梅尼埃病教学课件

1、Preva00000 in Japan. 15/100000 in US, 46/100000 in Sweden, 100/100000 in UK.nThe large differences are due to geographic, genetic, ethnic or environmental factors, or different diagnostic criteria.Backscribed a syndrome nIn 1938, nHallpike and Yamakawa reported the finding of endolymphatic hydrops i

2、n temporal bone from patients with MD.Backlso defined two sub-varieties: cochlear and vestibular MDnIn 1985, nAAO-HNS updated the term MD should be “restrictive and include only those cases with complement of classic symptoms and findings of the disease presumed to result from idiopathic endolymphat

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5、o o is usually sudden,nCompanied with nausea and vomitingnPersist for several hours, attacks last longer than 24 h make the diagnosis of MD doubtfulFluctuatinsHeariBiochemical and meoriesAural pressurssNatural hision of vertigo has been reported in up to 71% of cases with 8 years.nSpontaneous remiss

6、ion makes assessment of efficacy of therapy quite difficult.nUp to 50% of patients will eventually develop symptoms from the opposite ear. 50% of patients occurred within a period of 2 yearNatural hiaracterized by hearing improvement that accompanies an acute attack of vertigo. The hearing remains g

7、ood for a period of days or weeks only to gradually diminish before onset of the next attacknDrop-attacks associated with MD (Tumarkin): in addition to the typical symptoms, patients experience abrupt and brief attacks such that they find themselves thrown to the ground with no warning and with litt

8、le or no vertigo after the initial fallDelayed endolyopse-existent profound unilateral deafness of long duration.nSymptoms are relieved by labyrinthectomy in the deaf ear.nThe original cause of deafness may have led to the hydrops.Glycernt is considered suggestive of MD after oral glycerol administr

9、ation. Only 60% of MD was positive.nHowever, negative test result did not exclude a diagnosis, thereby, implying that the test was specific but not sensitive.nIn hydropic GP and rabbit ears, CAP thresholds show further worse rather than an improvement after administration of glycerol.Diagde on the b

10、asis of history.nPhysical examination is usually normalnMany tests are interesting for research purpose but no test proves or disproves the diagnosis.nVestibular, audiogram and ENG are performed to confirm the presence of function of the other ear. Differentiaspositional vertigonVestibular neuritisn

11、Vestibular drug toxicitynLabyrinthitisnHunt syndromenCogan syndromenDelayed endolymphatic hydropsnPerilymph fistulaBenign proxysmal igoxcitation of the PSCnLatency (1-4s), transient (1minute) with position changenDecreasing with repetitive testingnMixed vertigo torsional nystagmusnSpontaneous resolu

12、tion with 1 yearBenign proxysmal igorolonged bedrestnViral or ischemic labyrinthitisnOlder peoplenMechanismndislodged otoconia trapped in PSC from the utricle.Benign proxysmal igopontaneously resolvenCanalith repositioningnAmpullary nerve section nBlock posterior semicircular canal (preventing movem

13、ent of endolymph in the canal)PerilymTreaaim at control of vertigo. nMedicine nSurgery interventionnNo treatment has definitively proven to alter the natural course of disease in nFluctuative, progressive hearing lossnTinnitusnAural fullnessTreannSedativenThe key is to use sedative brieflynProlonged

14、 use of sedative impair compensation, prolongs symptoms and produces a suboptimal result.nDiureticSurgical inEvaluatroposed such procedures 11 years prior to the description of endolymphatic hydrops. nDefinition of clinically significant hearing change (1995 AAO-HNS committee)na change of at least 1

15、0 dB PTAnWord recognition score of at least 15% Evaluatng outcome (without control study)nHearing outcome after ESS is no different than hearing after vestibular nerve section, or attributable to natural history alone.nSome author indicated postoperative hearing stabilizes or improves in 55% to 85%

16、of patients after ESS follow up greater than 2 years.nTinnitus relief after ESS was reported in 21-75% of patients.Evaluatd that nsubjective hearing loss to be slightly significantly better in the ESS group compared with the placebo group. nObjective test showed no significant difference difference

17、between the two groups.nAbove mentioned data reexamed by Welling supported nESS is effective in management of MD and refutes the placebo effect nThe actively shunted group have significant improvement in vertigo, tinnitus, and combined overall score when compared with the placebo group. Evaluatudies

18、 showed the shunts and similar foreign materials become encapsulated by fibrous tissue proliferation which makes it doubtful that will remain patent.nThe pathway by which endolymph from the cochea might reach the sac is blocked at multiple location due to collapse of the endolymphatic lumen.Evaluato

19、us conflicting beliefs concerning the benefit of endolymphatic sac surgery in MD.nMost otologist routinely perform the procedure.nA success rate approaching 80%, low complications. Otology grouey of ESSnDo not offer the patients reasonable expectation for long-term, complete control of vertigo (7%).

20、nThe theoretic benefit of sac surgery in regard to the control of tinnitus, fullness, and either stabilization or improvement in hearing were not realized.nAs a result, ESS is no longer performed. Suboccipital vestibular nerve section is primarily recommendation.Evaluatoric test showed a lower perce

21、ntage of patients actally achieve total ablation of vestibular response.nThis is due to the difficult in severing all vestibular nerve fiber.nThe use of intraoperative evoked vestibular potential may overcome this problem.House institutcesine of surgical treatment for MD unresponsive to medical trea

22、tment ( diuretic and vasodilator therapy)nIn case with disable vertigo unresponsive to medical treatment or failing ESS, VNS is recommended and often combine with primary or revision ESS House institutcesnd VNS does not improvement hearing or tinnitus outcome over vestibular nerve section aloneKarolinska hocyill having serviceable hearing were primarily offered ELSnIn total loss of cochlear function or persisting symptoms after a previous ESS, intratympanic gen