an inner ear disorder that cause episodes of vertigo (spining) . this sildeshare contained detailed information about definition, causes, types, medical and nursing management.

1. MENIERE’S DISEASE
Submitted to :
Submitted by :
Name:- Ruby Kiran
Roll no. :- 29
Basic BSc nursing 3rdyear
College of Nursing
RIMS, Ranchi
Mrs. Mamta Toppo
Subject coordinator
College of nursing
RIMS, Ranchi

2. Contents
1. Definition
2. Types
3. Causes
4. Risk factor
5. Pathophysiology
6. Clinical manifestations
7. Diagnostic evaluation
8. Treatment
9. Medical Management
10. Surgical Management
11. Nursing Management
12. Patient Education
13. Prognosis
14. Complications
15. Recent research
16. Summary
17. Evaluation
18. Resources
19. Bibliography

3. Definition
• Meniere’s Disease is a disorder of the inner ear that can affect auditory
(hearing) and vestibular (balance) system.
• It is characterised by sudden and recurrent episodes of dizziness and
tinnitus and progressive hearing loss.
• It is caused by dilation or swelling of the endolymphatic sac,affecting
the drainage of endolymph or other tissues in the vestibular system of
the inner ear, which is responsible for the body’s sense of balance.
• It is named after the French physician Prosper Meniere, who first
reported that vertigo was caused by inner ear disorders in an article
published in 1861.

5. • Two types
1. Unilateral (most common)
2. Bilateral

6. Causes
• The exact cause is unknown but it is believed to be related to
endolymphatic hydrops (gross distension of endolymphatic system)
or excessive endolymph in the vestibular and semicircular canals
of the inner ear.
• In some cases, it may be related to head injury, middle ear
infection or syphilis.

7. Risk Factors
1. Allergies
2. Alcohol use
3. Fatigue
4. Recent Viral illness
5. Respiratory infection
6. Smoking
7. Stress
8. Use of certain medication including aspirin
9. Family history
10. Immune disorder
11. High Salt intake
12. Chronic exposure to loud noise

8. Pathophysiology
• Disease may result from over production of endolymph in the
labyrinth of the ear.
• Accumulation of endolymph leads to pressure increase that may
break the membrane that separates the perilymph resulting in
vestibular nerve malfunction leading to vertigo.
• Causes dilation of semicircular canal, utricle and saccule causing
degeneration of vestibular and cochlear hair cells.
• Overstimulation of the vestibular branch of cranial nerve VIII
impairs postural reflex and stimulates vomiting.

9. Clinical Manifestations
• Recurring episodes of vertigo
• Hearing loss
• Tinnitus
• Feeling of fullness in the ear
• Loss of balance
• Headache
• Nausea, Vomitting and Sweating caused by severe vertigo
• After an episode, signs and symptoms improve and might disappear
entirely. Episodes can occur weeks to years apart.

11. Diagnostic evaluation
• Imaging
• Computed tomography scanning (brain) and magnetic resonance imaging are used to rule out
acoustic neuroma or other neurological condition as a cause of symptoms.
• Audiometric test :- Results show a sensorineural hearing loss and a loss of discrimination; low-
frequency sounds are commonly affected.
• Cold caloric test:- Results show impairment of the oculovestibular reflex.
• Electronystagmography :- Results show normal or reduced vestibular response on the affected
side.
• Transtympanic electrocochleography :- Results show an increased ratio of summating potential
to action potential, usually > 35%.
• Brain stem evoked response audiometry test :- used to rule out acoustic neuroma, brain
tumor, and vascular lesions in the brain stem.

12. Treatments
• No cure exists for Meniere’s disease, but a number of treatments
can help reduce the severity and frequency of vertigo
episodes.There are no treatments for the hearing loss that occurs
with Meniere’s disease. All of the treatments- some conservative,
some aggressive- are to stop the spells of vertigo.
• GENERAL
Hearing aids:- A hearing aid in the ear affected by Meniere’s
disease might improve your hearing.Your doctor can refer you to an
audiologist to discuss what hearing aid options would be best for
you.

13. Cont..
• DIET
Avoidance of possible triggers,such as salt, caffeine, alcohol, nicotine,
and monosodium glutamate.
• ACTIVITY
Lying down to minimize head movement, and avoiding sudden
movements and glaring light to reduce dizziness.
• VESTIBULAR REHABILITATION THERAPY:- is an exercise based program for
reducing the symptoms of disequilibrium and dizziness associated with
vestibular pathology. The program may include exercises for:-
coordinating eye and movements, improving balance and walking ability,
and improving fitness and endurance.

14. Medical Management
• Intratympanic infusion of gentamicin (for patients not responding to
medication)
• Acute Attack Management:
• First-line agents: Atropine sulfate (AtroPen), diazepam (Valium),
transdermal scopolamine (Transderm-Scop)
• Second-line agents (I.V.): Droperidol (Inapsine), promethazine
hydrochloride (Promethegan), diphenhydrAMINE hydrochloride (Benadryl)
• Maintenance Therapy:
• First-line agents: Meclizine hydrochloride (Antivert), diazepam (Valium)
• Second-line agents: Dimenhydrinate (Dramamine), promethazine
hydrochloride, diphenhydramine hydrochloride (Benadryl), intratympanic
gentamicin or dexamethasone (oral; injection) (DexPak)

15. Surgical Management
• Endolymphatic sac decompression:- The endolymphatic sac
decompression operation is performed by making an incision behind the
involved ear amd exposing the mastoid bone. The mastoid is opened,
and the facial nerve is identified in its course through the mastoid. The
bone over the endolymphatic sac is then exposed and once identified,
the sac is opened. A non-reactive sheet of silastic or a valve is inserted
into the sac to allow for future drainage, when fluid reforms. The
operation takes about an hour.
• Cryosurgical Method:- A cryoprobe is placed on the semicircular canal
and subnormal temperature achieved which causes destruction of the
adjacent labyrinthine tissues.

16. Cont.
• Vestibular nerve resection/cochleovestibular 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, 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.
• Vestibular ablation( removal of a body part or the destruction of its
function)

17. Nursing Management
• ASSESSMENT
1. Obtain a health history and specific information about the onset
and characteristics of vertigo and hearing impairment.
2. Assess frequency and severity of attacks and how patient
handled them.
3. Assess vital signs to determine if symptoms are associated with
an infection.
4. Assess patient for any nutritional deficiency including
dehydration, weight loss or weight gain.

18. Cont..
5. Perform whisper voice, Rinne’s test and Weber test to assess the
degree of hearing impairment.
6. Assess for additional neurologic symptoms- visual changes,
changes in mental status, sensory and motor deficit.
7. Assess for effectiveness of the vestibular suppressants and
antiemetic medications.

19. Cont..
• NURSING DIAGNOSIS
1. Risk for injury related to sudden attack of vertigo.
2. Fluid volume deficit related to vomiting and impaired intake.
3. Altered nutrition, less than body requirement related to nausea
and vomiting.
4. Anxiety related to sudden onset of symptoms.
5. Self care deficit related to vertigo.

20. Cont..
• GOAL
1. Preventing injury
2. Ensuring adequate food and fluid
3. To reduce anxiety
4. To promote for self care

21. Cont..
• NURSING INTERVENTIONS
1. Assess the patient for any pattern of dizziness or vertigo.
2. Encourage rest during severe episodes and gradually increase activity.
3. Encourage the pateint to lie down during attack in safe place. Put side
rails up on bed if the patient is in hospital.
4. Instruct the pateint to seek assistance before ambulation due go to
loss of balance during attacks.
5. Avoid sudden movements that may aggravate symptoms. Avoid bright
lights, TV, and reading during attacks.

22. Cont..
• II
1. Check the skin tugor.
2. Monitorr electrolyte balance.
3. Assess intake and output as indicated by the doctors.
4. Encourage fluids and small feedings while patient feels better.
5. Mouth care should be performed twice daily.

23. Cont..
• III
1. Diets can include fresh meats, poultry, vegetables and fruits.
Processed meats, canned products, monosodium glutamate,
table salt and liye salt should be avoided totally.
2. Patients are advised to avoid caffeine, alcohol and tobacco, as
well as chocolate must also be eliminated from the diet.
3. Encourage patient to avoid smoking.
4. Avoid olives, pickled foods, chips and some cheeses.
5. Administer antiemetics as prescribed by doctor.

24. Cont..
• IV
1. Explain physiology behind vertigo and possible triggers.
2. Assist patient to adjust activities to minimize the impact of vertigo.
Encourage activity while vertigo is minimal and rest during acute
attack.
3. Explain methods to minimize symptoms during acute episodes such as
decreasing movement.
4. Encourage patient to explore concern about hearing loss. Hearing aids
may be needed for severe hearing loss.
5. Explain medication regime to help control symptoms.

25. Cont..
• V
1. Perform or assist with clients need when he is unable to meet his
own needs.
2. Support the client in making health related decisions.
3. Assist in developing self care practices and goals that promote
health.
4. Encourage the client for range of motion exercises.

26. Patient Education
• Encourage patient to express feelings of increased tolerance of activities and
comfort.
• Seek appropriate support to assist with coping
• Have patient verbalize an understanding of the disease process and identify
prescribed treatment plan to control his/her condition
• Educate the patient on strategies to safeguard his home or environment to prevent
falls.
• Have patient remain free from injury and to participate in decisions about his/her
care.
• Need to avoid sudden movements or positions that make vertigo hazardous to the
pt.
• Lifestyle modification in diet to reduce salt intake, and avoid caffeine and nicotine
substances

27. Prognosis
• Meniere’s disease has no cure but can be managed with life style
changes and stress management
• As disease progresses hearing loss may progress but can be treated
with hearing aid
• In severe cases of Meniere’s surgical intervention

28. Complications
1. Injury due to falls
2. Anxiety regarding symptoms
3. Accidents due to vertigo spells
4. Disability due to unpredictable vertigo
5. Progressive imbalance and deafness
6. Intractable tinnitus

29. Recent research

33. Summary
• Meniere's disease is a disorder of the inner ear. It can cause
severe dizziness, a roaring sound in your ears called tinnitus, hearing loss
that comes and goes and the feeling of ear pressure or pain. It usually
affects just one ear. It is a common cause of hearing loss.
• Attacks of dizziness may come on suddenly or after a short period of
tinnitus or muffled hearing. Some people have single attacks of dizziness
once in a while. Others may have many attacks close together over
several days
• There is no cure. Treatments include medicines to control dizziness,
limiting salt in your diet, and taking water pills. A device that fits into the
outer ear and delivers air pulses to the middle ear can help. Severe cases
may require surgery.

35. Evaluation
Q. The risk of Meniere’s disease is increased when a client –
1. Has a history of peptic ulcer
2. Consumes high doses of estrogen and progestin
3. Eat low sodium diet
4. Has hypothyroidism

36. • Ans :- 4. Has hypothyroidism

37. Q. The removal of the inner ear sense organ is known as –
1. Labyrinthectomy
2. Endolymphatic sac decompression
3. Middle and inner ear perfusion
4. Vestibular neurectomy

38. • Ans :- 1. Labyrinthectomy

39. Q. A diagnostic procedure which involves recording the electrical
activity of the inner ear in response to sound is –
1. Magnetic resonance imaging
2. Electronystagmography
3. Electrocochleography
4. Caloric stimulation

40. • Ans :- 3. Electrocochleography

41. Q. In instilling otic drop, the dropper should be held –
1. ½ cm above the ear canal
2. 1 cm above the ear canal
3. 1 inch above the ear canal
4. 2 inches above the ear canal

42. • Ans :- 2. 1 cm above the ear canal

43. Reference
• Book
• Internet
• Discussion with teacher

44. Bibliography
1.Ansari Javed : A textbook of medical surgical nursing-II;PV
publication;page no.- 43-49.
2.Bunner and suddarth’s;textbook of medical surgical nursing;13th
edition.
3.www.nurseslab.com
4.www.slideshare.com
5.www.researchgate.net