Hearing loss in its most varied degrees is one of the main problems that lead people to

otorhinolaryngology offices. In addition to difficulty hearing sounds, there are other symptoms,

such as tinnitus and a feeling of pressure in the ears.

According to Hearing Health Foundation,(2021), in the United States ,there are more than

600,000 cases of Ménière’s disease. The incidence is about 50000 on an annual basis. Gloablly ,

the incidence of Ménière’s disease is between 3.5 to 513 per 100,000.Around 15 percent of

people with Ménière’s will experience bilateral hearing loss.

One of the causes may be Ménière's Syndrome, a pathology that affects individuals of any age.

Clinically called endolymphatic hydrops, Ménière's Syndrome is an uncommon pathology that

damages the inner ear, causing vertigo, tinnitus, and hearing loss(Thompson‐Harvey, 

& Hain, 2019. p,109). It usually only affects one ear. Although it can occur in individuals of any

age, it is more common in those aged between 30 and 50 years. In addition, seizures come on

suddenly and vary from patient to patient, lasting from a few minutes to several hours. The

frequency is also very particular in each one.

Ménière's Syndrome arises due to fluid imbalance that fills the inner ear. Inside is the labyrinth,

formed by a set of semicircular arches containing a fluid called endolymph, which plays a

fundamental role in the balance and spatial location of the body.

Whenever an individual moves, this liquid also moves. This mobility produces electrical signals

that are conducted to the brain, where they are interpreted so that we can understand the position

we are in.
In people with this pathology, there is an increase in the volume of this fluid within the labyrinth,

generating greater internal pressure and, consequently, the dilation of this compartment. This

causes the signals sent to the brain to be incorrect, causing symptoms such as dizziness.

Causes

Allergy: Allergy accounts for about 14% of Ménière's disease cases(Ma et al.,2021). This

happens in patients whose symptoms are precipitated by inhaled or food irritants, as well as other

manifestations such as asthma, rhinitis, or nasal polyposis. The allergic mechanisms that can

produce the disease have connections with the immunocompetent cells (produced by the bone

marrow) of the inner ear, which are located in the interosseous area of the endolymphatic sac

(fluid contained in the membranous labyrinth of the inner ear), which have fenestrated vessels

(characterized by the presence of large holes in the cell walls). This may compromise the

reabsorption capacity of allergic mediators;

Genetic causes: Malformation or alterations in the development of the endolymphatic sac duct

(fluid contained in the membranous labyrinth of the inner ear), which are genetic, can cause

Ménière's Disease;

Chronic otitis media: The toxins produced by the infection can reach the endolymphatic space

(where the endolymphatic sac is located, the fluid contained in the membranous labyrinth of the

inner ear);

Otosclerosis: Impairment of the vestibular aqueduct (the most common anomaly of the inner

ear) caused by Otosclerosis can cause endolymphatic reabsorption dysfunction (fluid contained

in the membranous labyrinth of the inner ear);

Disturbance of carbohydrate metabolism: Both hypoglycemia and hyperglycemia can

compromise the function of the inner ear;

Trauma: Physical trauma to the membranous labyrinth can result in the detachment of sensory

organs from the inner ear;

Autoimmunity: One of the associations between Ménière and autoimmunity is the deposition of

autoimmune complexes in the endolymphatic sac, which can cause an inflammatory reaction at

the site.

Pathophysiology

Hallpike and Cairs, in 1938, proposed that the origin of the disease would be the increase in the

pressure of the endolymphatic fluid. Based on this theory, we defend that Meniere's Disease is a

labyrinth disorder caused by endolymphatic hydrops of the inner ear(Rizk et al.,2022). Hydrops

causes aggression and consequent injury to the membranous structures of the labyrinth as well as

to the sensory receptors located in this area. Endolymphatic hydrops cause dilation of the

endolymphatic spaces of the membranous labyrinth. Physiopathologically, hydrops is a

consequence of an imbalance in the formation and absorption of endolymph, produced by an

increase in its production (located in the stria vascularis) and a decrease in its absorption (located

in the aqueduct and endolymphatic sac). Distension of the membranous labyrinth initially affects

the cochlear saccule and scala media, later affecting Reissner's Membrane, namely in the

cochlear apex. During the course of the disease, dilation affects all spaces of the membranous

labyrinth, with loss of hair cells in the organ of Corti and atrophy of supporting cells and tectorial

membrane. All this leads to structural damage to the inner ear membranes, with mechanical,

biochemical, and neurosensory changes in the vestibule and cochlea. Clinically, recurrent

vertigo, tinnitus, and ipsilateral hearing loss appear, sometimes associated with the sensation of

aural fullness.

Diagnosis
Diagnosis of Ménière's disease can be difficult, as dizziness is an overlapping symptom with

many other conditions, including life-threatening neurological conditions such as a stroke. An

MRI is often used to rule out tumors or other abnormal growths.

A test called the caloric test determines the balance by flushing the ears with water or air. This

results in rapid eye movement called nystagmus. According to the pattern of rapid eye

movement, the doctor can sometimes interpret balance disturbance.

The diagnosis of Menière's Disease is based on the typical symptoms of vertigo, which are

accompanied by tinnitus and hearing loss in at least one of the ears. Audiometric and vestibular

exams are usually requested to help in the diagnostic investigation, among which the following

deserve mention: audiometry and electrocochleography, and more recently, the magnetic

resonance exam with a specific protocol.

Treatment

There is no cure for Ménière's Syndrome, but there are effective treatments to combat the

symptoms in most cases. In the case of hearing loss, the most indicated is the use of hearing aids,

especially the RIC model (receiver in the canal), which allows the exchange of the receiver to

adjust according to the intensity of the hearing loss.

With regard to tinnitus, there is the option of doing Notch Therapy, which offers a better quality

of life. In addition, the doctor may prescribe medication to relieve vertigo and nausea or drugs

such as blood flow modulators, calcium channel blockers, and vasodilators, among others.

Importance in nursing practice

Nursing Diagnosis
Risk for falls related to vertigo and imbalance secondary to Meniere's disease.

Meniere's disease and tinnitus are important in nursing practice. Nurses can play an important

role in managing the symptoms by administering medications providing emotional support, and

providing patient education. Nurses have to offer assistance to patients with mobility issues and

help patients with activities that trigger dizziness to prevent the risk of falls and injuries. Through

patient education, nurses can help patients understand the causes, symptoms, and importance of

treatment plans in managing the condition and ensuring patient safety.

References

Hearing Health Foundation. (2021). Ménière’s Disease Statistics. Retrieved from

https://hearinghealthfoundation.org/menieres-disease-statistics

Ma, Y., Sun, Q., Zhang, K., Bai, L., & Du, L. (2021). High level of IgE in acute low-tone

sensorineural hearing loss: A predictor for recurrence and Meniere Disease

transformation. American Journal of Otolaryngology, 42(2), 102856.

Rizk, H.G., Mehta, N.K., Qureshi, U., Yuen, E., Zhang, K., Nkrumah, Y., Lambert, P.R., Liu,

Y.F., McRackan, T.R., Nguyen, S.A. and Meyer, T.A.(2022). Pathogenesis and etiology of

Meniere disease: a scoping review of a century of evidence. JAMA Otolaryngology–Head &

Neck Surgery.

Thompson‐Harvey, A., & Hain, T. C. (2019). Symptoms in cervical vertigo. Laryngoscope

investigative otolaryngology, 4(1), 109-115.