<prompt> Endolymphatic hydrops:Menieres diseaseMonoaural DiplacusisLermoyez SyndromeOtosclerosis  <response>: Ans. a Menieres disease. Ref. Dhingra-3rd ed. 130; Bhargava-5th ed. 37Menieres 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 Reissners membrane.Etiology: Defective absorption by sac, Vasomotor disturbance; sympathetic over activity. Sodium and water retention, Hypoadrenalism, Hypopituitarism Hypothyroidism, Syphilis, trauma, Allergy; Pagets 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 Rinnies test positive Absolute bone conduction is reduced in affected ear. Webers 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 Ficks operation Sacculotomy Cody Tack operation Cochleosacculotomy Section of vestibular nerve Labyrinthectomy Endolymphatic shunt operationDrop attacks Tumarkins crisisIn this, there is sudden drop attack without loss of consciousness.No vertigo; No fluctuations in hearing loss.Lermoyez SyndromeReverse of Menires disease.In this syndrome; there is progressive deterioration of hearing, followed byattack of vertigo, at which time hearing improves. 