

Samuel Ross Patton, MD Tomoko Makishima, MD, PhD Dayton Young, MD The University of Texas Medical Branch (UTMB Health) Department of Otolaryngology Grand Rounds Presentation May 29, 2012

Introduction

normal hydrops

History

Prosper Meniere
1861

Demographics

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

Peak Onset: 4th and 5th decade

Presentation

Presentation

Presentation

Presentation

Pathophysiology

Pathophysiology

Possible Mechanisms

Auto-immune

virus

ischemic

Schuknecht theory

Problems with Theory

Merchant Study: -25 of idiopathic hydrops with no symptoms

Natural History
Silverstein Study

57%

43%

Natural History
Silverstein Study

8 years

71%

+
10% well controlled

Diagnosis

History

Physical Exam

ECoG

Audiogram VEMPs

Blood tests MRI VNG

ECoG

ECoG

ECoG

ECoG

ECoG

VEMPs

Classification

Classification

Treatments

Labyrinthectomy

Ablative Surgical Procedures

-Selective nerve sectioning

Non-surgical ablative procedures -Intra-tympanic gentimicin

Non-ablative procedures
-Endolympatic sac decompression

Conservative/Medical Treatment
-Diuretics -Low Na Diet -steroids (oral or IT)

Medical Therapy

Diuretics

Cochrane Review:

Medical Therapy

Steroids
90%

Labyrinthectomy

Ablative Surgical Procedures

-Selective nerve sectioning

Non-surgical ablative procedures -Intra-tympanic gentimicin

Non-ablative procedures
-Endolympatic sac decompression

Conservative/Medical Treatment
-Diuretics -Low Na Diet -steroids (oral or IT)

Endolymphatic Sac Surgery

Labyrinthectomy

Ablative Surgical Procedures

-Selective nerve sectioning

Non-surgical ablative procedures -Intra-tympanic gentimicin

Non-ablative procedures
-Endolympatic sac decompression

Conservative/Medical Treatment
-Diuretics -Low Na Diet -steroids (oral or IT)

Intratympanic Gentamicin

Labyrinthectomy

Ablative Surgical Procedures

-Selective nerve sectioning

Non-surgical ablative procedures -Intra-tympanic gentimicin

Non-ablative procedures
-Endolympatic sac decompression

Conservative/Medical Treatment
-Diuretics -Low Na Diet -steroids (oral or IT)

Vestibular Nerve Section

Labyrinthectomy

Ablative Surgical Procedures

-Selective nerve sectioning

Non-surgical ablative procedures -Intra-tympanic gentimicin

Non-ablative procedures
-Endolympatic sac decompression

Conservative/Medical Treatment
-Diuretics -Low Na Diet -steroids (oral or IT)

Labyrinthectomy

References
1Baloh RW. Prosper Meniere and His Disease. Arch Neurol. 2001;58:1151-1156 2. 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. 23282345. 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;111:7174. 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. Audiol Neurootol. 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

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.