Ménière's syndrome is characterized by an excess of endolymphatic fluid in the inner ear, leading to symptoms such as vertigo, tinnitus, and hearing loss, with initial reversible hearing loss becoming permanent over time. Key symptoms include headaches, nausea, and varying degrees of hearing impairment, often triggered by stress, infections, or other factors. Treatment may involve both nonsurgical and surgical interventions, focusing on preventing injury during vertigo attacks and managing symptoms.

1. .
M e n i e r e ’ s S y n d r o m e

2. Ménières Syndrome
- an excess of endolymphatic fluid that distorts the entire inner canal system.
- This distortion decreases hearing by dilating the cochlear duct, causes vertigo
because of damage to the vestibular system, and stimulates tinnitus.
- At first, hearing loss is reversible, but repeated damage to the cochlea from
increased fluid pressure leads to permanent hearing loss.
- usually first occurs in people between the ages of 20 and 50 years
three features:
1. tinnitus
2. one-sided sensorineural auditory SENSORY PERCEPTION loss
3. vertigo
- they occur in attacks that can last for several days

3. C A U S E S

4. a. Any factor that increases endolymphatic
secretion in the labyrinth
b. Viral and bacterial infections
c. Allergic reactions
d. Biochemical disturbances
e. Vascular disturbance, producing changes in
the microcirculation in the labyrinth
f. Long-term stress may be a contributing factor.

5. Signs and symptoms
1. headache
2. increasing tinnitus
3. fullness of the affected ear can precede the
attack of vertigo.
4. Patients often describe the tinnitus as a
continuous, low-pitched roar or a
humming sound, which worsens just before
and during an attack.
5. Hearing loss occurs first with the low-
frequency tones but progresses to include
all levels and, with repeated attacks, can
become permanent.

6. 6. vertigo, coupled with periods of a “whirling”
sensation, may cause patients to
fall. It is so intense that, even while lying down, the
patient often holds the bed or
ground to keep from falling.
- Severe vertigo usually lasts 3 to 4 hours, but the
patient may feel dizzy long after
the attack.
7. Nausea and vomiting
8. rapid eye movement (nystagmus),
9. severe headaches often accompany vertigo

7. 02
N U R S I N G D I A G N O S I S

8. B. Nursing Diagnoses
1. Disturbed auditory sensory perception
2. Acute Pain
3. Imbalanced nutrition, less than body requirements
related to nausea and
vomiting
4. Risk for deficient fluid volume related to vomiting
5. Risk for injury related to vertigo

9. C. Interventions
1. Nonsurgical interventions
a. Prevent injury during vertigo attacks.
b. Provide bed rest in a quiet environment.
c. Provide assistance with walking.
d. Instruct the client to move the head slowly to prevent
worsening of the vertigo.
e. Initiate sodium and fluid restrictions as prescribed.
f. Instruct the client to stop smoking.
g. Instruct the client to avoid watching television because
the flickering of lights
may exacerbate symptoms.

10. h. Administer nicotinic acid as prescribed for its vasodilatory
effect.
i. Administer antihistamines as prescribed to reduce the
production of histamine
and the inflammation.
j. Administer antiemetics as prescribed.
k. Administer tranquilizers and sedatives as prescribed to calm
the client; allow the
client to rest; and control vertigo, nausea, and vomiting.
l. Mild diuretics may be prescribed to decrease endolymph
volume.
m. Inform the client about vestibular rehabilitation as prescribed.

11. 2. Surgical interventions
a. Surgery is performed when medical therapy is ineffective and the
functional level of the client has decreased significantly.
b. Endolymphatic drainage and insertion of a shunt may be an option
early in the course of the disease to assist with the drainage of excess
fluids.
c. A resection of the vestibular nerve or total removal of the labyrinth
(i.e., a labyrinthectomy) may be performed.

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Postoperative interventions
a. Assess packing and dressing on the ear.
b. Speak to the client on the side of the unaffected ear.
c. Perform neurological assessments.
d. Maintain safety.
e. Assist with ambulating.
f. Encourage the client to use a bedside commode rather
than ambulating to the
bathroom.
g. Administer antivertiginous and antiemetic medications as
prescribed.