Meniers’s disease

Presented by
Sameena Magray
(MSC NURSING ist year)
MENIERE'S DISEASE.
Introduction:-In 1861 Prosper Meniere
described a syndrome characterized by
deafness, tinnitus, and episodic vertigo. He
linked this condition to a disorder of the
inner ear.
DEFINITION.
It is a syndrome characterized by a triad of symptoms; attacks of
incapacitating vertigo, Sensorineural hearing loss & Tinnitus.
It is an abnormality in inner ear fluid balance caused by a
malabsorbtion in the endolymphatic sac or a blockage in the
endolymphatic duct.
Endolymphatic hydrops (dilation of Endolymphatic space)develops
,and either increased pressure in the system or rupture of inner ear
membrane occurs producing symptoms of miniers disease.
INCIDENCE.
More common in adults, onset is generally
seen when adults reach their 40s ,with
symptoms between ages of 20 and 60years. It
appears to be equally common in men and
women.
ETIOLOGY.
Unknown cause.
Risk factor:-
Metabolic disorder
Toxicity
Allergies
Emotional factor
Circulatory disorder
Anatomical abnormalities
CLINICAL MANIFESTATIONS.
 Periodic episodes of vertigo Or dizziness. (Lasts for 2 to 4 hrs).
 Tinnitus.
 Sensorineural hearing loss.
 Fullness or pressure in ear.
 Nausea, vomiting.
 Increase pulse rate.
 Daiphoresis.
 Disorientation.
WARNING SIGNS.
Headache
A feeling of pressure or fullness in the ear
Behavioral changes
Irritability
Depression
Withdrawal
TYPES.
Cochlear Meniere’s disease.
It 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 .
 It is characterized as the occurrence of episodic vertigo
associated with aural pressure but no cochlear symptoms.
ASSESSMENT AND
DIAGNOSTIC FINDINGS.
History collection
Physical examination
 Audiogram: identify the type and magnitude of the hearing
loss(pike’s peak )looks like a mountain or mountain.
 CT or MRI
 Electronystagmogram: to evaluate the oculomotor and vestibular
systems to differentiate the cause of vertigo, tinnitus, and hearing
loss of unknown origin.
MANAGEMENT.
Pharmacologic therapy
Antihistamine: to suppress the vestibular system. Eg:
meclizine’,shortnes the attack.
 Tranquilizers: to control vertigo. Eg: diazepam help to
control vertigo
 Antiemetic: eg. Promethazine (Phenergan). To control the
nausea and vomiting and the vertigo because of their
antihistamine effect.
CONTINUE..
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.
 If not responding to drugs;
 Ablation therapy of vestibular hair cells (Destruction).
 Intratympanic injection of gentamicin is being used to cause
ablation of the vestibular hair cells.
SURGICAL MANAGEMENT.
 Endolymphatic sac Decompression.
 First line surgical Approach to treat Miner’s disease as it is safe’,simple and
can be performed on Outpatient basis.
 Through a post auricular incision ,a shunt or drain is inserted Into
endolymphatic sac And fluid is drained into subarachanod space.Thus release
of pressure On the endolymphatic system In the labyrinth.
 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.
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.
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
NURSING DIAGNOSIS.
 Risk for injury realted to altered mobility because of gait
disturbance and vertigo.
 Impaired auditory sensory perception related to altered
state of the ear.
 Risk of deficit fluid volume related to increased fluid
output, altered intake and medication.
 Anxiety related to threat to changes in health status.