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Ménière's Disease

2 min read

Reference:

  1. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 15th Edition, ISBN 978-197-51-6103-3, by Janice L. Hinkle, Kerry H. Cheever, and Kristen J. Overbaugh (Ch. 59, pp. 1935-1963)

A disorder of the inner ear affecting balance and hearing. The inner ear has a series of canals, which separate important fluids (endolymph, perilymph) and prevent them from mixing. When they mix (like if a rupture between the canals was present), the microscopic hair cells (a major component in hearing and balance) stiffen, become bent, or broken.

  • Etiology: swelling of part of the canal (endolymphatic sac). Exact cause is unknown. It may be related to otitis media, syphilis, head injury, recent viral illness, respiratory infection, stress, fatigue, use of drugs, allergies, smoking, alcohol use, and genetic risk factors.

Clinical Manifestations

  • Episodes of vertigo (may be episodic; minutes to 8 hours, worse with sudden movements) or dizziness.
  • Fluctuating, progressive, low-frequency hearing loss in one ear.
  • Tinnitus
  • Nausea and Vomiting
  • Sweating (may be profuse)
  • Uncontrollable eye movements
  • Sensations of fullness or pressure in the ear.

Diagnostic Examination

A neurologic examination may show abnormalities of cranial nerve VIII (vestibulocochlear), such as abnormalities of hearing, balance, or eye movement. Tests to distinguish Meniere’s disease from other causes of vertigo may include:

  1. Head CT Scan or MRI
  2. BAER
  3. ENG with Caloric Stimulation Test (abnormal results indicate Meniere’s disease)
  4. Audiometry to check for the extent of hearing loss.

Treatment

There is no known cure for Meniere’s disease. Treatment is focused on lowering the pressure within the endolymphatic sac and symptomatic treatment, which tend to occur in discrete attacks.

  • Antihistamines, Anticholinergics, and Diuretics may lower the amount of endolymphatic fluid, and therefore pressure.
  • A low-salt diet reduces fluid retention.
  • Symptoms such as dizziness, vertigo, and associated N&V may respond to sedative/hypnotics, benzodiazepines like Diazepam, and anti-emetics.
  • Labyrinthectomy, Endolymphatic Sac Surgery, or Vestibular Nerve Surgery may be required if symptoms are severe and are unresponsive.
  • Hearing Aids may be needed for severe hearing loss.
  • Avoid sudden movements that may aggravate symptoms.
  • Ambulatory aid may be required.
  • Rest during severe episodes, and gradually increase activity.
  • Avoid bright lights, TV, and reading during attacks, which may make symptoms worse.
  • Avoid hazardous activities until one week after symptoms disappear.

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