10/12/2014

Peripheral # Central Vestibular Disorders Peripheral

Peripheral # Central Causes of Vestibular Dizziness

Labyrinthine Causes    

BPPV Meniere’s Disease Labyrinthitis Perilymphatic fistula SCD

   

VIII Nerve Causes

Brainstem Causes

Vestibular Neuritis

   

Vestibular schwannoma Vascular loop syndrome Demyelination



Endolymphatic Hydrops Ménière's Disease It is a disorder of the inner ear characterized by: (1) recurrent, spontaneous, episodic vertigo; (2) SNHL that usually fluctuates; (3) Tinnitus and (4) Sensation of aural fullness. Meniere's affects roughly 0.2% of the population, between 40-60 years, bilateral disease is unclear range from 15-75%

Normal membranous labyrinth

Dilated membranous labyrinth

Central

MAD

Multiple Sclerosis Neoplasm Arnold-Chiari

 Ototoxicity

Peripheral Vestibular Disorders Meniere’s Disease

Clinical Presentation Usual Pattern 1- Aura consisting of:  Aural Fullness,   Tinnitus,   Hearing. 2- Incapacitating spinning vertigo (minutes to hours). 3- Accompanied by nausea, vomiting, diarrhea & sweating. 4- Attacks often occur in clusters separated by long remissions.

Unusual Patterns Otolithic crisis of Tumarkin Sudden unexplained falls without loss of consciousness

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10/12/2014

Peripheral Vestibular Disorders Meniere’s Disease

Management

Management

Low salt diet (1.5 – 2 grams/ day); avoidance of caffeine,

1- Lifestyle: smoking, Alcohol; maintaining regular eating/sleeping schedule 2- Medical Treatment:

Acute Therapy

 Anticholinegrnic,  Antihistaminic,  Antiemetic

Diuretic Therapy to reduce the endolymph accumulation , Betahistine to enhance microcirculation of the ear, Systemic Corticosteroids to reduce the immune reactivity.

Prophylaxis Therapy

Peripheral Vestibular Disorders Meniere’s Disease

3- Intratympanic “Infusion” Treatment: Transtympanic perfusion of middle ear with - Corticosteroid (Dexamethasone, 12-24 Mg/Ml) - Gentamicin (20-40 Mg/Ml)

Meniere’s Disease Management Flowchart: Correct Diagnosis of Meniere’s

4- Micropressure Treatment: Ventilation Tube +/- Meniett device portable

device, delivers intermittent low pressure pulses via ventilation tube to the ME ---- “milking” the inner ear fluid away from the areas involved in balance & hearing.

5- Surgical Treatment: Non-ablative Surgery 1. Endolymphatic Sac Surgery:  Decompression.  Shunting.  Drainage.  Removal of Sac. 2. Cochlear Endolymphatic Shunt

Reserved for patients failed medical treatment (6 - 12 months of severe vertigo) {~ 10%}

Vestibular Ablative Surgery Hearing conservative Vestibular Neurectomy

Non-Hearing Conservative Labyrinthectomy

Peripheral Vestibular Disorders

Vestibular Neuritis (VN) & Labyrinthitis

Salt Restriction (