美尼尔氏病解析 Meniere disease.pptVIP

Meniere’s Disease? By Mohd Al-Houqani Hisham Hamadi Abdul Kareem Al-Olama What is Meniere’s Disease? In 1861 Prosper Meniere described a syndrome characterized by deafness, tinnitus, and episodic vertigo. He linked this condition to a disorder of the inner ear. In 1938 Hallpike and Cairns described the underlying pathology of Meniere’s disease as being endolymphatic hydrops but the precise etiology still remains elusive. Possible Causes Anatomical-abnormalities Genetic-autosomal dominant Immunological-immune complex deposition Viral-serum IgE to herpes simples virus types I and II, Epstein-Barr virus and CMV Vascular-associated with migraines Metabolic-potassium intoxication Age Distribution and Incidence of the Disease WomenMen Symptoms Periodic episodes of rotatory vertigo or dizziness Fluctuating, progressive, low-frequency hearing loss Tinnitus Fullness/pressure Diagnosis The diagnosis of Meniere disease is made based on a careful history and physical exam. If the work-up is normal and the classic symptoms continue, the diagnosis of Meniere disease is made. History Most important part of the diagnosis Pattern of symptoms Association between hearing loss, tinnitus, and vertigo Physical Examination Examination results vary, depending upon the phase of disease. During remission, physical examination findings may be completely normal, particularly if the patient is symptom free. During an acute attack, the patient has severe vertigo. Patients are sometimes diaphoretic and pale. Vital signs may show elevated blood pressure, pulse, and respiration. Spontaneous nystagmus directed toward affected ear is typical during an acute attack. Physical Examination (con’t) The Romberg test generally shows significant instability and worsening when the eyes are closed. The Weber tuning fork test usually lateralizes away from the affected ear. The Rinne test usually indicates that air conduction remains better than bone conduction. Complete neurologic evaluation is im