Meniere's disease

By:

Jay Aries T. Gianan, EMT-B, RM, RN, MAN

Assistant Professor II
Guide Questions:
• What is Meniere’s Disease?
• Causes
• Signs & symptoms
• Pathophysiology
• Complications
• How to manage Meniere’s
Disease?
 1 2
Across
1 microbes enter your body and begin to
multiply
2 paired organ of hearing and balance
3 ringing in the ears

Down
1 a disease of unknown cause 3
2 involuntary, rapid and repetitive
movement of the eyes 2
3 a sensation of feeling off balance

3
What is Meniere's disease?
Meniere's disease
• Aka “Idiopathic Endolymphatic
Hydrops”

• A chronic disorder of the inner ear

that can cause dizzy spells &
hearing loss.

• 2 clinical variations:
• Vestibular
• Cochlear
• more common
Causes/Risk Factor
Diet
• Unknown
Auto-
Smoking
immune
• Associated with aging
• Most often in middle age Meniere’s
Disease
• Middle-ear infection
• Head trauma Migraine
Viral
infection
• More often in women
Genetic
Signs & symptoms
1. Sudden episodes of severe
whirling vertigo
• with an inability to stand or walk
• episode may last up to several hours
2. Buzzing tinnitus
• worsens before & during an episode
3. Sensorineural hearing loss
• Fullness in the ear
• Nausea, vomiting, & diaphoresis
• Possibly
• brief loss of consciousness with
nystagmus
 Causes Obstruction of
Meniere's disease
endolympathic duct/sac
Idiopathic
Associated with aging
Hypersecretion or

What really happen?

Middle ear infection
hypoabsorption of
Head trauma
endolymph or both

Excessive accumulation of
endolymph

Distention of membranous
labyrinth & endolymphatic
Leading to sac

Increase in pressure &

rupture of inner membrane

Loss of auditory &

vestibular function
Partial/total loss of hearing

Complications
Constant tinnitus Vertigo
Permanent balance Tinnitus
disorder Meniere's disease S/S Nausea
Fear, phobia Vomiting
Dehydration Diaphoresis
Trauma from falling
Complications
Loss of
• Partial/total loss of hearing hearing

• Constant tinnitus
• Permanent balance disorder Tinnitus
Balance
disorder
• Fear, phobia
Complications
• Dehydration
• Trauma from falling

Dehydration Trauma
How to manage Meniere's disease?
Diagnostic & assessment
• Audiometric testing
• reveals sensorineural hearing loss
• Criteria for firm diagnosis
• Vertigo:
• >=2 spontaneous episodes with each
lasting >= 20 minutes.
• Tinnitus and/or perception of
aural fullness.
• Sensorineural hearing loss
• confirmed by audiometry.
• Electronystagmogram
• Reduced vestibular response
Nursing diagnosis
• Risk for injury
• r/t altered mobility because of gait disturbed & vertigo.
• Impaired adjustment
• r/t disability requiring change in lifestyle because of
unpredictability of vertigo.
• Risk for fluid volume imbalance & deficit
• r/t increased fluid output, altered intake, & medications.
• Anxiety
• r/t threat of, or change in, health status & disabling effects of
vertigo.
• Ineffective coping
• r/t personal vulnerability & unmet expectations stemming
from vertigo.
• Feeding, bathing/hygiene, dressing/grooming, &
toileting self-care deficits
• r/t labyrinth dysfunction & episodes of vertigo.
• The priority nursing diagnosis
for a patient experiencing an
acute attack with Meniere's
disease is
a. risk for falls related to dizziness.
b. impaired verbal communication
related to tinnitus.
c. self-care deficit (bathing and
dressing) related to vertigo.
d. imbalanced nutrition: less than
body requirements related to
nausea.
Nursing Goals
• Goal of treatment may include:
• recommendations for changes in
lifestyle & habits or surgical
treatment.
• Treatment approaches are:
• Rehabilitative
• Dietary
• Medical & surgical
• Psychological evaluation may be
indicated:
• if patient is:
• anxious, uncertain, fearful or
depressed.
Question:
• A patient complaint that they
get severe attack from Meniere’s
Disease. As a nurse what will be
your action?

• Bed rest
• Side rails up
• Avoid sudden movements
• Stand up only with assistance
Nursing management
• Provide nursing care during
acute attack.
• Provide a safe, quiet, dimly lit
environment & enforce bed rest
• Provide emotional support &
reassurance to alleviate anxiety
• Administer prescribed medications
• Antihistamines
• Antiemetics
• Mild diuretics
Nursing management
• Instruct the client on self-care
instructions
• to control the number of acute
attacks.
• Discuss, prepare & assist the
client with surgical options.
Question:
• A patient who is planning to
undergo surgery to manage
Meniere’s Disease ask you for
some information, as a nurse
what will be your response?

• Hearing loss, tinnitus & aural

fullness may continue
• Surgery only try to eliminate
attacks of vertigo
Pharmacologic therapy
• Antihistamines
• Meclizine (Antivert) – most common
• to control vertigo & to suppress the
vestibular system
• Antiemetics
• Prometazine, Prochlorperazine
• relieve the symptoms of nausea,
vomiting & vertigo
• Diuretics
• Diamox (acetazolamide)
• to lower pressure in the endolymphatic
system
Pharmacologic therapy
• Tranquilizers
• Diazepam
• control vertigo
• Vasodilators
• Betahistine
• often used in conjunction with other
therapies
• Middle & inner ear perfusion or systemic
injections of ototoxic medications
• streptomycin, gentamicin
• to eliminate vertigo
• procedure is highly successful in
decreasing vertigo
• Watch out for risk of hearing loss.
• Ototoxic
Dietary Management
• Low sodium diet
• reduce the fluid pressure in
your inner ear
• Esp. in endolymph & perilymph
• 1000 to 1500 mg of sodium
per day
• ¾ teaspoon (4 grams) of salt
• Electrolyte given
• ammonium chloride
• Avoidance of alcohol, nicotine &
caffeine
Surgical management
• Labyrinthectomy
• Advise bed rest post-op
• Low salt diet
• Destruction of inner ear
• Monitor for bell's palsy- facial
paralysis
• Endolymphatic sac decompression or
shunt
• Middle & inner ear perfusion with
placement of intraotologic catheters
• for drainage & infusion of medication
• Vestibular nerve section
• 8th cranial nerve
• Highest success rate (approximately 98%)
• A client with Meniere's disease
is experiencing severe vertigo.
Which instruction would the
nurse give to the client to assist
in controlling the vertigo?
a. Increase fluid intake to 3000 ml
a day
b. Avoid sudden head movements
c. Lie still and watch the television
d. Increase sodium in the diet
• A 42-year-old woman with
Ménière's disease is admitted with
vertigo, nausea, and vomiting.
Which nursing intervention will be
included in the care plan?
a. Dim the lights in the patient's
room.
b. Encourage increased oral fluid
intake.
c. Change the patient's position
every 2 hours.
d. Keep the head of the bed
elevated 30 degrees.