DR.

RSMEHTA, BPKIHS
• The disease is named after a
French doctor - Prosper Ménière-
who described the condition as
being characterised by sudden
attacks of
dizziness, nausea, vomiting, loss
of hearing and a buzzing in the
ears (tinnitus).
DR. RSMEHTA, BPKIHS
 Meniers disease is a disorder of inner
ear where the endolymphatic system is
distended.
It is chracterisedby
i. Virtigo
ii. Sensorial hearing loss
iii. Tinnitus and
iv. Aural fullness

DR. RSMEHTA, BPKIHS

 Function of ear
• Hearing: Sound conduction andtransmission

• Balance and equilibrium

DR. RSMEHTA, BPKIHS

 Anatomy of ear
It consists of:
• Outer ear

• Middle ear

• Inner ear

DR. RSMEHTA, BPKIHS

 Inner ear
Bony labyrinth:
 Vestibule
 Semicircular canals
 Cochlea

Membranous labyrinth
Cochlear duct
Utricle and saccules
Semi-circular ducts
Endolymphatic duct
DR. RSMEHTA, BPKIHS
 Definition
• Meniere’s disease is a disorder of inner ear in
which the endolymphatic system isdistended.
• It is also called endolymphatic hydrops.

DR. RSMEHTA, BPKIHS

 Incidence
• Male are affected more than female.
• Disease is mainly unilateral.
• It is more common in age group 35-60years
• About 50,000 - 100,000 people of world
develop Meniere's disease in ayear.
• About 50 %of the patients who have
Meniere's disease have a positive family
history of this disease.
DR. RSMEHTA, BPKIHS
 Etiology
The exact cause of Meniere’s disease is unknown.
Possible causes include:
• Defective absorption by endolymphaticsac
• Allergies
• Sodium and waterretention
• Hypothyroidism
• Autoimmune and viralaetiologies
• Mumps(infection of salivary gland
• Syphilis( sexually transmitted disease)
• Head trauma
• Previous infection
• Hormonal (Pregnant females are moreprone)
DR. RSMEHTA, BPKIHS
 Risk factors
• Smoking
• Alcohol use
• Fatigue
• Respiratory infection
• Stress
• Use of certain medications, including aspirin
• Genetics may also play a role

DR. RSMEHTA, BPKIHS

 Pathophysiology
Obstruction of endolymphatic duct/sac

Alteration in production and absorption ofendolymph

Distension of endolymphatic sac

Increased in pressure and rupture of innermembranes

Vertigo, tinnitus, hearing loss(Meniere’s)

DR. RSMEHTA, BPKIHS

 Dilated membranous labyrinth in
Normal membranous labyrinth Meniere's disease (Hydrops)

DR. RSMEHTA, BPKIHS

 Clinical features
Cardinal symptoms of Miniere’s diseaseare:
• Episodic vertigo
 Sudden onset
 Feeling of rotation of himself/environment

• Fluctuating hearing loss

Following /accompanying vertigo
 Deterioration in hearing with eachattack

DR. RSMEHTA, BPKIHS

 Cont
• Tinnitus
 Low pitch roaring type

• Sense of aural fullness:

Accompany/ preceed
vertigo

DR. RSMEHTA, BPKIHS

 Other features
• Headache
• Pain or discomfort in the abdomen
• Nausea and vomiting
• Uncontrollable eye movements

DR. RSMEHTA, BPKIHS

 Physical Examination
• During an acute attack, the patient
has severe vertigo.
• Patients are sometimes diaphoretic
and pale.
• Vital signs may show elevated blood
pressure, pulse, and respiration.

DR. RSMEHTA, BPKIHS

• The Weber tuning fork test usually lateralized to the better
ear.
• The Rinne test is positive absolute bone conduction is
reduced in the affected ear
Weber Test:
Normal: equal hearing both sides of sametype
Abnormal – Tone louder in on one side
=Conductive loss – tone louder on affectedside
=SNHL– tone louder on contralateral side
Rinne test:
Normal: AC >BC
Abnormal
Negative Rinne – louder on mastoid process
Positive Rinne – Bilateral SNHL
DR. RSMEHTA, BPKIHS
 Investigations
• Otoscopy
• Audiometry
• Electrocochleography

DR. RSMEHTA, BPKIHS

 Imaging Studies
• Magnetic resonance imaging:
Brain scan should be done to rule out
abnormal anatomy or mass lesions.

• CT scans reveal dehiscent superior

semicircular canals and/or widened
cochlear and vestibular aqueducts

DR. RSMEHTA, BPKIHS

 Transtympanic
electrocochleography

• Transtympanic electrocochleography
(ECOG) specifically detects
distortion of the neural membranes
of the inner ear.

DR. RSMEHTA, BPKIHS

Electronystagmography (ENG)

• Electronystagmography (ENG) is a test

of the inner ear function (particularly the
semicircular canals).

DR. RSMEHTA, BPKIHS

 Management
General measures:
• Reassurance: psychological support
• Cessation of smoking
• Low salt diet
• Avoid excessive intake of water
• Life style modification

DR. RSMEHTA, BPKIHS

 Cont..
Management of acuteattack
• Reassurance
• Bed rest
• Vestibular sedatives:
prochlorperazine,diazepam
• Vasodilators: adenosine triphosphate

DR. RSMEHTA, BPKIHS

 Cont…
Management of chronicphase
• Vestibular sedatives: prochlorperazine,
• Vasodilators: nicotinic acid,betahistine
• Diuretics: furesemide
• Avoid allergen

DR. RSMEHTA, BPKIHS

 Cont..
Surgical management
• Conservative procedure:
 Endolymphatic decmpression
 Endolymphatic shunt operation
 Ultrasonic destruction of vestibular labyrinth

• Destructive measure:
 Labyrinthectomy

DR. RSMEHTA, BPKIHS

 Nursing management
• Assess the severity and frequency of attack,
any associated ear symptoms (hear loss,
tinnitus).
• Encourage patient tolie down during attack in
safe place.
• Put side rails in the bed if patient is in bed
• Place pillow to restrict movement.

DR. RSMEHTA, BPKIHS

 Cont..
• Administer or teach anti-vertiginous
medication and sedation medication as
prescribed
• Avoid noises and glary bright light whichmay
initiate attack.
• Advise patient to avoid food that cause allergy.
• Assist with ambulation when indicated.
• Provide comfort measures and avoid stress
producing activities.
DR. RSMEHTA, BPKIHS
 Post operative instructions:
• Antibiotic and other medication are to be taken
as prescribed.
• Nose blowing to be avoided (fewweeks).
• Sneezing and coughing should be done with the
mouth open for a few weeks after surgery.
• Heavy lifting, straining, and bending are to be
avoided for a few weeks after surgery.
• Minor discomfort is expected can relief by
analgesic, excessive pain should be reported to
surgeon.

DR. RSMEHTA, BPKIHS

• Excessive or purulent drainage should be
reported to the surgeon.
• The cotton ball in the ear can be changed as
needed but not to touch or remove any packing
from the external auditorycanal.
• Post auricular suture line should be cleanedand
antibiotic oint. Applied twicedaily.
• The surgeon should consult for regular air travel.
• Getting water in the operated ear must be
avoided for 2 weeks after surgery.

DR. RSMEHTA, BPKIHS

• Dressing first open-3rd day
• Suture removal 10th day
• Head up 300 (3-10days)
• Avoid: Chewing, sneezing, coughing etc
• Prevent water in ear: 6weeks
• Never put oil inear
• Observe complications: Facial nerve palsy (VII),
brain abscess, meningitis etc
• Avoid flying in air for 2 months

DR. RSMEHTA, BPKIHS

 Complications

• Inability towalk or function due to

uncontrollable vertigo.
• Hearing loss on the affected side.
• Possible of injury due to imbalance.

DR. RSMEHTA, BPKIHS

 Prognosis
• The outcome varies. Meniere's disease can
often be controlled with treatment.
• The condition may get better on its own
sometimes.
• Meniere's may be chronic disabling causing
permanent hearing loss.

DR. RSMEHTA, BPKIHS

DR. RSMEHTA, BPKIHS