MENIERE’

S
DISEASE
(Endolymphatic
Hydrops)
What is MENIERE’S
DISEASE?
– Refers to a condition of increased hydraulic pressure
within the inner ear endolymphatic system.
Factors that might
contribute to MENIERE'S
DISEASE, include:
– Improper fluid drainage, perhaps because of a blockage or
anatomic abnormality
– Abnormal immune response
– Allergies
– Viral infection
– Genetic predisposition
– Head trauma
– Migraines
Signs and Symptoms:

– Recurring episodes of vertigo. You have a spinning sensation

that starts and stops spontaneously. (most characteristic
manifestation)
– Hearing loss. Hearing loss in Meniere's disease may come and
go, particularly early on. Eventually, most people have some
permanent hearing loss.
– Ringing in the ear (tinnitus). Tinnitus is the perception of a
ringing, buzzing, roaring, whistling or hissing sound in your
ear.
– Feeling of fullness in the ear. People with Meniere's disease
often feel pressure in the affected ears (aural fullness) or on
the side of their heads.
Hearing Assessment:

– A hearing test (AUDIOMETRY) assesses how well you

detect sounds at different pitches and volumes and how
well you distinguish between similar-sounding words.
People with MENIERE'S DISEASE typically have problems
hearing low frequencies or combined high and low
frequencies with normal hearing in the mid frequencies.
– Weber test shows that tone lateralizes better in the good
ear.
Medical Treatment
– Low sodium diet to prevent water retention.
– Avoid drinking large volume of fluids.
– Avoid reading during vertigo
– Avoid driving

Pharmacologic therapy
– Tranquilizers and antihistamines such as meclizine (Antivert) to control vertigo and
to suppress the vestibular system; antiemetics for nausea and vomiting.
– Diuretics to lower pressure in the endolymphatic system
– Vasodilators are often used in conjunction with other therapies
– Middle and inner ear perfusion or systemic injections of ototoxic medications:
streptomycin, gentamicin to eliminate vertigp; procedure is highly successful in
decreasing vertigo but is accompanied by a significant risk for hearing loss.
Surgery
– Endolymphatic Sac Surgery
– Decompression:
– Removal of bone overlying the sac
– Shunting
– Placement of synthetic shunt to drain endolymph into mastoid
– Drainage
– Incision of the sac to allow drainage
– Removal of sac
– Excision of the sac

– Vestibular nerve section. This procedure involves cutting the nerve that connects balance and
movement sensors in your inner ear to the brain (vestibular nerve). This procedure usually corrects
problems with vertigo while attempting to preserve hearing in the affected ear. It requires general
anesthesia and an overnight hospital stay.
– Labyrinthectomy. With this procedure, the surgeon removes the balance portion of the inner ear
(labyrinth), thereby removing both balance and hearing function from the affected ear. This procedure
is performed only if you already have near-total or total hearing loss in your affected ear.
Nursing
Management:
– Provide nursing care during acute attack.
– Provide a safe, quiet, dimly lit environment and enforce bed rest
– Provide emotional support and reassurance to alleviate anxiety
– Administer prescribed medications, which may include antihistamines,
antiemetics, and possibly, mild diuretics
– Instruct the client on self-care instructions to control the number of acute
attacks.
– Discuss the nature of the disorder
– Discuss the need for a low-salt diet
– Explain the importance of avoiding stimulants and vasoconstrictions (e.g.
caffeine, decongestants, alcohol)
– Discuss medications that may be prescribed to prevent attacks or self-
administration of appropriate medications during an attack, which may
include anticholinergics, vasodilation, antihsitamines, and possibly,
diuretics or nicotinic acid.
THANK YOU