ABSTRACT
Menière's disease is defined by the association of 4 symptoms: vertigo attacks, fluctuating hearing loss, tinnitus and an auricular plenitude sensation. The pathophysiology is commonly explained by a distension of membranous labyrinth by the endolymph, equally called endolymphatic hydrops. Recent studies also tend to relate the disease to immune mechanisms. The treatment is medical in the majority of patients but there is no international consensus on the management of the different stages of Menière's disease. Regarding the lack of clinical studies clearly demonstrating the effectiveness of a certain therapy or another. the recommendations are usually based on the empirical experience of practitioners and on the observation of a marked amelioration at 2 years of treatment in the majority of patients. The treatment of the acute phase of Menière's disease is basically symptomatic. Vestibular suppressant drugs have a well-established record in controlling acute attacks of vertigo. Most have variable anticholinergic, anti-emetic and vestibular sedative effects. If necessary, the administration of benzodiazepines will help to alleviate anxiety. Long term management of Menière's disease includes a low salt diet, the use of diuretics in the post-crisis phase, and the very common use in Europe of histaminergic agents. Corticosteroids are used in bilateral forms of Menière's disease, particularly if an autoimmune basis is suspected. All authors insist on the interest and the importance of regular follow-up, especially with regard to the psychological status and responsiveness to treatment of the patient. Surgical indications are rare and the least invasive procedures are used first. The choice of the procedure should take into consideration the need to preserve the auditory function of the patient.
Subject(s)
Diet Therapy , Meniere Disease/drug therapy , Meniere Disease/physiopathology , Acute Disease , Aminoglycosides , Anti-Bacterial Agents/therapeutic use , Antiemetics/therapeutic use , Benzodiazepines/therapeutic use , Calcium Channel Blockers/therapeutic use , Diagnosis, Differential , Diuretics/therapeutic use , Drinking , Edema/etiology , Edema/therapy , Humans , Meniere Disease/surgery , Sodium, DietaryABSTRACT
The auditory brainstem responses, in a series of 131 patients with surgically confirmed acoustic neuroma, are reported. Six groups have been individualized according to the value of the I-V interpeak latency, the synchronisation of the waveform shape and the need to perform an electrocochleography. If we exclude the sixteen cases of profoundly deafness, or cophosis, where ABR and ECoG don't permit the recording of waves, the electrophysiological investigations allowed to provide the diagnosis of retrocochlear lesion in 115 patients, for a rate of 98.26%. This high degree of sensitivity favorably with data reported in literature, and supports the reliability of this method for detection of acoustic neuroma. According to these results, our diagnosis workup of a patient suspected of having an acoustic neuroma, presenting normal ABR findings, is presented.
