Endolymphatic hydrops:

Ans. a (Meniere's disease). (Ref. Dhingra-3rd ed. 130; Bhargava-5th ed. 37)Meniere's diseaseEndolymphatic hydrops; a disorder of inner ear characterized by triad of: -Vertigo, -Sensory neural deafness& -Tinnitus.Pathology:# Distension of Endolymphatic system, mainly affecting cochlear duct and saccule# Dilatation of cochlear duct# Marked bulging of Reissner's membrane.Etiology:# Defective absorption by sac, Vasomotor disturbance; sympathetic over activity.# Sodium and water retention, Hypoadrenalism, Hypopituitarism# Hypothyroidism, Syphilis, trauma, Allergy; Paget's disease, Autoimmune and viral etiologyClinical features:# 30-60 yrs males more affected.# Sudden onset of vertigo associated with nausea, vomiting with ataxia, nystagmus.# Fluctuating hearing loss.# Tinnitus, aggravated during acute attacks.# Sense of fullness# Intolerance of loud soundOtoscopy: Normal tympanic membraneTuning fork test:# Sensory neural Loss# Rinnie's test positive# Absolute bone conduction is reduced in affected ear.# Weber's lateralized to better ear.# Tullio Phenomenon: Loud sound produces vertigo and nystagmus and is due to distended saccule lying against stapes footplate.# Diplacusis: Distortion of soundAudiometry:# Sensory neural loss, initially lower frequencies affected.# Deafness becomes severe during and after attack of vertigo.Recruitment testSISI test; better than 70% =>Cochlear LesionTone decay test < 20 dB.Caloric test: Canal paresis on the affected side with directional preponderance to healthy sideGlycerol test: Glycerol is dehydrating agent; when given orally, reduces endolymphatic pressure and thus causes an improvement in hearing.Treatment:Conservative:# Vestibular sedatives, - Vasodilators * Nicotinic acid , * Betahistine, - Diuretics# Chemical Labyrinthectomy: Intratympanic Gentamycin therapy.Surgical# Endolymphatic decompression (Treatment of choice)# Fick's operation (Sacculotomy)# Cody Tack operation (Cochleosacculotomy)# Section of vestibular nerve# Labyrinthectomy# Endolymphatic shunt operationDrop attacks (Tumarkin's crisis)In this, there is sudden drop attack without loss of consciousness.No vertigo; No fluctuations in hearing loss.Lermoyez SyndromeReverse of Meni&re's disease.In this syndrome; there is progressive deterioration of hearing, followed byattack of vertigo, at which time hearing improves.