Ménière's disease - Revision history

Cmb23: /* Clinical Features */

2023-10-28T18:52:00Z

Clinical Features

← Older revision		Revision as of 18:52, 28 October 2023
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	==Clinical Features==		==Clinical Features==
	*Episodes of sudden-onset [[vertigo]] with [[nausea/vomiting]]		*Episodes of sudden-onset [[vertigo]] with [[nausea/vomiting]]
			**Can include "drop attacks" where the patient feels knocked to the ground
	**Duration: usually 2-8hr		**Duration: usually 2-8hr
	**Frequency: Ranges from several episodes per week to several times per month		**Frequency: Ranges from several episodes per week to several times per month

Beren85: /* Clinical Features */

2022-06-01T15:17:14Z

Clinical Features

← Older revision		Revision as of 15:17, 1 June 2022
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	*[[hearing loss\|Diminished hearing]]		*[[hearing loss\|Diminished hearing]]
	*Fullness in affected ear		*Fullness in affected ear
	*Between attacks patient is well (although decreased hearing may persist)		*Between attacks patient is well (although decreased hearing and constant tinnitus may persist)

	==Differential Diagnosis==		==Differential Diagnosis==

Elcatracho: /* Background */

2021-02-11T01:01:23Z

Background

← Older revision		Revision as of 01:01, 11 February 2021
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	==Background==		==Background==
	*Occurs due to increased endolymph within the cochlea and labyrinth (''endolymphatic hydrops'')		*Occurs due to increased endolymph within the cochlea and labyrinth (endolymphatic hydrops)
	*First attack usually occurs in patients >65yrs		*First attack usually occurs in patients >65yrs
	*Usually is unilateral but may become bilateral with time		*Usually is unilateral but may become bilateral with time

Elcatracho: /* Background */

2021-02-11T01:00:26Z

Background

← Older revision		Revision as of 01:00, 11 February 2021
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	==Background==		==Background==
	*Occurs due to increased endolymph within the cochlea and labyrinth		*Occurs due to increased endolymph within the cochlea and labyrinth (''endolymphatic hydrops'')
	*First attack usually occurs in patients >65yrs		*First attack usually occurs in patients >65yrs
	*Usually is unilateral but may become bilateral with time		*Usually is unilateral but may become bilateral with time

ClaireLewis: /* Evaluation */

2019-10-02T00:46:20Z

Evaluation

← Older revision		Revision as of 00:46, 2 October 2019
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	*No workup required for classical Meniere disease in the ED		*No workup required for classical Meniere disease in the ED
	*Confirmed by ENT via glycerol testing or vestibular-evoked potentials		*Confirmed by ENT via glycerol testing or vestibular-evoked potentials
	*Imaging with MRI if suspicion or need to rule out lesions such as<ref>Lorenzi MC, Bento RF, Daniel MM, Leite CC. Magnetic resonance imaging of the temporal bone in patients with Ménière's disease. Acta Otolaryngol. 2000 Aug. 120(5):615-9.</ref>:		*Imaging with [[brain MRI\|MRI]] if suspicion or need to rule out lesions such as<ref>Lorenzi MC, Bento RF, Daniel MM, Leite CC. Magnetic resonance imaging of the temporal bone in patients with Ménière's disease. Acta Otolaryngol. 2000 Aug. 120(5):615-9.</ref>:
	**[[Acoustic neuroma]]		**[[Acoustic neuroma]]
	**Cerebellopontine angle lesion		**Cerebellopontine angle lesion

ClaireLewis at 21:18, 30 September 2019

2019-09-30T21:18:35Z

← Older revision		Revision as of 21:18, 30 September 2019
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	==Clinical Features==		==Clinical Features==
	*Episodes of sudden-onset vertigo with nausea/vomiting		*Episodes of sudden-onset [[vertigo]] with [[nausea/vomiting]]
	**Duration: usually 2-8hr		**Duration: usually 2-8hr
	**Frequency: Ranges from several episodes per week to several times per month		**Frequency: Ranges from several episodes per week to several times per month
	*Roaring tinnitus		*Roaring [[tinnitus]]
	*Diminished hearing		*[[hearing loss\|Diminished hearing]]
	*Fullness in affected ear		*Fullness in affected ear
	*Between attacks patient is well (although decreased hearing may persist)		*Between attacks patient is well (although decreased hearing may persist)
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	==Management==		==Management==
	*Treat vertigo symptomatically with [[scopolamine]], [[antihistamines]], or [[benzodiazepines]]		*Treat vertigo symptomatically with [[scopolamine]], [[antihistamines]], or [[benzodiazepines]]
	*~~Vestibulosuppressant~~ options<ref>Minor LB, Schessel DA, Carey JP. Ménière's disease. Curr Opin Neurol. 2004 Feb. 17(1):9-16.</ref>		*Vestibulo-suppressant options<ref>Minor LB, Schessel DA, Carey JP. Ménière's disease. Curr Opin Neurol. 2004 Feb. 17(1):9-16.</ref>
	**[[Meclizine]] 25-50mg PO		**[[Meclizine]] 25-50mg PO
	**[[Diazepam]] 5-10mg PO or IV		**[[Diazepam]] 5-10mg PO or IV
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	**[[Triamterene]]		**[[Triamterene]]
	**[[Acetazolamide]]		**[[Acetazolamide]]
	**Avoid loop diuretics due to ototoxicity		**Avoid loop [[diuretics]] due to ototoxicity
	*Consider IM steroid injection, followed by tapered PO [[prednisone]]<ref>Sajjadi H. Medical management of Meniere's disease. Otolaryngol Clin North Am. 2002 Jun. 35(3):581-9, vii.</ref>		*Consider IM [[steroid]] injection, followed by tapered PO [[prednisone]]<ref>Sajjadi H. Medical management of Meniere's disease. Otolaryngol Clin North Am. 2002 Jun. 35(3):581-9, vii.</ref>
	*Routine ENT referral for medical treatment failures (endolymphatic decompression, vestibular nerve section, labyrunthectomy, intra-TM injections)<ref>Pullens B, Giard JL, Verschuur HP, van Benthem PP. Surgery for Ménière's disease. Cochrane Database Syst Rev. 2010 Jan 20. CD005395.</ref><ref>Barrs DM. Intratympanic corticosteroids for Meniere's disease and vertigo. Otolaryngol Clin North Am. 2004 Oct. 37(5):955-72, v.</ref>		*Routine ENT referral for medical treatment failures (endolymphatic decompression, vestibular nerve section, labyrunthectomy, intra-TM injections)<ref>Pullens B, Giard JL, Verschuur HP, van Benthem PP. Surgery for Ménière's disease. Cochrane Database Syst Rev. 2010 Jan 20. CD005395.</ref><ref>Barrs DM. Intratympanic corticosteroids for Meniere's disease and vertigo. Otolaryngol Clin North Am. 2004 Oct. 37(5):955-72, v.</ref>

Kxl328: /* Disposition */

2018-10-19T14:56:35Z

Disposition

← Older revision		Revision as of 14:56, 19 October 2018
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	==Disposition==		==Disposition==
	*Refer to ENT for vestibular nerve section (surgical or chemical), endolymph sac decompression, endolymphatic-subarachnoid shunt, or labyrinthectomy		*Refer to ENT for further evaluation and management
			*Surgery may include vestibular nerve section (surgical or chemical), endolymph sac decompression, endolymphatic-subarachnoid shunt, or labyrinthectomy

	==References==		==References==

Kxl328: /* Disposition */

2018-10-19T14:55:41Z

Disposition

← Older revision		Revision as of 14:55, 19 October 2018
Line 40:		Line 40:

	==Disposition==		==Disposition==
	*Refer to ENT		*Refer to ENT for vestibular nerve section (surgical or chemical), endolymph sac decompression, endolymphatic-subarachnoid shunt, or labyrinthectomy

	==References==		==References==

Kxl328: /* Management */

2018-10-19T14:54:57Z

Management

← Older revision		Revision as of 14:54, 19 October 2018
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	*[[Diuretics]] may decrease fluid pressure in ear:		*[[Diuretics]] may decrease fluid pressure in ear:
	**[[Hydrochlorothiazide]]		**[[Hydrochlorothiazide]]
			**[[Triamterene]]
	**[[Acetazolamide]]		**[[Acetazolamide]]
	**Avoid loop diuretics due to ototoxicity		**Avoid loop diuretics due to ototoxicity

ClaireLewis: Created page with "==Background== Occurs due to increased endolymph within the cochlea and labyrinth First attack usually occurs in patients >65yrs *Usually is unilateral but may become bilate..."

2017-08-17T05:00:02Z

Created page with "==Background== *Occurs due to increased endolymph within the cochlea and labyrinth *First attack usually occurs in patients >65yrs *Usually is unilateral but may become bilate..."

New page

==Background==
*Occurs due to increased endolymph within the cochlea and labyrinth
*First attack usually occurs in patients >65yrs
*Usually is unilateral but may become bilateral with time

==Clinical Features==
*Episodes of sudden-onset vertigo with nausea/vomiting
**Duration: usually 2-8hr
**Frequency: Ranges from several episodes per week to several times per month
*Roaring tinnitus
*Diminished hearing
*Fullness in affected ear
*Between attacks patient is well (although decreased hearing may persist)

==Differential Diagnosis==
{{Vertigo DDX}}

==Evaluation==
*No workup required for classical Meniere disease in the ED
*Confirmed by ENT via glycerol testing or vestibular-evoked potentials
*Imaging with MRI if suspicion or need to rule out lesions such as<ref>Lorenzi MC, Bento RF, Daniel MM, Leite CC. Magnetic resonance imaging of the temporal bone in patients with Ménière's disease. Acta Otolaryngol. 2000 Aug. 120(5):615-9.</ref>:
**[[Acoustic neuroma]]
**Cerebellopontine angle lesion
**[[Multiple sclerosis]]
**[[Arnold-Chiari malformation]]

==Management==
*Treat vertigo symptomatically with [[scopolamine]], [[antihistamines]], or [[benzodiazepines]]
*Vestibulosuppressant options<ref>Minor LB, Schessel DA, Carey JP. Ménière's disease. Curr Opin Neurol. 2004 Feb. 17(1):9-16.</ref>
**[[Meclizine]] 25-50mg PO
**[[Diazepam]] 5-10mg PO or IV
**Other options: [[scopolamine]], [[promethazine]], [[prochlorperazine]], [[metoclopramide]]
*[[Diuretics]] may decrease fluid pressure in ear:
**[[Hydrochlorothiazide]]
**[[Acetazolamide]]
**Avoid loop diuretics due to ototoxicity
*Consider IM steroid injection, followed by tapered PO [[prednisone]]<ref>Sajjadi H. Medical management of Meniere's disease. Otolaryngol Clin North Am. 2002 Jun. 35(3):581-9, vii.</ref>
*Routine ENT referral for medical treatment failures (endolymphatic decompression, vestibular nerve section, labyrunthectomy, intra-TM injections)<ref>Pullens B, Giard JL, Verschuur HP, van Benthem PP. Surgery for Ménière's disease. Cochrane Database Syst Rev. 2010 Jan 20. CD005395.</ref><ref>Barrs DM. Intratympanic corticosteroids for Meniere's disease and vertigo. Otolaryngol Clin North Am. 2004 Oct. 37(5):955-72, v.</ref>

==Disposition==
*Refer to ENT

==References==
<references/>

[[Category:ENT]]
[[Category:Neurology]]

Ménière's disease - Revision history

Cmb23: /* Clinical Features */

Beren85: /* Clinical Features */

Elcatracho: /* Background */

Elcatracho: /* Background */

ClaireLewis: /* Evaluation */

ClaireLewis at 21:18, 30 September 2019

Kxl328: /* Disposition */

Kxl328: /* Disposition */

Kxl328: /* Management */

ClaireLewis: Created page with "==Background== *Occurs due to increased endolymph within the cochlea and labyrinth *First attack usually occurs in patients >65yrs *Usually is unilateral but may become bilate..."

ClaireLewis: Created page with "==Background== Occurs due to increased endolymph within the cochlea and labyrinth First attack usually occurs in patients >65yrs *Usually is unilateral but may become bilate..."