Ear lecture
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| Meniere's disease dfn | Referred to Endolymphatic hydrops
Chronic disorder of the labyrinth in the inner ear
Labyrinth: system of cavities and canals in the inner ear that affects hearing, balance, and eye movement
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| Meniere's disease stats | Characterized by unknown cause of attacks of:
Vertigo
Loss of hearing: one or both ears
Ringing in the ear
Diagnosed about 1 in every 2,000
people: 2.4 millions affected
Equally affects men and women
between the ages of 35 and 60
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| Meniere's disease patho | Controlled balance and position sense by Semicircular canals of the inner ear & Cranial nerve VIII.
Semicircular canal is filled with fluid.
Swelling of the part of the semicircular canal: endolymphatic sac.
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| Meniere's disease patho | Endolymphatic sac controls the filtration & excretion of the fluid of the semicircular canal.
Unclear the exact cause of the condition
Ab high amount of endolymphatic fluid = Abnormal pressure within the inner ear: leads to disturbed balance & hearing.
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| Meniere's disease risk factors | Middle ear infection (Otitis media)
Syphilis, Head injury, Viral illness, Respiratory infection
Stress, Fatigue, Smoking, Alcohol use
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| Meniere's disease clinical manifestations | Repeated episodes of sudden, severe dizziness
Worse with sudden mvmt
Lost low frequency noises first and may have changes in the extent of hearing loss
Tinnitus, Nausea/Vomiting
Sweating: may be profuse
Loss of balance
Feeling of fullness in the e
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| Meniere's disease clinical manifestations timing | CMs appear periodically and can last from a few hours to most of a day or longer.
May have no symptoms at all for long periods from several hrs to yrs
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| Meniere's disease triggers and timing | Most ppl experience few attacks & learn to cope with the inconvenience & discomfort associated with the s/s
Commonly identified symptom triggers
High salt
Too much caffeine or alcohol
High level of stress.
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| Meniere's disease comorbidities | Some people who suffer from debilitating nausea, vertigo, and complete deafness
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| Meniere's disease diagnostic tests | Neurological exam: abnormality of cranial nerve VIII.
Ct scan or MRI: to rule out other problems related to head.
Electroencephalogram – brain waves.
Weber test: usually shows sensorineural hearing loss (both ears have poor hearing)
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| Meniere's disease diagnostic tests | Auditory brain stem response: measures electrical activity in the hearing nerve and brain stem
Electrocochleography: records the electrical activity of the inner ear in response to sound
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| Meniere's disease diagnostic tests | Electronystagmography: measure involuntary, rapid eye movement in response to stimulation of vestibular system (most common with hot water in ear canal to watch rapid eye mvmt)
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| Meniere's disease medical management | No known cure
Treatment is focused on relieving symptoms by decreasing the pressure within the endolymphatic sac.
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| Meniere's disease lifestyle changes | Limit daily sodium intake to 1500 mg to reduce fluid retention
Reduction of stress: biofeedback, meditation, yoga, daily exercise
Avoid vasoactive stimulants (caffeine and alcohol)
No smoking
Avoid sudden movements that may aggravate symptoms
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| Meniere's disease lifestyle changes | Help may be needed with walking b/c loss of balance.
Rest during severe episodes & gradually incr activity
Avoid hazardous activities until 1 wk after symptoms disappear.
Avoid bright lights, TV, or reading which may make symptoms worse during episodes
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| Meniere's disease medications | Decrease inner ear pressure
Diuretics: Dyazide, Furosemide, Methazolamide (carbonic anhydrase inhibitor commonly used for glaucoma to decrease eye pressure) by increasing fluid excretion thru kidneys
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| Meniere's disease medications: Controlling vertigo, nausea, and vomiting | Valium, Antivert: sedate the vestibular sys
Phenergan: help n-v & vertigo anti-histamine effect
Maj of pts: success tx with conservative Txs
20-40% of patients continue to have disabling attacks of vertigo may less conservative treatment such as surger
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| Conductive hearing loss | affect the outer/external or middle ear
Interrupted nml trans of sound waves from the tympanic membrane to the sensory part of the middle ear
neg Rinne test: BC>AC: beter bone than air conduction
Not always perm
treated medically or surgically.
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| Risk factors for conductive hearing loss | Earwax build-up, Severe ear infections
Acoustic trauma (i.e. explosion, loud noise):
Harden and less mobile middle ear bones (Otosclerosis)
Middle ear infections (otitis media).
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| Sensorineural heaing loss | Permanent hearing loss from damage to the pathway that sound impulses take from the hair cells of the inner ear to the auditory nerve and the brain.
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| Risk factors for hearing loss | Presbycusis, Drugs, Acoustic traumaAcoustic trauma by loud noise: damage hair cells.
Acoustic neuromas: benign tumor affecting the auditory nerve
Mumps, Meningitis: loss of hair cells or damage to auditory nerve
Meniere's Disease
neuro conditions
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| Presbycusis | Age-related hearing loss partly due to the loss of hair cells in the cochlea
progressive: starts with high-freq sound such as speech
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| Drugs r/t sensorineural hearing loss | powerful antibiotics, high doses of aspirin (temporary tinnitus), anti-malarial drug (Quinine)
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| CM of presbycusis | diff to hear high-pitched voices of wmn & child
Distortion of sound in speech: may confuse consonants: S, F, SH, CH, C
Diff understanding speech in noisy enviro
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| Med management of presbycusis | no known cure;
tx focused on fcnl improvement
reading lips and visual cues may help
Prognosis: hearing loss is pregressive
may lead to deafness
annual hearing test
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| Noise-induced hearing loss | aka: occupational hearing loss
dmg to inner ear from noise or vibration from job or entertainment
max job noise exposure reg by law: prot measures taken
partial, complete, or progressive hearing loss
may not be corrected
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| Otosclerosis | Abnml growth of bone of inner ear
affects stapes: becomes fixed into the oval window and interferes with sound waves
most common cause of conductive in yg adults: age 30
unknown cause
10% of pop
runs in fam
both ears
asymmetrical rates of hearing l
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| CM of otosclerosis | slow, progressive hearing loss
hearing better in noisy than quiet areas
ringing in ears (tinnitus)
reddish or pinkish-orange tympanic membrane b/c increased vasc of middle ear
Rhinne: BC= or > AC
diff conversing in person, better on phone
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| Diagnostic tests for otosclerosis | audiometry, CT scan of head
skull x-ray: rule out other cause of hearing loss
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| Med management of otosclerosis | conservative tx to communicate (hearing aid)
sodium flouride
stependectomy: microscopic laser surgery to remove disease stapes
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| Sodium Flouride | tx otosclerosis
slow bone absorption & enhance calcification of new bone, essentially to prevent further disease progression: can stabilize hearing loss in 80%
reduce tinnitus & s/s of imbalance
SE: rash, arthritis, and GI
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| Audiogram/audiometry | measured air conduction placing earphones over both ears and tests ability to hear various sound freq
hearing threshold: quietest sound heard by the person
nml: 20dB or better
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