Meniere's disease is a balance disorder caused by abnormal fluid balance in the inner ear. It is characterized by episodes of vertigo, tinnitus, and fluctuating hearing loss. The cause is unknown but may involve excess fluid accumulation in the inner ear. Treatment involves managing symptoms with medication and a low-sodium diet. If conservative measures fail, surgical procedures like endolymphatic sac decompression or vestibular nerve sectioning can be performed to eliminate vertigo attacks.

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Meniere’s Disease
Mr. Binu Babu
M.Sc. Nursing
Mrs. Jincy Ealias
M.Sc. Nursing

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Introduction
• First described by Prosper Meniere in
1861.
• Ménière’s disease is a balance disorder.

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Definition
• Meniere’s disease is an abnormal inner
ear fluid balance caused by a
malabsorption in the endolymphatic sac or
a blockage in the endolymphatic duct.
• It is also called endolymphatic hydrops.
• It occurs bilaterally in about 20% of
patients.

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Etiology
• Unknown.
• Common in adults
• Age : between 40 and 60 years of age
• Equally common in men and women
• Family history: 50% of the patients have a positive family
history
• Hypersecretion or hypoabsorption of endolymph or both
• Deficit membrane permeability
• Allergy
• Viral infection
• Hormonal Imbalance
• Mental stress.

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Pathophysiology
Obstruction of endolymphatic duct/sac
Hypersecretion or hypoabsorption of endolymph or both
Excessive accumulation of endolymph
Distension of membranous labyrinth & endolymphatic sac
Increased in pressure and rupture of inner membranes
Loss of auditory and vestibular function
Vertigo, tinnitus, hearing loss

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Clinical features
Triad of Meniere's disease
Tinnitus
Vertigo
Hearing
loss

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Clinical Manifestations
• Fluctuating, progressive sensorineural hearing
loss
• Tinnitus
• Vertigo
– Accompanied by nausea and vomiting and
nystagmus.
– Vertigo lasts 2 to 4 hours.
– And followed by dizziness and unsteadiness.

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• Warning signs
– Headache
– A feeling of pressure or fullness in the ear
• Behavioral changes
– Irritability
– Depression
– Withdrawal

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Types
• Two subtypes
Cochlear Meniere's disease
Vestibular Meniere's disease

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• Cochlear Meniere's disease is
recognized as a fluctuating, progressive
sensorineural hearing loss associated with
tinnitus and aural pressure in the absence
of vestibular symptoms.
• Vestibular Meniere's disease is
characterized as the occurrence of
episodic vertigo associated with aural
pressure but no cochlear symptoms.

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Diagnostic measures
• History collection
• Physical examination
• Audiogram : identify the type and
magnitude of the hearing loss.
• CT or MRI:
• Electronystagmogram : to evaluate the
oculomotor and vestibular systems to
differentiate the cause of vertigo, tinnitus,
and hearing loss of unknown origin.

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Management
Medical Management
• Pharmacologic therapy
• Dietary management

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Pharmacologic therapy
• Antihistamine : to suppress the vestibular
system. Eg: meclizine
• Tranquilizers: to control vertigo. Eg:
diazepam
• Antiemetic: eg. promethazine
(Phenergan). To control the nausea and
vomiting and the vertigo because of their
antihistamine effect.

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• Diuretic: relieve symptoms by lowering
the pressure in the endolymphatic system.
Eg: hydrochlorothiazide, triamterene
• Vasodilators: eg: papaverine
hydrochloride
• Avoid aspirin and aspirin-containing
medications. Aspirin may increase tinnitus
and dizziness.

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If not responding to drugs;
• Ablation therapy
Intratympanic injection of gentamicin is
being used to cause ablation of the
vestibular hair cells.

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Dietary management
• Low-sodium (1000 to 1500 mg/day or less)
diet.
• The amount of sodium is a factor that
regulate the balance of fluid within the
body. Sodium and fluid retention disrupts
the delicate balance between endolymph
and perilymph in the inner ear.

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• Limit foods high in salt or sugar.
• Eat meals and snacks at regular intervals to stay
hydrated. Missing meals or snacks may alter the
fluid level in the inner ear.
• Limit intake of coffee, tea, and soft drinks. Avoid
caffeine because of its diuretic effect.
• Limit alcohol intake. Alcohol may change the
volume and concentration of the inner ear fluid
and may worsen symptoms.
• Avoid monosodium glutamate (MSG), which
may increase symptoms.

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Surgical Management
• The surgical treatment of Meniere's
disease is aimed at eliminating the attacks
of vertigo, so hearing loss, tinnitus, and
aural fullness may continue. The surgical
procedures are:
1. Endolymphatic sac procedures
2. Vestibular nerve section.

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Endolymphatic Sac Decompression
• First-line surgical approach to treat the
vertigo of Meniere's disease as it is simple,
safe and can be performed on an
outpatient basis.
• Through a postauricular incision, a shunt
or drain is inserted in the endolymphatic
sac and fluid is drained into subarachnoid
space . Thus release of pressure on the
endolymphatic system in the labyrinth

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Vestibular Nerve Sectioning
• Performed by a translabyrinthine approach
or in a manner that can conserve hearing
(ie, suboccipital or middle cranial fossa),
depending on the degree of hearing loss.
Cutting the nerve prevents the brain from
receiving input from the semicircular
canals.

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Nursing management
• Assess the severity and frequency of attack, any
associated ear symptoms (hear loss, tinnitus).
• Acute vertigo: provide bedrest, sedation,
antiemetics
• Encourage patient to lie down during attack in
safe place.
• Advise patient to avoid food that cause allergy.
• Maintain the prescribed low-salt diet

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• Impaired comfort related to impairment in
auditory function or vestibular function.
• Impaired auditory sensory perception
related to altered state of the ear.
• Risk for deficient fluid volume related to
increase fluid output, altered intake.
• Risk for injury related to impaired
equilibrium
• Anxiety related to threat to changes
health status.