Meniere Hastalığı
Özet
Meniere hastalığı; tekrarlayan vertigo atakları, dalgalı sensörinöral işitme kaybı, tinnitus ve kulakta dolgunluk ile seyreden kronik, progresif bir iç kulak bozukluğudur. Patogenezde endolenfatik hidrops, spiral ganglion dejenerasyonu, oksidatif stres ve immünolojik mekanizmalar rol oynar. Tipik olarak orta yaşta başlar, nadiren çocuklukta görülür ve zamanla bilateral tutulum gelişebilir. Tanı esas olarak klinik bulgulara dayanır; odyometri, elektrokokleografi, cVEMP/oVEMP, kalorik test ve son yıllarda MRI ile hidrops görüntülemesi tanıya katkı sağlar. Başlangıç tedavisinde tuz kısıtlaması, kafein ve alkolün azaltılması, betahistin, diüretik ve gerektiğinde sistemik veya intratimpanik steroid uygulanır. Medikal tedaviye dirençli olgularda intratimpanik gentamisin, endolenfatik kese cerrahisi veya ablasyon (vestibüler nörektomi, labirentektomi) düşünülebilir. İşitme kaybı ilerleyen olgularda işitme cihazı veya koklear implant rehabilitasyonu önemlidir. Vertigo ve denge bozukluklarında vestibüler rehabilitasyon destekleyicidir. Güncel yaklaşım, işitme koruyucu, minimal invaziv ve hasta odaklı tedavi stratejilerini öncelikli kılar.
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