Auditory neurotherapy is an effective modality of treatment for which of the following abnormalities of hearing?
Ans. b. Meniere's disease (Ref Dhingra 6th/100-104. 5/e pg 112-113; Lagan- Turner 10th/335; Scott-Brown 7/e p3570).Among the given options, only Meniere's disease involves the vestibular system of inner ear. Hence, a neurotherapv. Le. direct nerve stimulation, is going to be useful only in Meniere 's disease.Meniere's DiseaseMeniere's disease is also known as endolymphatic hydropsQDisorder of the inner ear where the endolymphatic system is distended due to increased volume of endolymphQ.Cardinal symptoms of Meniere's Disease* Episodic vertigoQ* Fluctuating hearing lossQ* TinnitusQ * Sense of fullness or pressureQ in the involved earTullio phenomenonLoud sounds or noise produce vertigoQDue to distended saccule lying against the stapes footplate.Some cases of Meniere's Disease show Tullio phenomenonQAlso seen when there are three functioning windows in the ear, e.g. fenestration of horizontal canal in the presence of mobile stapes.Displacusis may be seen in Meniere's disease.Displacusis: Condition in which the pitch of single tone is heard as two different pitches by the two earsQ.This causes distortion of soundQ.Patients with Meniere's disease cannot tolerate loud sounds due to recruitment phenomenonQ, they are thus poor candidates for hearing aids.Investigations for Meniere's DiseasePure tone audiometrySpeech audiometrySpecial audiometry testsElectrocochleog raphy* In early stages, lower frequencies are affected and the curve is of rising type.* When higher frequencies are involved curve becomes flat or falling type.* Discrimination score is usually 55-85% between the attacks but discrimination ability is much impaired during & immediately following an attack.* They indicate cochlear nature of disease and thus help to differentiate from retro- cochlear lesions e.g. acoustic neuroma.* Electrocochleog raphy is diagnostic* Ratio of Sum mating Potential (SP) to Action Potential (AP) is >30%. Management of Meniere's DiseaseMedicalSurgicalOthers* Medical management is the mainstay of treatment:- Vestibular sedatives to relieve vertigo (Promethazine, Diazepam)- Vasodilators: Carbogen, histamine drip, nicotinic acid (in chronic phase)- Intratympanic Gentamicin therapy: Gentamicin is vestibulotoxic.* Surgical treatment when medical management fails:- Decompression of endolymphatic Sac- Shunt between endolymphatic sac & subarachnoid space- Sacculotomy (Fick's operation)* Intermittent low pressure pulse therapy (Meniett device) using a myringotomy and a ventilation tube.
CSOM
Meniere's disease
Malignant otitis externa
Otosclerosis
Ear