membranous labyrinth
Introduction
Introduction to membrane lost water Ménièredisease (Ménièredisease) is also known as labyrinthine hydrops, which is caused by epileptic edema of the inner eardrum, and volatility deafness and tinnitus are the main manifestations of inner ear disease. In 1861, the French scholar Ménière first discovered that lost disease caused dizziness, tinnitus and hearing loss through autopsy, but the case reported by Ménière actually died of leukemia inner ear hemorrhage, instead of what is now called the membrane lost water. The disease is usually a single ear, more common in young adults. The cause of Meniere's disease is unknown, and may be related to congenital inner ear abnormalities, autonomic dysfunction, viral infection, allergic, endocrine disorders, salt and water metabolism disorders, etc. It is generally believed that endolymphatic reflux obstruction or absorption disorder is the main Causes of the disease, such as endolymphatic stenosis or occlusion; autonomic dysfunction can cause small blood vessels in the inner ear, leading to labyrinthine microcirculatory disorders, tissue hypoxia, changes in endolymph biochemical properties, increased osmotic pressure and caused membrane labyrinth. basic knowledge The proportion of the disease: the incidence of this disease is about 0.1% Susceptible people: more common in young adults Mode of infection: non-infectious Complications: deafness, dizziness
Cause
Membrane lost water
The cause of Meniere's disease is unknown, and may be related to congenital inner ear abnormalities, autonomic dysfunction, viral infection, allergic, endocrine disorders, salt and water metabolism disorders, etc. It is generally believed that endolymphatic reflux obstruction or absorption disorder is the main Causes of the disease, such as endolymphatic stenosis or occlusion; autonomic dysfunction can cause small blood vessels in the inner ear, leading to labyrinthine microcirculatory disorders, tissue hypoxia, changes in endolymph biochemical properties, increased osmotic pressure and caused membrane labyrinth.
Prevention
Membrane lost water prevention
1. During the attack, rest in bed, pay attention to prevent the patient from suddenly falling out of bed and falling.
2, the bedroom is quiet, to prevent noise and glare, the light should be soft.
3, the air in the bedroom should be smooth, but at the same time pay attention to not too warm.
4, should not drink more tea drinks, should be low-salt foods, eat cold, greasy, hot and sour, too sweet, so as not to aggravate nausea and vomiting.
5, when vomiting is serious, acupuncture inside the Guan, Zusanli.
6, soup should be warm clothes, generally around 40 ~ 45 ° C is appropriate, if there is vomiting and filthy, can be divided into multiple servings.
7, should pay attention to mental care, this disease is often caused by emotional discomfort, worry and fear, excessive fatigue, so pay attention to keep the patient comfortable.
Complication
Membrane labyrinth hydrops Complications, deafness, dizziness
In patients with longer course of disease, there are degeneration of inner ear receptors and basement membrane, and sensorineural deafness and vestibular function are permanently degraded. Although severe lesions occur once or twice, there may be severe sensorineural hearing loss.
Symptom
Membrane lost water symptoms Common symptoms Hearing loss Deafness nausea and vomiting Tinnitus Nausea pale pale paroxysmal vertigo
Typical symptoms are paroxysmal vertigo, volatility, deafness, tinnitus,
(1) Vertigo (vertigo): characterized by sudden onset, severe dizziness, and rotation, that is, feeling that the body or surrounding objects are rotating, the head is slightly moved, that is, the vertigo is aggravated, accompanied by nausea, vomiting, pale complexion and other autonomic dysfunction. Symptoms, after a few hours or days, the vertigo is reduced and gradually disappears. The intermittent period can be several weeks, months or years, and the symptoms disappear completely during the interval.
(B) tinnitus (tinnitus): the vast majority of cases have tinnitus before vertigo, but often not noticed, tinnitus is mostly low-frequency sound, light and heavy, generally in the onset of vertigo, tinnitus increased,
(3) Deafness: It is often unconscious in the early stage. Generally, the hearing loss is felt during the attack period. Most of them are one-sided. Although the patient has deafness, but the high-frequency sound is harsh, even when he hears a huge sound, it is very harsh. This phenomenon is called re-vibration, and the hearing often recovers during the interval, but when the hearing again falls, there is a characteristic hearing fluctuation phenomenon. In the late stage, the hearing may be a sensorineural hearing loss.
(4) Others: When the vertigo occurs, there may be a feeling of fullness of the affected side or a heavy head, and a sense of oppression.
Examine
Membrane water retention check
(1) vestibular function examination: It is not easy to see the climax of vertigo episodes in clinical practice. Symptoms and signs have been alleviated or disappeared when coming to the clinic. In the case of episodes, horizontal or horizontal rotation type with different strengths and weaknesses can be found. Spontaneous nystagmus, fast-moving multi-directional side, but with the strength of the lesion, the direction of the nystagmus may change, sometimes in some head position can be aggravated, the Romberg test shows that the dumping is opposite to the direction of the nystagmus, the vestibule Functional examination may reduce the vestibular function of the affected side after repeated episodes, and may also be normal or allergic.
(2) Hearing examination: the affected side is often sensorineural hearing loss, early hearing is mainly low frequency hearing loss, high frequency hearing is also decreased after repeated occurrences, high frequency hearing loss is obvious in the late stage; refraction phenomenon Often one of the characteristics of this disease, that is, the increase in ear loudness is faster than the increase in sound level.
(3) Glycerin test: After fasting for 2 hours, give 50% glycerol 3ml per kilogram of body weight, take it once, take a pure tone every hour before taking the medicine and taking the medicine, such as Meniere's disease, 2~ After 3 hours, the hearing can be increased by more than 15dB, which is positive, and other symptoms are temporarily improved. The positive is diagnostic, but the negative does not rule out the disease.
(D) Cochlear electrogram examination: -SP / AP ratio > 40% has clinical significance.
Diagnosis
Diagnosis and identification of membrane lost water
diagnosis
Diagnosis can be based on the cause, symptoms and related tests.
Differential diagnosis
Because of the many diseases that cause dizziness, the reasons are complex and must be differentiated from the following diseases:
(A) labyrinthitis: there is suppurative otitis media.
(2) Auricular drug poisoning: There is a history of ototoxic drugs such as streptomycin or gentamicin. The ear drug poisoning involves many ears. The vertigo is mostly not hidden, less rotatory, and has no recurrent symptoms. The vestibular function is significantly reduced or disappeared on both sides or on one side, and is often accompanied by hearing loss and tinnitus.
(3) vestibular neuron inflammation: more than the upper respiratory tract virus infection, may be caused by viral infection of the vestibular neurons, clinically characterized by sudden vertigo and spontaneous nystagmus with nausea, vomiting, no tinnitus and Deafness, vertigo lasts for a long time, vertigo is mostly swaying instability, can also be rotatory, has a natural tendency to relieve, vestibular function test is significantly reduced, and rarely relapse after healing.
(4) Acoustic neuroma: vertigo is lighter, gradually occurring, less rotatory, often suffering from hearing loss and tinnitus on the affected side, gradually developing into severe sensorineural hearing loss, but there are also sudden deafness The vestibular dysfunction or disappearance of the affected side may lead to trigeminal or facial nerve dysfunction during the course of the disease. X-ray and CT scan of the rock showed an enlargement of the internal auditory canal and a mass, and the protein content in the spinal fluid increased.
(5) Positional vertigo: vertigo episodes are related to specific head position, no tinnitus, deafness, positional nystagmus can occur at the same time, positional nystagmus can be divided into central and peripheral types, and when examined, peripheral positionality The nystagmus performance has an incubation period, which is mostly horizontal rotation. After several times of positional examination in a short time, the direction of the nystagmus does not change, but it disappears or is relieved quickly. It is fatigue, and there is a good prognosis in the surrounding. Self-healing, called benign paroxysmal positional vertigo, the cause is unknown, it is thought that it may be vestibular terminal lesions, otolithic detachment deposited on the posterior semicircular canal, due to gravity traction, can be induced at a specific head position Dizziness and nystagmus, the central feature is that nystagmus appears immediately at a specific head position, no nystagmus latency, repeated trials and recurrence of nystagmus without fatigue, nystagmus can be vertical, direction can be changed.
(6) Sudden sputum: It is a kind of sensory neuropathic sputum whose main cause is sudden loss or loss of hearing. It is accompanied by tinnitus, and some may have dizziness, nausea, vomiting, but not repeated episodes. Some patients may recover or partially recover their hearing.
(7) Insufficient blood supply to the vertebral-basal artery: mostly caused by compression of the vertebral artery, such as hyperosteogeny of the cervical vertebrae, or arterial spasm caused by stimulation of the sympathetic plexus that innervates the vertebral artery, and the clinical manifestation is in the turning head or When you look up, when you bow your head or change your position, you may experience a sudden vertigo, which is mostly a sense of rotation or swaying instability. You may have blurred vision, recurrence or blackness, sometimes spontaneous nystagmus, tinnitus, deafness, and more. Positional nystagmus can occur, and X-ray cervical radiographs often have bone changes.
(8) Heart, vascular disease: high blood pressure, low blood pressure, heart disease, arteriosclerosis, etc. can cause dizziness, but are accompanied by the clinical manifestations of the primary disease.
(9) Cerebellar posterior inferior arterial thrombosis: or dorsolateral medullary syndrome, heavier vertigo, ipsilateral soft palate, pharyngeal muscle, laryngeal muscle paralysis, difficulty in swallowing and language difficulties.
(10) Hunt syndrome is often accompanied by mild dizziness, tinnitus and hearing impairment, and severe earache, and herpes zoster and facial paralysis in the ear help to identify.
