Meniere's disease - Revision history

ClaireLewis: Redirected page to Ménière's disease

2017-08-17T05:00:12Z

← Older revision		Revision as of 05:00, 17 August 2017
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	~~==Background==~~		#REDIRECT[[Ménière's disease]]
	*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~~]]

ClaireLewis: /* Management */

2017-04-03T15:20:14Z

Management

← Older revision		Revision as of 15:20, 3 April 2017
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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>		*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		**[[Meclizine]] 25-50mg PO
	**Diazepam 5-10mg PO or IV		**[[Diazepam]] 5-10mg PO or IV
	**Other options: scopolamine, promethazine, prochlorperazine, metoclopramide		**Other options: [[scopolamine]], [[promethazine]], [[prochlorperazine]], [[metoclopramide]]
	*Diuretics may decrease fluid pressure in ear:		*[[Diuretics]] may decrease fluid pressure in ear:
	**~~HCTZ~~		**[[Hydrochlorothiazide]]
	**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>

Rossdonaldson1: Text replacement - " prednisone" to " prednisone"

2016-08-03T09:09:40Z

Text replacement - " prednisone" to " prednisone"

← Older revision		Revision as of 09:09, 3 August 2016
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	**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>

Rossdonaldson1: Text replacement - "r/o" to "rule out"

2016-07-31T03:16:33Z

Text replacement - "r/o" to "rule out"

← Older revision		Revision as of 03:16, 31 July 2016
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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 ~~r/o~~ 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 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

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-24T17:11:12Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 17:11, 24 July 2016
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	{{Vertigo DDX}}		{{Vertigo DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*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

Neil.m.young: Text replacement - "0 mg" to "0mg"

2016-07-22T19:09:53Z

Text replacement - "0 mg" to "0mg"

← Older revision		Revision as of 19:09, 22 July 2016
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	*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>		*Vestibulosuppressant options<ref>Minor LB, Schessel DA, Carey JP. Ménière's disease. Curr Opin Neurol. 2004 Feb. 17(1):9-16.</ref>
	**Meclizine 25-~~50 mg~~ PO		**Meclizine 25-50mg PO
	**Diazepam 5-~~10 mg~~ PO or IV		**Diazepam 5-10mg PO or IV
	**Other options: scopolamine, promethazine, prochlorperazine, metoclopramide		**Other options: scopolamine, promethazine, prochlorperazine, metoclopramide
	*Diuretics may decrease fluid pressure in ear:		*Diuretics may decrease fluid pressure in ear:

Neil.m.young: Text replacement - " w/ " to " with "

2016-07-12T01:01:21Z

Text replacement - " w/ " to " with "

← Older revision		Revision as of 01:01, 12 July 2016
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	*Occurs due to increased endolymph within the cochlea and labyrinth		*Occurs due to increased endolymph within the cochlea and labyrinth
	*First attack usually occurs in patients >65yrs		*First attack usually occurs in patients >65yrs
	*Usually is unilateral but may become bilateral w/ time		*Usually is unilateral but may become bilateral with time

	==Clinical Features==		==Clinical Features==
	*Episodes of sudden-onset vertigo w/ 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

Neil.m.young: Text replacement - "==Treatment==" to "==Management=="

2016-07-07T09:54:38Z

Text replacement - "==Treatment==" to "==Management=="

← Older revision		Revision as of 09:54, 7 July 2016
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	**[[Arnold-Chiari malformation]]		**[[Arnold-Chiari malformation]]

	==~~Treatment~~==		==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>		*Vestibulosuppressant options<ref>Minor LB, Schessel DA, Carey JP. Ménière's disease. Curr Opin Neurol. 2004 Feb. 17(1):9-16.</ref>

Neil.m.young: Text replacement - " pt " to " patient "

2016-07-01T19:59:03Z

Text replacement - " pt " to " patient "

← Older revision		Revision as of 19:59, 1 July 2016
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	*Diminished hearing		*Diminished hearing
	*Fullness in affected ear		*Fullness in affected ear
	*Between attacks pt is well (although decreased hearing may persist)		*Between attacks patient is well (although decreased hearing may persist)

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

Ostermayer: Text replacement - " pts" to " patients"

2016-06-21T16:49:48Z

Text replacement - " pts" to " patients"

← Older revision		Revision as of 16:49, 21 June 2016
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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
	*First attack usually occurs in ~~pts~~ >65yrs		*First attack usually occurs in patients >65yrs
	*Usually is unilateral but may become bilateral w/ time		*Usually is unilateral but may become bilateral w/ time