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
MANIFESTATION
S
 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
Cochlear
fluctuating, progressive
sensorineural hearing loss
associated with tinnitus and
aural pressure in the absence
of vestibular symptoms or
findings.
Vestibular
characterized as the
occurrence of episodic
vertigo associated with
aural pressure but no
cochlear symptoms
PATHOPHYSIOLOGY
Risk Factors
1. Age
2. Gender
3. Congenital
4. High-sodium diet
5. Conditions:
a. Syphilis
b. Autoimmune Disease
c. Herpes Virus Infection
 Fluid imbalance in the
endolymphatic sac

Feeling of
fullness Accumulation of fluid in
Pressure in the the endolymphatic sac
ear

Membranes becomes dilated

Burst into other duct

channels
Cochlear duct Saccule Utricle

Compression of
Organ of Corti Vertigo

Flactuating, Nausea and

progressive vomiting
sensorineural
hearing loss
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
CLASS GENERIC BRAND
1. Antihistamines meclizine Antivert
2. Tranquilizers diazepam Valium
3. Antiemetics promethazine Phenergan
4. Diuretic hydrochlorothiazide Hydrodiuril
5. Vasodilators papaverine HCl Pavabid
Methantheline Br Banthine
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 MANAGEMENT
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.
 SALAMAT
SA
PAGPAMINAW!
REFERENCE
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