Meniere's Disease MCQs

This is a case of BPPV(Benign Paroxysmal Positional Vertigo). Otoliths or otoconia are calcium carbonate crystals lying embedded in the gelatinous layer of macula. Macula is the sensory end organ of utricle and saccule whose function is linear acceleration. In certain head positions, the displaced otoconia come to rest against the cupula of SCC causing vertigo. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 52.

Primary treatment is medical management. Refractory patients are offered further treatments. like transtympanic injection of gentamycin using microwicks or microcatheters. Meniett device is external device used for pulse pressure therapy to labyrinth. Donaldson's line is surgical landmark for localisation of endolymphatic sac to conduct endolymphatic sac decompression therapy. Schwartz operation is other name for cortical mastoidectomy which is done in cases of acute mastoiditis. Reference : Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8th Edition, Chapter name: Meniere's disease, Page number: 124

In superior semicircular canal dehiscence, the patient will have conductive hearing loss due to leakage of sound waves from the dehiscence which acts like a third window. This is called third window phenomenon. Reference: Scott Brown's Otolaryngology, Head and Neck Surgery, 8 th edition, Volume 2, Page - 1192.

Patient shows conductive hearing loss on audiometry due to leakage of sound energy from third window which has been created in SCC(apart from oval and round window). This is called third window phenomenon. Reference : Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8th Edition, Chapter name: Meniere's Disease, Page number: 120

Pulsatile tinnitus is seen in Glomus tumor. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 120.

LERMOYEZ SYNDROME- rare variant of Meniere’s disease where hearing loss is followed by vertigo. (Reverse Meniere’s disease). In the classical menieres disease, vertigo is followed by hearing loss. Meniere’s disease Episode finishes within 24hrs. (BPPV-Few second vertigo without hearing loss or tinitus) During an episode some patients can develop diarrhoea. (Very rare) During episodes some people fall down without turning unconscious, this is called as Tumarkin’s crisis (Rare) Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 122.

Inner ear ablation is only required in all those cases of Meniere's disease who have more frequent disabling episodes of vertigo with no significant residual hearing. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 123, 124.

This patient has normal cochlear function and disabling vertigo. So a treatment method which preserves hearing is preferred. Among the options given, vestibular neurectomy is the correct answer. Reference: Diseases of Ear, Nose and Throat & Head and Neck Surgery by P L Dhingra, 8 th Edition, Page - 123, 124.