Unit 1: Meniere's Disease Flashcards
Meniere’s Disease
inner ear disorder
- affects balance and hearing
- triad of symptoms: vertigo, tinnitus, and hearing loss
- occurs as an “attack”
- too much fluid in the inner ear
Meniere’s Disease: Triad of Symptoms
- vertigo
- tinnitus
- hearing loss
Risk Factors for Meniere’s Disease
- head injury
- middle ear infection
- syphillis
- allergies
- alcohol abuse
- fatigue
- respiratory infection
- hx of recent viral illness
- smoking
- certain medications
Pathophysiology of Meniere’s Disease
excess of endolymphatic fluid in the inner canal of the ear
- obstructs inner canal system
- damages vestibular system (balance)
- decreased hearing and vertigo from dilation of cochlear duct
Clinical Manifestations of Meniere’s Disease
- Vertigo
- Tinnitus
- Hearing Loss (unilateral or bilateral)
- Nausea and Vomiting
- Sweating
- Increase in symptoms w/ sudden movements
- Diarrhea
- Headaches
- Abdominal Pain
- Nystagmus (uncontrollable eye movement)
What is the Goal of Treatment
- improve and stabilize fluid volume in the endolymphatic sac
- preserve hearing
- control vertigo
- help optimize quality of life
Medical Management
- symptomatic relief
- medications and dietary changes
- low-sodium diet (to decrease total amount of body fluid)
- balance testing (Romberg Test)
Prevention and Treatment
- low-sodium diet
- avoid sudden movements
- avoid bright lights
- 8 hours of sleep at night
- daily exercise
- limit caffeine and alcohol
Surgical Management
for severe (unrelenting) Meniere’s Disease
- risk for hearing loss w/ surgery
- Vestibular nerve transection
- Surgically instilling gentamicin
- Labyrinthectomy
Clinical Manifestations: Vertigo
membranous portion of the labyrinth is encased by bone necessary for hearing and balance
-it is filled with fluid called endolymph, and a disturbance in the volume of fluid may be responsible for vertigo
Clinical Manifestations: Tinnitus
extra or unusual sounds may be heard b/c of the increase in endolymph within the labyrinth
Nursing Assessments
- Vital Signs
- Positive Romberg’s Test
- Caloric Test
- MRI/CT scan
Nursing Assessments: Vital Signs
not noticed until there are secondary changes d/t other procedures (anxiety/infection) that may lead to increase in temperature, blood pressure, pulse, and respiratory rate
Nursing Assessments: Positive Romberg’s Test
- disturbance in balance
- may have nystagmus
- sensations of dizziness and strange sounds
Nursing Assessments: Caloric Test
evaluates for presence of nystagmus
-involves introducing cool and warm water into the ear canal; the water increases the flow of endolymph to induce nystagmus and vertigo
Nursing Assessments: MRI/CT Scan
performed when patients present with balance/vertigo/tinnitus issues to r/o presence of tumor or structured abnormalities
Nursing Action
- Medications
- Limit sodium intake
- Positioning of patient
- Safety measures
- Collaboration w/ neurology or otolaryngology
- Acupuncture
Nursing Action: Limit Sodium
minimizes fluid retention
-can minimize the excess lymphatic fluid
Nursing Action: Positioning of patient
in a way that minimizes frequent or vigorous head turn; decreases vertigo by decreasing fluid movement within the vestibular system of the inner ear
Nursing Action: Safety Measures
- prevent falls
- decrease clutter in room
- use of cane or walker to help w/ stability when ambulating
Nursing Action: Acupuncture
positive effects on balance and nausea
Nursing Teachings
- Disease process
- Testing (pre and post op teaching)
- Medications (increase compliance)
- Safety (use of assistive devices)
- Follow-up care (frequent regular checkups)
Medications
- Meclizine (Antivert)
- Furosemide (Lasix)
- Ondansetron (Zofran)
Meclizine (Antivert)
- antihistamine
- decreases excitability of the inner ear labyrinth
- blocks conduction of the inner ear vestibular cerebellar pathways
Furosemide (Lasix)
Diuretic
- decrease fluid
- decreases pressure in the ear
Ondansetron (Zofran)
decreases nausea and vomiting
