MENIERE’S

DISEASE

Chlodette Eizl Laurente

Medical-Surgical Nursing II
 OBJECTIVES
 To introduce the history of Meniere’s Disease
 To define what is Meniere’s Disease
 To state the etiology of Meniere’s Disease.
 To illustrate the Parts of the ears.
 To discuss the Pathophysiology of Disease.
 To explain the causes of Meniere’s disease
 To know the clinical manifestation of the disease.
 To identify possible diagnostic testing for Meniere’s
Disease.
 To discuss nursing management, surgical
management and pharmacologic management
of the disease.
 Introduction : History
 First described by Prosper Meniere in 1861.

 In 1902, Parry performed a CN VIII division for

vertigo in a patient with suspected Meniere’s
disease.
 Portman did endolymphatic sac decompression
via a transmastoid approach in 1926.

• In 1931, McKenzie performed a selective

vestibular neurectomy.
 Meniere's disease
(Idiopathic Endolymphatic Hydrops)

Meniere’s disease is a balance disorder that

is caused by abnormally large amounts of
fluid collecting in the semi-circular canals of
your inner ear.

Meniere’s disease usually affects one ear,

but it can also happen in both ears at the
same time.
PATHOPHYSIOLOGY
•Meniere’s disease appears to involve overproduction or decreased
absorption of endolymph, with resultant degeneration of vestibular and
cochlear hair cells.

•Recurrent attacks result in progressive sensorineural hearing loss

(especially low tones), usually unilateral in nature.
 What causes Meniere’s disease?
 Meniere’s disease is caused when 2 different fluids mix
together inside your inner ear. To understand this better,
you should know that there are 3 canals in each of your
ears that are sensitive to movement. This is your balance
system. Each of these ear canals has 2 separate
chambers:

 1. The outer bony chamber contains perilymphatic fluid.

 2. The inner membranous chamber contains

endolymphatic fluid. These 2 fluids are very different from
one another. During a Meniere’s attack, the amount of
endolymphatic fluid in the inner chamber increases,
causing the pressure within your balance and hearing
systems to rise.
 When the pressure becomes too high, it causes
the inner and outer chambers to rupture or burst.

 Thetwo fluids in the chambers then mix and

cause an attack of vertigo (feeling of movement
when you are still). This is known as a Meniere’s
“attack.” 4
 The chamber membranes eventually heal
themselves and the fluid balance in your ear
canal is restored. However, this mixing of fluid can
happen over and over, causing more attacks.
 The cause of this disorder is not known.
 TYPES OF MENIERE'S DISEASE
1.Classical Meniere’s disease - episodic vertigo
attacks (often with nausea and vomiting),
sensorineural hearing loss, tinnitus, and pressure or
fullness in the involved ear (usually unilateral)

2.Vestibular Meniere’s disease – vestibular

symptoms and aural pressure

3.Cochlear Meniere’s disease – cochlear symptoms

and aural pressure

4.Lermoyez syndrome – Reverse Meniere’s

5.Tumarkin’s crisis – Utricular Meniere’s

 CLINICAL MANIFESTATION
 1. Vertigo: A feeling of movement when you are still. This is
similar to the sensation you experience if you spin around
quickly several times and suddenly stop. You feel as though the
room is still spinning, and you lose your balance. Episodes of
vertigo can occur without any warning and usually last 20
minutes to 2 hours or more. You may also experience severe
nausea, vomiting, and sweating.
2. Tinnitus: A ringing, buzzing, whistling, hissing or roaring sound
in the ear. This sound is not heard by others. Tinnitus may get
louder as the disease progresses.
3. Aural Fullness: A “full” feeling, or pressure in the affected ear.
4. Hearing Loss: Tends to come and go in the early stages of
Meniere’s disease, but some people may experience a degree
of permanent hearing loss.
Other less common symptoms of the disease may include
headaches, stomach discomfort and diarrhea.
HEARING LOSS
1. Sensori neural in nature
2. Fluctuating and progressive
3. Affects low frequencies
4. Mild low frequency conductive hearing loss (rare)
5. Profound sensori neural hearing loss (End stage)
TINNITUS
 Roaring in nature
 Subjective
 Could be continuous / intermittent
 Non pulsatile in nature
 Frequency of tinnitus corresponds to the
region of cochlea which has suffered the
maximum damage
Spontaneous nystagmus
 The direction of the observed
spontaneous nystagmus varies; it can
consistently beat toward the
 Involved ear (irritative)
 Away from it (paralytic)
 Change from an irritative to a paralytic
pattern over time, and thus cannot be
used to lateralize the disease
LERMOYEZ SYNDROME

• This is a variant of Meniere’s disease. It is

characterized by sudden sensori neural
hearing loss which improves during or
immediately after the attack of vertigo.
TUMARKIN’S DROP ATTACKS
• Abrupt falling attacks of brief duration
without loss of consciousness. due to excess
endolymphatic volume. Utricular crisis is
used to indicate this condition.
• In the later disease stages the valve of
Bast remaining patent may cause sudden
drainage of endolymph from the utricle due
to longitudinal flow resulting in these drop
attacks
What can I expect during a
Meniere’s attack?
 If you have Meniere’s disease, you will have
intermittent “attacks” of vertigo, hearing loss,
ringing and fullness of the ear that can vary in
frequency and length. On average, an attack
lasts 2 to 4 hours.
 Following an attack, you may feel very tired and
will need to sleep. 5 Meniere’s episodes may also
occur in clusters (several attacks that occur within
a short period of time). Between the acute
attacks, most people are free of symptoms or note
only mild imbalance and tinnitus problems. Years
may pass between episodes.
Laboratory and diagnostic
study findings
 Hearing assessment
A hearing test (audiometry) assesses how well you
detect sounds at different pitches and volumes and
how well you distinguish between similar-sounding
words. People with Meniere's disease typically have
problems hearing low frequencies or combined high
and low frequencies with normal hearing in the
midrange frequencies.

 Balance assessment
Between episodes of vertigo, the sense of balance
returns to normal for most people with Meniere's
disease. But you might have some ongoing balance
problems.
Tests that assess function of the inner ear include:
 Videonystagmography (VNG). This test evaluates balance function by assessing
eye movement. Balance-related sensors in the inner ear are linked to muscles
that control eye movement. This connection enables you to move your head
while keeping your eyes focused on a point.
 Rotary-chair testing. Like a VNG, this measures inner ear function based on eye
movement. You sit in a computer-controlled rotating chair, which stimulates your
inner ear.
 Vestibular evoked myogenic potentials (VEMP) testing. This test shows promise for
not only diagnosing, but also monitoring Meniere's disease. It shows characteristic
changes in the affected ears of people with Meniere's disease.
 Posturography. This computerized test reveals which part of the balance system
— vision, inner ear function, or sensations from the skin, muscles, tendons and
joints — you rely on the most and which parts may cause problems. While
wearing a safety harness, you stand in bare feet on a platform and keep your
balance under various conditions.
 Video head impulse test (vHIT). This newer test uses video to measure eye
reactions to abrupt movement. While you focus on a point, your head is turned
quickly and unpredictably. If your eyes move off the target when your head is
turned, you have an abnormal reflex.
 Electrocochleography (ECoG). This test looks at the inner ear in response to
sounds. It might help to determine if there is an abnormal buildup of fluid in the
inner ear, but isn't specific for Meniere's disease.
 Tests to rule out other conditions
 Blood tests and imaging scans such as an MRI may be used to rule out disorders
that can cause problems similar to those of Meniere's disease, such as a tumor in
the brain or multiple sclerosis.
Tracking your attacks
You should keep a detailed diary of all your attacks and include
this information:

• When the attack happened – What day? At what time? What

were you doing at the time of the attack?

• The length of time that the attack lasts (minutes or hours)

• Symptoms that come with the attack (spinning, headache,

tinnitus, pressure, fullness, hearing loss, floating)

• How you felt after the attack – How long did this feeling last?
• Did you take any medications to help you? By tracking your
attacks, your doctor or healthcare team will have a better
understanding of how Meniere’s affects you and, can then
make decisions on how to best help you deal with it.
 TREATMENTS
 No cure exists for Meniere's disease. A number of
treatments can help reduce the severity and
frequency of vertigo episodes. But, unfortunately,
there aren't any treatments for the hearing loss.
 Medications for vertigo
 Your doctor may prescribe medications to take
during a vertigo episode to lessen the severity of an
attack:
 Motion sickness medications, such as meclizine or
diazepam (Valium), may reduce the spinning
sensation and help control nausea and vomiting.
 Anti-nausea medications, such as promethazine,
might control nausea and vomiting during an
episode of vertigo.
Medical Managements
1. You may be asked by your doctor to take diuretics
to help reduce your inner ear fluid pressure.

2. Your doctor may recommend that you take

medications to help with the vertigo, nausea and
vomiting.

3. You may be offered Vestibular rehabilitation

exercises. This therapy includes exercises and
activities that you perform during therapy sessions
and at home, to help your body and brain to regain
the ability to process balance information correctly.
 Noninvasive therapies and
procedures
 Rehabilitation. If you have balance problems between
episodes of vertigo, vestibular rehabilitation therapy might
improve your balance.
 Hearing aid. 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.
 Positive pressure therapy. For vertigo that's hard to treat, this
therapy involves applying pressure to the middle ear to lessen
fluid buildup. A device called a Meniett pulse generator
applies pulses of pressure to the ear canal through a
ventilation tube. You do the treatment at home, usually three
times a day for five minutes at a time.
 Positive pressure therapy has shown improvement in symptoms
of vertigo, tinnitus and aural pressure in some studies, but not in
others. Its long-term effectiveness hasn't been determined yet.
 Pharmacologic
Tranquilizers and antihistamines
such as meclizine (Antivert) to control vertigo
and to suppress the vestibular system;
antiemetics for nausea and vomiting.
 Diuretics to lower pressure in the
endolymphatic system
 Vasodilators are often used in conjunction with
other therapies
 Middle and inner ear perfusion or systemic
injections of ototoxic medications: streptomycin,
gentamicin to eliminate vertigo/
 Middle ear injections
 Medications injected into the middle ear, and then
absorbed into the inner ear, may improve vertigo
symptoms. This treatment is done in the doctor's
office. Injections available include:
 Gentamicin, an antibiotic that's toxic to your inner
ear, reduces the balancing function of your ear,
and your other ear assumes responsibility for
balance. There is a risk, however, of further hearing
loss.
 Steroids, such as dexamethasone, also may help
control vertigo attacks in some people. Although
dexamethasone may be slightly less effective than
gentamicin, it's less likely than gentamicin to cause
further hearing loss.
Steroid Injection
(Dexamethasone)
 The doctor applies some freezing to your
ear drum while you lie on a bed. After some
time, he or she will inject the
dexamethasone into the middle ear
(through your ear drum) and you will be
asked to lie in the same position for about
20 minutes. You will return once or twice a
week until your symptoms and attacks
settle, or the maximum number of injections
have been done..
Dietary Management

• Low sodium (2,000 mg/day)

• Avoidance of alcohol, nicotine and caffeine
Surgical
Managements
 Labyrinthectomy – the surgeon removes a portion, or all of the
inner ear, thereby removing both the balance and hearing
function from the affected ear. This surgery will be done only if
you already have near-total or total hearing loss in your
affected ear.
 Vestibular Neurectomy – the surgeon cuts the nerve that
connects balance and movement sensors in your inner ear to
your brain. This usually corrects the problems you are having
with vertigo, but still allow you to hear out of the affected ear.
 Chemical Labyrinthectomy – destroys the vestibular tissue with
controlled injections of an antibiotic called, “Gentamicin” into
your middle ear. The Gentamicin will be given a few times a
day, for several days, through a tube inserted in the eardrum
of your affected ear. At the start of this treatment, you may
have a loss of balance, but if successful, the balance system in
the treated ear will be destroyed. This will reduce or stop your
attacks and you will still be able to hear out of this ear as you
had before the treatment.
Nursing Diagnosis

• Risk for injury related to altered mobility because of gait

disturbed and vertigo.
• Impaired adjustment related to disability requiring change
in lifestyle because of unpredictability of vertigo.
• Risk for fluid volume imbalance and deficit related to
increased fluid output, altered intake, and medications.
• Anxiety related to threat of, or change in, health status
and disabling effects of vertigo.
• Ineffective coping related to personal vulnerability and
unmet expectations stemming from vertigo.
• Feeding, bathing/hygiene, dressing/grooming, and
toileting self-care deficits related to labyrinth dysfunction
and episodes of vertigo.
Health teachings
 Educate patient the importance to follow a “low-
salt” (sodium) or “salt-free” diet. This will help to
reduce your inner ear fluid pressure.
 Try to avoid caffeine, smoking and alcohol. Talk to
your doctor if you need help.
 Get regular sleep and try to eat properly.
 Stay active and avoid excessive fatigue.
 Try to reduce your stress, which can also cause the
spinning sensations and ringing in your ears
 Sitor lie down when you feel dizzy. During an
episode of vertigo, avoid things that can make your
signs and symptoms worse, such as sudden
movement, bright lights, watching television or
reading. Try to focus on an object that isn't moving.
 Rest during and after attacks. Don't rush to return to
your normal activities.
 Be aware you might lose your balance. Falling
could lead to serious injury. Use good lighting if you
get up in the night. A cane for walking might help
with stability if you have chronic balance problems.
 Provide nursing care during acute
attack
1. Provide a safe, quiet, dimly lit environment and
enforce bed rest
2. Provide emotional support and reassurance to
alleviate anxiety
3. Administer prescribed medications, which may
include antihistamines, antiemetics, and possibly,
mild diuretics