01.06 Meniere’s Disease

Hey guys! Today we’ll be covering ménière’s disease. By the end of today’s lesson you will have a better understanding of what ménière’s disease is, how it is caused, assessment findings, therapeutic management, and nursing considerations when caring for a patient with this disease process.

So guys, basically ménière’s disease is a disorder of the inner ear caused by excess fluid that distorts the inner-canal system in the inner ear, causing vertigo, tinnitus, and sensorineural hearing loss.

Okay guys, let’s kick things off with a little patho. So with ménière’s disease, there is an excess of endolymphatic fluid that distorts the entire inner-canal system. So this picture shows a close up of the inner ear structures. So here let’s draw extra fluid, which throws off the entire system. This disease decreases hearing by dilating the cochlear duct. It also causes vertigo due to damage to the vestibular system due to the increased pressure from the excess fluid. It also stimulates tinnitus which is the perception of noise or ringing in the ear.

So the key characteristics with a patient with ménière’s disease includes tinnitus, one-sided sensorineural hearing loss, and vertigo. These attacks can be pretty severe. Patients can also present with nausea and vomiting. Sometimes patients will experience an aura kind of like people do with migraines. So they could experience headaches or fullness in the affected ear prior to an attack. So in early stages, the patient’s hearing is normal or nearly normal between episodes or attacks. Permanent hearing loss develops over time as the attacks increase due to the damage to the cochlea from the increased fluid pressure.

So treatment starts with nonsurgical management. A patient with this disease could try the Hydrops diet, which helps stabilize body fluid levels to prevent excess endolymph accumulation. Considerations with this diet include even food intake levels through the day, avoiding foods high in salt, ensuring adequate fluid intake while minimizing caffeine intake. Patients should also limit alcohol and avoid foods with MSG in them. The medications that will be given are aimed at reducing vertigo and vomiting and helping the patient restore normal balance. One of the medication therapies is the use of mild diuretics, which helps decrease the endolymph volume. This directly reduces vertigo, hearing loss, and tinnitus. Medications like Dramamine, Benadryl, and Antivert can help reduce the severity or help stop the attack all together. Antiemetics such as Zofran and Phenergan can be given to help reduce nausea and vomiting. Finally, Valium can be given to help calm the patient as well as reduce vertigo, nausea, and vomiting. It also helps the patient rest and relax during the attack. Surgical management is kind of a last ditch effort. It is only used if conservative treatment fails, as it can cause further hearing loss. One procedure that can be performed is a resection of the vestibular nerve or labyrinthectomy. These are both the most radical procedures. Another procedure that can be performed early in the course of the disease is endolymphatic decompression with drainage and shunt placement. The effectiveness varies with this procedure, but basically the endolymphatic sac is drained and a tube is placed to help improve fluid drainage.

Patient education is pretty straightforward with this disease process. First, we want to teach patients to move their head slowly to prevent worsening of their vertigo. We will also educate about the Hydrops diet if indicated.

One of the nursing concepts with ménière’s disease is an alteration in sensory perception, as the patient has difficulty with hearing and tinnitus. The other nursing concept is an alteration in functional ability. Since our senses comprise so much of our day to day life, a decrease in hearing ability can greatly impact a patient’s functional ability.

Alright guys, let’s do a recap of the key points for this lesson. So first, I want you to remember the key assessment findings. These include tinnitus, one-sided sensorineural hearing loss, and vertigo. Treatment starts with nonsurgical management such as the Hydrops diet or different medications to help with symptom management as well as to help reduce the endolymph volume. Surgical management is last resort as it can cause further hearing loss. We also want to teach our patients to move their head slowly to help with vertigo and educate about the Hydrops diet if indicated.

Alright guys, that’s it for our lesson on ménière’s disease. Make sure to check out the other resources attached to this lesson. Now, go out and be your best self today. And, as always, Happy Nursing!