Meniere's Disease

Subject: Medical and Surgical Nursing II (Theory)

Overview

The endolymphatic system is enlarged in Meniere's disease, an inner ear ailment. Additionally known as endolymphatic hydrops. A family history of Meiners illness is present in around 50% of patients. Meniers illness has an etiology that is not known. However, there are a number of other factors that might be to blame, such as poor endolymphatic sac absorption, vasomotor disturbances, allergies, salt and water retention, and autoimmune and viral etiologies. Episodic vertigo, sudden onset, feeling that one is rotating with respect to one's environment, and fluctuating hearing loss that follows or goes along with vertigo are the main symptoms of a miners disease. Examine the severity and frequency of the attack, as well as any associated ear symptoms. Help the patient avoid aura so they can get ready for an attack.

Meniere's Disease

Meniere's disease is a disorder of inner ear in which the endolymphatic system is distended. It is also called endolymphatic hydrops.

Incidence

  • Males are more impacted than females
  • Most illnesses are unilateral.
  • Ages 35 to 60 are the ones with the highest prevalence.
  • A family history of Meiners disease is present in approximately 50% of patients.

Etiology

  • The exact cause of a meniers disease is unknown.

But the possible causes include

  • Ineffective endolymphatic sac absorption
  • Vasomotor dysfunction
  • Allergies
  • Retention of water and sodium
  • Hypothyroidism
  • viral and autoimmune etiologies

Risk Factor

  • Smoking
  • Alcohol use
  • Fatigue
  • Respiratory infection
  • Stress
  • Use of certain medication, including aspirin
  • Genetics may also play a role

Pathophysiology

  • Endolymphatic duct/sac obstruction
  • Changes in endolymph production and absorption
  • Endolymphatic sac dilation
  • pressure increase and inner membrane rupture
  • hearing loss, dizziness, and tinnitus

Clinical Feature:

Cardinal symptoms of a meniers disease are:

  • vertigo on occasion
  • abrupt onset
  • a sense of spinning about oneself or the environment
  • fluctuating hearing loss after or along with dizziness
  • hearing gets worse with each attack tinnitus
  • Tinnitus
  • Low-pitched roaring
  • Sensation of auditory fullness: occurs with or before dizziness

Other Features

  • Diarrhea
  • Headache
  • Pain or discomfort in the abdomen
  • Nausea and vomiting
  • Uncontrollable eye movement

Investigation

  • Otoscopy
  • Sound-only audiometry
  • unique acoustic test
  • Electrocochleography
  • Reduced response on the affected site during the caloric test
  • Glycerol test: lowers endolymph pressure and enhances hearing

Management

  • General Management
    • Reassurance: psychological support
    • Cessation of smoking
    • Low salt diet
    • Avoid excessive intake of water
    • Lifestyle modification
  • Management of acute attack
    • Reassurance
    • Bed rest
    • Vestibular sedatives: dimenhydrinate, prochlorperazine, diazepam
    • Vasodilators: papaverine, isoxsuprine, adenosine triphosphate
  • Management of chronic phase
    • Vestibular sedatives: prochlorperazine
    • Vasodilators: nicotinic acid, betahistine
    • Diuretics: frusemide
    • Avoid allergen
    • HRT for hypothyroidism
    • Chemical labyrinthectomy:
    • Intratympanic Gentamicin therapy

Surgical Management

Conservative procedure:

  • Endolymphatic decompression
  • Endolymphatic shunt operation
  • Sacculotomy (fick operation)
  • Ultrasonic destruction of vestibular labyrinth
  • Destructive measure:
  • Labyrinthectomy

Nursing Management:

  • Examine the intensity and frequency of the episode as well as any ear symptoms that may be present ( hear loss, tinnitus)
  • Help the patient avoid the aura so they have time to get ready for an assault.
  • Encourage the patient to lie down in a safe location during an attack.
  • If the patient is lying down, add side rails to the bed.
  • Use a cushion to limit your mobility.
  • administer or instruct students to administer sedatives and antivertiginous drugs as directed.
  • Avoid loud noises and bright lights to prevent attack.
  • Inform the patient to stay away from allergenic foods.
  • When necessary, provide ambulation assistance.
  • Comfort measures should be given, and stressful activities should be avoided.

Complication

  • walking or functioning is impossible due to uncontrollable dizziness.
  • loss of hearing on the affected side
  • Injury risk because of imbalance
Things to remember
  • The endolymphatic system is enlarged in Meniere's disease, an inner ear ailment.
  • Additionally known as endolymphatic hydrops.
  • A family history of Meiners illness is present in around 50% of patients.
  • Meniers illness has an etiology that is not known.
  • However, there are a number of other factors that could be to blame, such as poor endolymphatic sac absorption, vasomotor disturbances, allergies, sodium and water retention, and autoimmune and viral etiologies.
  • Meniers illness is characterized by episodic vertigo, abrupt onset, the sensation that one is rotating in one's environment, and fluctuating hearing loss that follows or goes along with vertigo.
  • Examine the intensity and frequency of the episode as well as any ear symptoms that may be present ( hear loss, tinnitus).
  • Help the patient avoid the aura so they have time to get ready for an assault.
Questions and Answers

Meniere's disease is an inner ear disorder characterized by a distended endolymphatic system. Endolymphatic hydrops is another name for it.

  • The exact cause of meniers disease is unknown.

But the possible causes include

  • Defective absorption by endolymphatic sac
  • Vasomotor disturbances
  • Allergies
  • Sodium and water retention
  • Hypothyroidism
  • Autoimmune and viral etiologies

 

Risk factor

  • Smoking
  • Alcohol use
  • Fatigue
  • Respiratory infection
  • Stress
  • Use of certain medication, including aspirin
  • Genetics may also play a role

Cardinal symptoms of meniers disease are:

  • Episodic vertigo
  • Sudden onset
  • Feeling of rotation of himself/environment
  • Fluctuating hearing loss following / accompanying vertigo
  • Deteriorating in hearing with each attack tinnitus
  • Tinnitus
  • Low pitch roaring type
  • Sense of aural fullness: accompany/ precede vertigo

 

Other features

  • Diarrhea
  • Headache
  • Pain or discomfort in the abdomen
  • Nausea and vomiting
  • Uncontrollable eye movement

Management

1.General management

  • Reassurance : psychological support
  • Cessation of smoking
  • Low salt diet
  • Avoid excessive intake of water
  • Lifestyle modification

2.Management of acute attack

  • Reassurance
  • Bed rest
  • Vestibular sedatives: dimenhydrinate, prochlorperazine, diazepam
  • Vasodilators: papaverine, isoxsupine, adenosine triphosphate

3.Management of chronic phase

  • Vestibular sedatives: prochlorperazine
  • Vasodilators: nicotinic acid , betahistine
  • Diuretics: frusemide
  • Avoid allergen
  • HRT for hypothyroidism
  • Chemical labyrinthectomy:
  • Intratympanic Gentamicin therapy

4.Surgical management

Conservative procedure:

  • Endolymphatic decompression
  • Endolymphatic shunt operation
  • Sacculotomy (fick operation)
  • Ultrasonic destruction of vestibular labyrinth
  • Destructive measure:
  • Labyrinthectomy

 

Nursing management

  • Assess the seveity and frequency of attack, any associated ear symptoms ( hear loss, tinnitus)
  • Help patient prevent from aura, so patient has time to prepare for an attack.
  • Encourage patient to lie down during attack in safe place
  • Put side rails in the bed if the patient is in bed
  • Place pillow to restrict movement
  • Administer or teach antivertiginous medication and sedation medication as prescribed
  • Avoid noises and glary bright light which may initiate attack
  • Advise patient to avoid food that cause allergy
  • Assist with ambulation when indicated
  • Provide comfort measures and avoid stress producing actoivities

 

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