meniere disease is the inner ear condition which affect the patient haring and balance this ppt can help the nurses to take care of the patient affected with this disease and can be used as a study material for their examination

1. Meniere’s Disease
DEPARTMENT
OF
MEDICAL SURGICAL NURSING

2. Learning Objectives
At the end of this lecturer, students should be able to:
• Define meniere’s disease
• List out the causes of Ménière’s Disease
• Enumerate the clinical manifestation of Ménière’s Disease
• Describe diagnostic evaluation of Ménière’s Disease
• Explain the management of Ménière’s Disease

3. Definition
• Meniers disease is a disorder of inner ear where the
endolymphatic system is distended. It is chracterised by
Virtigo, Sensorial hearing loss, Tinnitus and Aural
fullness

4. Definition
• Ménière’s disease is an abnormal inner ear fluid balance
caused by a malabsorption in the endolymphatic sac.
• Meniere ‘s disease is a disorder that affects the inner ear.
That is responsible for hearing and balance
• Evidence indicates that many people with Ménière’s disease
may have a blockage in the endolymphatic duct.

6. Incidence
• Male are affected more than female.
• Disease is mainly unilateral.
• It is more common in age group 35-60 years
• About 50,000 - 100,000 people of world develop
Meniere's disease in a year.
• About 50 % of the patients who have Meniere's disease
have a positive family history of this disease.

7. Causes
• Unknown
• Auto immune disease
• Allergies
• Endolymphatic hydrops
• Either increased pressure in the system or rupture of the
inner ear membranes occurs, producing symptoms of
Ménière’s disease.

8. Risk factors
• Toxicity (alcohol consumption )
• Head trauma
• Smoking
• Use of certain medication like asprin
• Metabolic disorder (hypothyroidism)
• Emotional factor (stress)
• Anatomical abnormalities

9. pathophysiology
Due to etiological causes
Over production of endolymph
Excessive accumulation in inner ear
Increase pressure
Rupture membrane
Permanent loss auditory & vestibular function

10. Clinical Manifestations
• fluctuating, loss of balance, headache
• progressive sensorineural hearing loss;
• tinnitus or a roaring sound;
• a feeling of pressure or fullness in the ear; and
episodic,
• incapacitating vertigo,
• nausea and vomiting.

12. Assessment and Diagnostic Findings
• A careful history
• Patients also complain of diaphoresis and
• a persistent feeling of imbalance or disequilibrium,
which may last for days.
• During an acute attack, the patient has severe vertigo.
Patients are sometimes diaphoretic and pale. Vital signs
may show elevated blood pressure, pulse, and
respiration.

13. • Weber test from a tuning fork. – lateralized to the
better ear
• Otoscopy
• Audiometry
• Electrocochleography
• MRI, CT Scan

14. Complications
• Inability to walk or function due to uncontrollable
vertigo.
• Hearing loss on the affected side.
• Possible of injury due to imbalance.
• Trauma from fall
• Decrease quality of life

15. Medical Management
• low-sodium (2,000 mg/day)diet.
• Reassurance and bed rest
• Psychological evaluation
• Antihistamines such as meclizine
• Tranquilizers such as diazepam
• Antiemetics such as promethazine
• Diuretic therapy (eg, hydrochlorothiazide)

16. Treatment summary
1. Atropine: stop attack for 20-30 Minutes
2. Bed rest in quite environment
3. Labyrinthine sedative like: Prochlorperazine
(stemetil), Idmenhydrinate (Dramamine) to
control giddiness and N/V
4. Vasodilators: Nicotinic acid, betahistamine to
control vasospasm

17. 5. Tranquilizer and anti-depressant to relieve anxiety
6. Prphylactic antihistamine or mild sedative:
Phenobarbitone, diazepam may be helpful.
7. Steroid to reduce inflamation
8. Antibiotics: esp. Aminoglycocise groups

18. SURGICAL MANAGEMENT
•Endolymphatic Sac Decompression.
•Endolymphatic sac decompression, or
shunting.
•Middle and Inner Ear Perfusion.
•Intraotologic Catheters.
•Vestibular Nerve Section.

19. Nursing management
• Assessment
History collection and physical examination
• Nursing diagnosis
• Imbalance nutritional status less than body requirement
related to vomiting and fluid loss
• Risk for injury related to disequilibrium or vertigo
• Risk for Fluid volume deficit related to altered intake
• Anxiety related to change health status and confusion

20. Altered auditory sensory perception related to
altered state of the ear
• Intervention
• Assess the severity and frequency of attack, any
associated ear symptoms (hear loss, tinnitus).
• Help patient prevent from aura, so patient has time
to prepare for an attack.
• Encourage patient to lie down during attack in safe
place.
• Put side rails in the bed if patient is in bed
• Place pillow to restrict movement.

21. Check vital sign
Maintain patients fluid balance
Monitor patient hearing activity
Provide psychological support
Provide medication as per doctor prescription
Administer or teach anti-vertiginous medication and
sedation medication as prescribed
 Avoid noises and glary bright light which may initiate attack.
Advise patient to avoid food that cause allergy.
Assist with ambulation when indicated.
Provide comfort measures and avoid stress producing
activities.

22. Post operative instructions:
• Antibiotic and other medication are to be taken as
prescribed.
• Nose blowing to be avoided (few weeks).
• Sneezing and coughing should be done with the
mouth open for a few weeks after surgery.
• Heavy lifting, straining, and bending are to be
avoided for a few weeks after surgery.
• Minor discomfort is expected can relief by analgesic,
excessive pain should be reported to surgeon.

23. • Some slightly bloody or serosanganious drainage
from the ear is normal after surgery.
• Excessive or purulent drainage should be reported to
the surgeon.
• The cotton ball in the ear can be changed as needed
but not to touch or remove any packing from the
external auditory canal.
• Post auricular suture line should be cleaned and
antibiotic oint. Applied twice daily.
• The surgeon should consult for regular air travel.
• Getting water in the operated ear must be avoided
for 2 weeks after surgery.

24. • Dressing first open-3rd day Suture removal 10th day
Head up 300 (3-10 days) Avoid: Chewing, sneezing,
coughing etc Prevent water in ear: 6 weeks Never
put oil in ear Hearing may be impaired for few
months RT edema, blood, fluid
• Observe complications: Facial nerve palsy (VII),
brain abscess, meningitis etc
• Avoid flying in air for 2 months
• BIPP dressing (bismuth icthymol parafin paste)
while doing mastoid surgery

25. Summary
• So far we have discussed about Definition, causes & risk
factors, clinical manifestation, diagnostic evaluation and
management of meniere's disease.

26. Bibliography
• Lewis et al, Medical Surgical Nursing, Mosby
Elsevier,7th edition.
• Joyce.M.Black et al, Medical Surgical Nursing,
Saunders publication.
• Brunner and Siddhartha, Medical Surgical Nursing,
Lippincott Williams and Wilkins.

27. Thank You