Meniere’s Disease

Mr. Binu Mrs. Jincy

Babu M.Sc. Ealias M.Sc.
Nursing Nursing
Page 1
 Introduction
• First described by Prosper Meniere in
1861.

• Ménière’s disease is a balance

disorder.

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 Definition

• Meniere’s disease is an abnormal inner ear

fluid balance caused by a malabsorption in
the endolymphatic sac or a blockage in the
endolymphatic duct.

• It is also called endolymphatic hydrops.

• It occurs bilaterally in about 20% of

patients.
Page 3
Page 4
 Etiology
• Unknown.
• Common in adults
• Age : between 40 and 60 years of age
• Equally common in men and women
• Family history: 50% of the patients have a positive family
history
• Hypersecretion or hypoabsorption of endolymph or both
• Deficit membrane permeability
• Allergy
• Viral infection
• Hormonal Imbalance
• Mental stress.
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 Pathophysiology
Obstruction of endolymphatic duct/sac

Hypersecretion or hypoabsorption of endolymph or both

Excessive accumulation of endolymph Distension

of membranous labyrinth & endolymphatic sac

Increased in pressure and rupture of inner membranes Loss

of auditory and vestibular function

Vertigo, tinnitus, hearing loss Page 6

Page 7
 Clinical features

Hearing
Vertigo loss

Tinnitus

Triad of Meniere's disease

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 Clinical Manifestations
• Fluctuating, progressive sensorineural hearing loss
• Tinnitus
• Vertigo
– Accompanied by nausea and vomiting and
nystagmus.
– Vertigo lasts 2 to 4 hours.
– And followed by dizziness and unsteadiness.

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• Warning signs
– Headache
– A feeling of pressure or fullness in the ear
• Behavioral changes
– Irritability
– Depression
– Withdrawal

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 Types
• Two subtypes

Cochlear Meniere's disease

Vestibular Meniere's disease

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• Cochlear Meniere's disease is
recognized as a fluctuating, progressive
sensorineural hearing loss associated with
tinnitus and aural pressure in the absence of
vestibular symptoms.

• Vestibular Meniere's disease is

characterized as the occurrence of
episodic vertigo associated with aural
pressure but no cochlear symptoms.

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 Diagnostic measures
• History collection
• Physical examination
• Audiogram : identify the type and
magnitude of the hearing loss.
• CT or MRI:
• Electronystagmogram : to evaluate the
oculomotor and vestibular systems to
differentiate the cause of vertigo, tinnitus,
and hearing loss of unknown origin.
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 Management

Medical Management
• Pharmacologic therapy
• Dietary management

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 Pharmacologic therapy

• Antihistamine : to suppress the vestibular

system. Eg: meclizine
• Tranquilizers: to control vertigo. Eg:
diazepam
• Antiemetic: eg. promethazine
(Phenergan). To control the nausea and
vomiting and the vertigo because of their
antihistamine effect.

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• Diuretic: relieve symptoms by lowering the
pressure in the endolymphatic system. Eg:
hydrochlorothiazide, triamterene
• Vasodilators: eg: papaverine
hydrochloride

• Avoid aspirin and aspirin-containing

medications. Aspirin may increase tinnitus
and dizziness.
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If not responding to drugs;
• Ablation therapy
Intratympanic injection of gentamicin is
being used to cause ablation of the vestibular
hair cells.

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 Dietary management
• Low-sodium (1000 to 1500 mg/day or less)
diet.

• The amount of sodium is a factor that

regulate the balance of fluid within the
body. Sodium and fluid retention disrupts
the delicate balance between endolymph
and perilymph in the inner ear.

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• Limit foods high in salt or sugar.
• Eat meals and snacks at regular intervals to stay
hydrated. Missing meals or snacks may alter the
fluid level in the inner ear.
• Limit intake of coffee, tea, and soft drinks. Avoid
caffeine because of its diuretic effect.
• Limit alcohol intake. Alcohol may change the
volume and concentration of the inner ear fluid
and may worsen symptoms.
• Avoid monosodium glutamate (MSG), which
may increase symptoms.

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 Surgical Management
• The surgical treatment of Meniere's disease is
aimed at eliminating the attacks of vertigo, so
hearing loss, tinnitus, and aural fullness may
continue. The surgical procedures are:
1. Endolymphatic sac procedures
2. Vestibular nerve section.

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Endolymphatic Sac Decompression
• First-line surgical approach to treat the vertigo
of Meniere's disease as it is simple, safe and
can be performed on an outpatient basis.
• Through a postauricular incision, a shunt or
drain is inserted in the endolymphatic sac
and fluid is drained into subarachnoid space .
Thus release of pressure on the
endolymphatic system in the labyrinth

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Vestibular Nerve Sectioning
• Performed by a translabyrinthine approach or
in a manner that can conserve hearing (ie,
suboccipital or middle cranial fossa),
depending on the degree of hearing loss.
Cutting the nerve prevents the brain from
receiving input from the semicircular canals.

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 Nursing management
• Assess the severity and frequency of attack, any
associated ear symptoms (hear loss, tinnitus).
• Acute vertigo: provide bedrest, sedation,
antiemetics
• Encourage patient to lie down during attack in
safe place.
• Advise patient to avoid food that cause allergy.
• Maintain the prescribed low-salt diet

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• Impaired comfort related to impairment in
auditory function or vestibular function.
• Impaired auditory sensory perception
related to altered state of the ear.
• Risk for deficient fluid volume related to
increase fluid output, altered intake.
• Risk for injury related to impaired
equilibrium
• Anxiety related to threat to changes
health status. Page 24