Menieres 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
Nauseaor vomiting
Sweating and/or
Abnormal eye movements.

Menieres disease
Menieres disease is an abnormal inner

ear fluid balance caused by

malabsorption in the endolymphatic sac
People with menieres disease may have
blockage in the endolymphatic duct.
Cause
Increase pressure in the system or rupture
of the inner ear membranes that
producing menieres 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 Menieres
Disease
1. Cochlear Menieres Disease
Is recognized as fluctuating,

progressive sensory neural

hearingloss, tinnitus and aural
pressure.
2. Vestibular Menieres 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 menieres disease)
Audiogram reveals a sensorineural
hearing loss in the affected ear. In
the form of Pikes 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!