Definition
- Meniere’s disease is a chronic disorder of the inner ear involving sensorineural hearing loss, severe vertigo and tinnitus.
Risk Factors
- Unknown
- Associated with aging
- Middle-ear infection
- Head trauma
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.
Assessment/Clinical Manifestations/Signs and Symptoms
- Sudden episodes of severe whirling vertigo, with an inability to stand or walk; episode may last up to several hours
- Buzzing tinnitus (worsens before and during an episode)
- Nausea, vomiting, and diaphoresis
- Possibly, brief loss of consciousness with nystagmus
Laboratory and diagnostic study findings
- Audiometric testing reveals sensorineural hearing loss
Medical Management
- Goal of treatment may include recommendations for changes in lifestyle and habits or surgical treatment. The treatment is designed to eliminate vertigo or to stop the progression of or stabilizes the disease.
- Treatment approaches are rehabilitative, dietary, medical and surgical.
- Psychological evaluation may be indicated if patient is anxious, uncertain, fearful or depressed.
Pharmacologic therapy
- 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 vertigp; procedure is highly successful in decreasing vertigo but is accompanied by a significant risk for hearing loss.
Dietary Management
- Low sodium (2,000 mg/day)
- Avoidance of alcohol, nicotine and caffeine
Surgical Management
- Endolymphatic sac decompression or shunt
- Middle and inner ear perfusion with placement of intraotologic catheters for drainage and infusion of medication
- Labyrinthectomy (destruction of inner ear)
- Vestibular nerve section (8th cranial nerve)
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.
Nursing Management
- Provide nursing care during acute attack.
- Provide a safe, quiet, dimly lit environment and enforce bed rest
- Provide emotional support and reassurance to alleviate anxiety
- Administer prescribed medications, which may include antihistamines, antiemetics, and possibly, mild diuretics
- Instruct the client on self-care instructions to control the number of acute attacks.
- Discuss the nature of the disorder
- Discuss the need for a low-salt diet
- Explain the importance of avoiding stimulants and vasoconstrictions (e.g. caffeine, decongestants, alcohol)
- Discuss medications that may be prescribed to prevent attacks or self-administration of appropriate medications during an attack, which may include anticholinergics, vasodilation, antihsitamines, and possibly, diuretics or nicotinic acid.
- Discuss, prepare and assist the client with surgical options.
- A labyrinthectomy is the most radical procedure and involves resection of the vestibular nerve or total removal of the labyrinth performed by the transcanal route, which results in deafness in that eat.
- An endolynmphatic decompression consists of draining the endolymphatic sac and inserting a shunt to enhance the fluid drainage
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