Ménière’s

Disease

OVERVIEW

Idiopathic disease an abnormal inner ear fluid

balance caused by a mal-absorption of fluid in the endolymphatic sac

a blockage in the endolymphatic duct

regardless what cause it, endolymphatic hydrops develops.

NORMAL

DILATED

OVERVIEW

more common in adults an average age of onset in the 40s with symptoms usually beginning

between the ages of 20 and 60 years

common in both genders the right and left ears are affected

with equal frequency

CLINICAL MANIFESTATIONS fluctuating, progressive

sensorineural hearing loss tinnitus or a roaring sound a feeling of pressure or fullness in

the ear episodic, incapacitating vertigo,

often accompanied by nausea and vomiting

2 SUBSETS OF MENIERE’S DISEASE

Cochlearfluctuating, progressive sensorineural hearing loss associated with tinnitus and aural pressure in the absence of vestibular symptoms or findings.

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

PATHOPHYSIOLOGYRisk Factors

1.Age2.Gender3.Congenital4.High-sodium diet5.Conditions:

a.Syphilisb.Autoimmune Diseasec.Herpes Virus

Infection

Fluid imbalance in the endolymphatic

sac

Accumulation of fluid in the

endolymphatic sac

Burst into other duct channels

Feeling of fullness

Pressure in the ear

Membranes becomes dilated

Cochlear duct Saccule Utricle

Flactuating, progressive sensorineural hearing

loss

Compression of Organ of

Corti

Vertigo

Nausea and vomiting

ASSESSMENT & DIAGNOSTIC FINSINGS A careful history is taken to determine

the frequency, duration, severity, and character of the vertigo attacks.

Sounds from a tuning fork Weber Test

Audiogram Electronystagmogram

MEDICAL MANAGEMENT Can be successfully treated

with diet and medication therapy

Many patients can control their symptoms by adhering to a low-sodium (2,000 mg/day) diet

PHARMACOLOGIC THERAPY

1. Antihistamines2. Tranquilizers3. Antiemetics 4. Diuretic5. Vasodilators

meclizinediazepampromethazinehydrochlorothiazidepapaverine HClMethantheline Br

AntivertValiumPhenerganHydrodiuril PavabidBanthine

CLASS GENERIC

BRAND

SURGICAL MANAGEMENT

Endolymphatic Sac Decompression equalizes the pressure in the

endolymphatic space favored by many otolaryngologists as a

first-line surgical approach to treat the vertigo of Ménière’s disease

SURGICAL MANAGEMENT

Middle and Inner Ear Perfusion used to decrease vestibular function and

decrease vertigo ototoxic medications, such as streptomycin

or gentamicin, can be given to patients by infusion into the middle and inner ear

SURGICAL MANAGEMENT

Intraotologic Catheters catheters are being developed to provide a

conduit from the outer ear to the inner ear uses of these catheters include treatment

for sudden hearing loss and various disorders causing intractable vertigo

SURGICAL MANAGEMENT

Vestibular Nerve Section provides the greatest success rate

(approximately 98%) in eliminating the attacks of vertigo

cutting the nerve prevents the brain from receiving input from the semicircular canals

NURSING MANAGEMENT

Nursing Dx: Risk for injury related to altered mobility because of gait disturbance

1.Assess extent of disability in relation to activities of daily living.

2.Recommend that patient keep eyes open and stare straight ahead when lying down and experiencing vertigo.

2. Place pillow on each side of head to restrict movement.

3. Encourage patient to sit down when dizzy.

Nursing Dx: Risk for deficient fluid volume related to increased fluid output, altered intake and medications

1.Monitor intake and output.

2.Assess indicators of dehydration (e.g. pulse, skin turgor, blood pressure, mucous membranes).

3.Encourage oral fluids as tolerated; discourage beverages containing caffeine.

NURSING MANAGEMENT

SALAMAT SA

PAGPAMINAW!

REFERENCES Bickley, L. (2007). Bates’ pocket guide to physical examination

and history taking. (5th ed.). Philippines: Lippincott Williams & Wilkins Black, J.M. & Hawks, J.H. (2009). Clinical management for ositive outcomes. (8th ed.). Missouri: Saunders Elsevier, Inc. Bullock, B.L. & Henze, R.L. (2000). Focus on pathophysiology. Philadelphia: Lippincott Williams & Wilkins Dillon, P.M. (2007). Nursing Health Assessment: a critical thinking, case studies approach.(2nd ed. ). Philadelphia: F.A. Davis Company Hockenberry, M. & Wilson, D. (2007). Wong’s nursing

care of infants and children. (8th eds: .). Philippines: Elsevier

Hockenberry, M. & Wilson, D. (2007). Wong’s nursing care of infants and children. (8th eds: .). Philippines: Elsevier Huether, S. & McCane, K. (2005). Understanding pathophysiology. (3rd ed.). Philippines: Mosby Inc. Ignatavicius, D.D. & Workman, M.L. (2006). Medical – surgical nursing: critical thinking for collaborative care. (5th ed.). Singapore: Elsevier Pte Ltd. Kozier, B. (2004). Fundamentals of nursing. New Jersey: Pearson Education Inc. Lewis, S. M., et.al. (2004). Medical – surgical nursing: assessment and management of clinical problems. (6th ed.). Philadelphia: Mosby, Inc. Marieb, E. (2002). Essentials of human anatomy and physiology. (6th ed.). Philippines: Pearson Education Inc. SUCN Level II Procedure Manual