Meniere's Disease

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 Definition:

    Meniere's Disease is an inner ear disorder that affects balance and hearing.


Causes:

    Exact cause is unknown, but believed that the disease is related to an excess of fluid in the inner ear.

Risk factors include:

  • Head injury
  • Middle or inner ear infection
  • Family history
  • Respiratory infection
  • Smoking and alcohol use
  • Certain medicines


Signs and symptoms:


    Four main symptoms include 

  1. Pressure in the ear (fullness in the ear)
  2. Drop in hearing
  3. Vertigo
  4. Ringing or roaring in the affected ear (Tinnitus)




Other symptoms include;

  • Nausea and vomiting
  • Headaches
  • Nystagmus
  • Diarrhea
  • Abdominal discomfort


Diagnosis:
  • Medical history and physical examination of the ear
  • Audiometry- to assess problems in hearing
  • Electronystagmography - Abnormal results can be a sign of Meniere's Disease
  • Neurological examination and MRI head - to rule out other causes of the symptoms 







Management:
   
    There is no cure for Meniere's disease. The treatment aims at relieving the symptoms

  •  Diuretics - can reduce fluid pressure in the inner ear
  • Anti-emetics- to relieve vomitting
  • Tranquilizers - to claim the patient
  • Antihistamines
Life style changes:
  • Eat a well balanced healthy diet. Low sodium in diet
  • Limit caffeine and alcohol
  • Get enough sleep
  • Exercise regularly
  • Avoid sudden movements, bright lights, and activities such as driving, operating heavy machines during and after the attacks for 1 to 2 weeks
  • Take rest during the attacks
  • Activities should be gradually resumed

Surgical Management:
  
   When Medical therapy and life style changes fail, surgical management is performed.
  • Resection of vestibular nerve - helps to control vertigo and doea not damage hearing
  • Drainage of the fluid in the inner ear and creating a shunt for the drainage of excess fluid
  • Labyrinthectomy - helps to control vertigo but can cause complete hearing loss

Hearing aids may be required in cases of severe hearing loss



Nurse's Interventions:
  • During attacks advice bed rest in a quiet environment and provide assistance in walking to prevent injury
  • Advise sodium and fluid restriction as prescribed
  • Administer medication such as antiemetics and antihistamines as prescribed
  • Instruct the patient to move the head slowly to prevent worsening of symptoms 
Post-operative Interventions:
  1. Speak to the patient on the side of the unaffected ear
  2. Assess packing and dressing on the ear
  3. Assist with ambulation
  4. Encourage the patient to use a bedside commode rather than walking to the washroom
  5. Assess neurological status
  6. Administer medications as prescribed 

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