Ans. is 'a' i.e., Menieres disease Treatment of Meniere's disease Most treatments are for symptoms believed to be caused by excess endolymphatic fluid. Treatment of Meniere's disease is of two types :? A) Medical management B) Surgical management Medical management: Treatment of Meniere's disease begins first with medical management. Medical treatment controls the condition in over two third of patients. Medical management includes :? 1. Antihistamine labyrinthine sedatives (vestibular sedatives) Many cases can be controlled by vestibular sedatives like prochlorperazine, promethazine, dimenhydramine, and cinnarzine. 2. Anxiolytic and tranquillizers Many patients are anxious, therefore they may be helped by anxiolytic and tranquillizers like diazepam. 3. Vasodilators Betahistine hydrochloride appears to be the most useful recent addition to the medical armamentarium and is routinely prescribed for most patients. It increases labyrinthine blood flow by releasing histamine. Other vasodilators employed include nicotinic acid, thymoxamine, inhaled carbogen (5% CO2 with 95% 02), and histamine drip. Vasodilators increase vascularity of endolymphatic sac and its duct and thereby increases reabsorption of endolymphatic fluid. 4. Diuretics (furosemide) Diuretics with fluid and salt restriction can help to control recurrent attacks if not controlled by vestibular sedatives or vasodilators. 5. Other drugs Propantheline bromide, phenobarbitone and hyoscine are effective alternatives. Surgical management Surgical therapy for meneire's disease is reserved for medical treatment failures and is otherwise controversial. Surgical procedures can be divided into two main categories Destructive surgical procedures Nondestructive surgical procedures Destructive surgical procedures : rationale is to control veigo. Endolymphatic hydrops causes fluid pressure accumulation within the inner ear, which causes temporary malfunction and misfiring of the vestibular nerve. These abnormal signals cause veigo. Destruction of the inner ear and / or the vestibular nerve prevents these abnormal signals. The procedures performed are : Labyrinthectomy Intermittent low pressure pulse therapy (Meniett device therapy) Conservative surgical procedures : are used in cases where veigo is disabling but hearing is still useful & needs to be preserved. They are : Decompression of endolymphatic sac Endolymphatic shunt operation Sacculotomy (Fick's operation & Cody's tack procedure) Vestibular neuronectomy Ultrasonic destruction of vestibular labyrinth to preserve cochlear function. Stellate ganglion block or cervical sympathectomy I ntratympanic gentamycin Vestibular nerve section