Meniere's disease & hearing loss Flashcards
aka as endolymphatic hydrops
Meniere’s Disease
What is the other term for Meniere’s Disease?
Endolymphatic hydrops
Characterized by symptoms caused by inner disease
Meniere’s Disease
What is Meniere’s Disease?
characterized by symptoms caused by inner disease
What are the manifestation or symptoms that caused by inner disease in meniere’s disease?
-Episodic vertigo
- Tinnitus
- Fluctuating sensorineural hearing loss
- sense of aural fullness
Etiology of Meniere’s Disease
-Idiopathic
- Excessive accumulation of endolymph in the membranous labyrinth
- Infections
- Allergies
- Abnormal immune response
What causes of the excessive accumulation of endolymph in the membranous labyrinth?
Causes rupture
Clinical Manifestations of Meniere’s Disease
-“Drop Attacks”
-“ Whirling in space” feeling
- Fullness in the ear
- Increasing tinnitus
- Muffled hearing
The feeling of being pulled to the ground
Drop attacks
What is drop attacks?
-The feeling of being pulled to the ground
-May last hours or day
Diagnostics of Meniere’s Disease
-Audiography
-Glycerol Test
Demonstrates a mild, low-frequency sensorineural hearing loss
Audiography
What is audiography?
Demonstrates a mild, low-frequency sensorineural hearing loss
Glycerol (an osmotic) is given orally, followed by serial audiography over 3 hours
Glycerol Test
What type of agent is the glycerol test?
-Osmotic
-It act as diuretic
What is glycerol test?
-Improved hearing supports the diagnosis
-Glycerol (an osmotic) is given orally, followed by serial audiography over 3 hours
Surgical Management of Meniere’s Disease
-Endolymphatic Shunt
- Labyrinthectomy
It is a nonablative surgery
Endolymphatic Shunt
A small silicone tube is positioned to empty extra fluid
Endolymphatic Shunt
What is endolymphatic shunt?
-nonablative surgery
-a small silicone tube is positioned to empty extra fluid
Surgical procedure of the temporal bone
Labyrinthectomy
Completely destroy the vestibular end organs to eliminate vestibular function
Labyrinthectomy
What is labyrinthectomy?
-Surgical procedure of the temporal bone
-Completely destroy the vestibular end organs to eliminate vestibular function
Drug Management for Meniere’s Disease
-Sedatives
-Benzodiazepines
-Anticholinergics
-Antiemetics
-Antihistamines
What cranial nerve is affected in meniere’s disease?
Cranial nerve VIII
What is the function of cranial nerve VIII?
Providing the sense of hearing and balance.
What nerve is CN VIII?
Vestibulocochlear nerve
Fastest growing and one of the most prevalent, chronic conditions
Hearing loss & deafness
Age risk factors of Hearing Loss & Deafness
65 years of age and older
What is hearing loss & deafness?
fastest growing and one of the most prevalent, chronic conditions
Etiology of hearing loss & deafness
-Age-related presbycusis
-Noise-induced hearing loss
Pathophysiology of Hearing Loss & Deafness
-Tiny hair cells pick up soundwaves & convert them into electrical signals that the brain can interpret
-Loud sounds destroy the tiny hair cells
-Hair cells don’t grow back once destroyed
What are the types of hearing loss?
- Conductive hearing loss
- Sensorineural hearing loss
- Mixed hearing loss
- Central & Functioning hearing loss
Occurs when conditions in the outer or middle ear impair the transmission of sound through air to the inner air
Conductive Hearing loss
What is conductive hearing loss?
Occurs when conditions in the outer or middle ear impair the transmission of sound through air to the inner air
Causes of Conductive Hearing Loss
-Otitis media with effusion
-Impacted cerumen
-Otosclerosis
-Narrowing of the external auditory canal
Characteristics of Conductive Hearing Loss
-air bone gap of at least 15 dB
- Patients may speak softly because they hear their own voices
- Patients hear better in a noisy environment
Hearing sensitivity is better by bone conduction than by air conduction
Air bone gap
What is air bone gap?
Hearing sensitivity is better by bone conduction than by air conduction
What type of hearing loss where patients may speak softly because they hear their own voices
Conductive hearing loss
What type of hearing loss where patients hear better in a noisy environment
Conductive hearing loss
Caused by impairment of function of the inner ear or the vestibulocochlear nerve
Sensorineural Hearing Loss
What is sensorineural hearing loss?
Caused by impairment of function of the inner ear or the vestibulocochlear nerve
Causes of sensorineural hearing loss
-congenital and hereditary factors
- noise trauma over time
- aging (presbycusis)
- Meniere’s Disease
-Ototoxicity (ASA, NSAIDS, Aminoglycosides, Chemotherapy Drugs)
Drugs that can cause ototoxicity
-ASA
-NSAIDS
-Aminoglycosides
-Chemotherapy drugs
Problems of Sensorineural Hearing Loss
-Inability to understand speech despite the ability to hear sound
- The lack of understanding of the condition by other people
Other problems/characteristics of Sensorineural Hearing Loss
-Inability to hear high-pitched sounds
-Muffled sounds
Inability to hear high-pitched sounds
Sensorineural Hearing Loss
Muffled sounds
Sensorineural Hearing Loss
Combination of Conductive and Sensorineural causes
Mixed Hearing Loss
Involves the inability to interpret sound, including speech, because of a disorder in the brain
Central Hearing Loss
What is central hearing loss?
Involves the inability to interpret sound, including speech, because of a disorder in the brain
Caused by an emotional or a psychological factor
Functional Hearing Loss
Patient does not seem to hear or respond to pure-tone subjective hearing tests
Functional Hearing Loss
What is functional hearing loss?
Caused by an emotional or a psychological factor
What happens to patient in functional hearing loss?
Patient does not seem to hear or respond to pure-tone subjective hearing tests
What are the classification of hearing loss?
-Normal hearing
-Slight hearing loss
-Mild impairment
-Moderate impairment
-Moderately severe impairment
-Severe impairment
-Profound deafness
What is the range of normal hearing
0-15 dB
Range of slight hearing loss
16-25 dB
Range of Mild Impairment
26-40
Range of moderate impairment
41-55
Range of moderately severe impairment
56-70
range of severe impairment
71-90
range of profound deafness
> 90
Clinical manifestations of Hearing loss & deafness
-Answering questions inappropriately
-Not responding when not looking at the speaker
-Asking others to speak up
-Showing irritability with others who do not speak up
-Lip reading
Nursing Management of Hearing Loss and Deafness
-Amplified music (iPods or MP3 Player) should not exceed 50% of maximum volume
-Avoidance of continued exposure to noise levels greater than 70dB
-MMR vaccine
-Avoid ototoxic drugs (ASA, NSAIDS, antibiotics
Why MMR vaccine is important in managing patient who have central and functional hearing loss?
Rubella causes sensorineural deafness
Communication with patients who have hearing impairments (NONVERBAL AIDS) (DUMAM)
-Draw attention with hand movements
-Use touch
-Maintain eye contact
-Avoid distracting environment
-Move close to better ear
Communication with patients who have hearing impairment (VERBAL AIDS) (SURDS)
-Speak normally and slowly
-Use simple sentences
-Rephrase sentence; use different words
-Do not shout
-Speak in normal voice directly into better ear
Intervention if CN VIII is affected
Let the patient walk with straight lines
What are the concern of Meniere’s Disease?
Concern is safety because of balance
Nursing management of Meniere’s Disease
-quiet, darkened room during attacks
-avoid sudden head movements or position changes
-avoid fluorescent & flickering lights
-emesis basin at bedside
-side rails up and the bed low in position when the patient is in bed
-medications are given parenterally
-unsteadiness may remain even after attacks
