Meniere's Disease

Meniere's Disease

Meniere's disease is disorder of inner ear, affect auditory (hearing) system and vestibular (balance) system.

Characterized by;

Sudden and recurrent episodes of dizziness

Tinnitus

Progressive hearing loss

Meniere's disease caused by dilation or swelling of endolymphatic sac, affecting drainage of endolymph or other tissue in vestibular system of inner ear, which responsible for sense of balance.

Etiology

1. Respiratory infection

2. Viral infection

3. Allergy

4. Middle ear infection

5. Head injury

Clinical Manifestations

1. Vertigo and Dizziness

2. Tinnitus

3. Hearing loss or deafness

4. Fullness of both ear

5. Photophobia

Diagnostic Evaluation

1. Caloric stimulation

2. Electronystagmography

3. MRI scan

4. CT scan

5. Audiogram; hearing test

Management

1. Treatment to reduce pressure in inner ear

Antihistamines, anticholinergic, steroids, and diuretics.

2. Management of vertigo and Dizziness

3. Management of nausea and vomiting 

Antiemetics

4. Hearing aids

5. Low salt diet reduce fluid retention in inner ear.

Surgical Management

1. Endolymphatic sac decompression

Make incision behind ear exposed mastoid bone. 

Bone will be removed to reveal the endolymphatic sac. Then mastoid bone is opened, the bone over endolymphatic sac exposed. Then make hole in the outer layer of the endolymphatic sac. A shunt/valve inserted into the sac to allow drainage. 

This procedure help in maintain the hydrostatic pressure and endolymph homeostasis in the inner ear.

2. Labyrinthecyomy

Surgical removal of labyrinth of the inner ear, This procedure is performed to treat vertigo.

3. Vestibular neurectomy

Vestibular nerve fibers are resection while leaving the auditory nerve fibers intact.

This surgical procedure cure vertigo and preserve hearing.

4. Chemical labyrinthecyomy

Antibiotic Gentamicin directly apply into ear. 

Gentamicin destroys the vestibular hair cells, thereby preventing impulses from vestibular nerve passing into the brain. Used to treat vertigo.

Nursing Diagnosis

1. Risk of injury related to sudden attack of vertigo.

2. Altered nutrition; less than body requirement related to nausea and vomiting

3. Anxiety related to disease conditions

4. Disturbed auditory sensory perception related to ear disorder

5. Self care deficit related to vertigo