Medical Surgical Nursing - Meniere's Disease

MENIERE’S
DISEASE
By Jaycel V. Santillan

INTRODUCTION
First described by Prosper Menière
in 1861
Argued that vertigo could be
caused by diseases of the inner ear.
Meniere’s Disease is a BALANCE
DISORDER

INTRODUCTION
Ménière’s disease (idiopathic endolymphatic
hydrops) is a rare inner ear disorder that
affects your sense of balance and hearing.
People with this condition experience
symptoms like vertigo, ringing in their ears
(tinnitus) and difficulty hearing.
In Ménière’s disease, there is an abnormal
buildup of fluid (called endolymph) in these
structures.
This excess fluid can disturb the signals sent
from the inner ear to the brain, causing
sudden symptoms.

ANATOMY AND PHYSIOLOGY
The ear is the organ responsible for
hearing and balance. It is divided into three
main parts:
EXTERNAL EAR (Outer Ear)
Pinna (Auricle): The visible part of the
ear that collects sound waves.
External Auditory Canal (Meatus):
Channels sound waves toward the
tympanic membrane (eardrum).
Tympanic Membrane (Eardrum):
Vibrates when struck by sound waves.

MIDDLE EAR
Ossicles (three tiny bones):
Malleus (hammer)
Incus (anvil)
Stapes (stirrup)
These amplify vibrations and transmit
them from the tympanic membrane to the
inner ear.
Eustachian Tube: Connects the middle
ear to the nasopharynx, equalizing
pressure on both sides of the eardrum.

3. INNER EAR (Labyrinth)
Cochlea: Spiral-shaped, responsible
for hearing. Contains the organ of
Corti (receptor organ for hearing).
Vestibular System: Includes
semicircular canals, utricle, and
saccule, which help with balance
and spatial orientation.

PATHOPHYSIOLOGY
1.Obstruction of the Endolymphatic Duct/Sac
A blockage or dysfunction in the endolymphatic duct or sac
prevents normal drainage of inner ear fluid (endolymph), setting
the stage for fluid buildup.
2. Alteration in Production and Absorption of Endolymph
Due to the obstruction, the body may produce too much
endolymph or fail to absorb it properly, disturbing the delicate fluid
balance required for inner ear function.

PATHOPHYSIOLOGY
3. Distension of the Endolymphatic Sac
As excess endolymph accumulates, it stretches and swells the
endolymphatic sac and other parts of the inner ear, a condition
known as endolymphatic hydrops.
4. Increased Pressure and Rupture of Inner Membranes
The pressure from swelling can cause the thin membranes
separating different inner ear fluid compartments to rupture,
leading to mixing of endolymph and perilymph.

PATHOPHYSIOLOGY
5. Vertigo, Tinnitus, Hearing Loss (Ménière’s Symptoms)
The fluid imbalance and membrane rupture disrupt the function
of sensory hair cells, resulting in classic symptoms like spinning
dizziness (vertigo), ringing in the ear (tinnitus), hearing loss, and
a feeling of fullness in the ear.

CAUSES
Fluid buildup in the inner ear
Genetic factors
Autoimmune issues
Viral infections
Head injury or trauma
Poor blood flow
Allergies
Environmental factors
Ear structure problems
Other health conditions (highblood pressure or diabetes)

SIGNS AND SYMPTOMS
Vertigo (severe dizziness)
Hearing loss (fluctuating, usually in
one ear)
Tinnitus (ringing or buzzing in the ear)
Aural fullness (feeling of fullness or
pressure in the ear)
Nausea and vomiting (due to vertigo)
Balance problems (difficulty standing
or walking)
Unpredictable episodes (symptoms
can come and go)

ASSESSMENT
Chief Complaint:
Vertigo: The patient typically complains of episodes of
spinning dizziness, often lasting 20 minutes to several
hours.
Hearing Loss: Patients may report fluctuating hearing
loss, especially in one ear.
Tinnitus: Ringing or a buzzing sound in the affected
ear.
Aural Fullness: A feeling of fullness or pressure in the
ear.

ASSESSMENT
Past Medical History:
History of frequent vertigo attacks lasting minutes to hours.
Occasional hearing loss and ear fullness. No history of head
trauma or neurological conditions.
Family History:
No known family history of Ménière’s disease or other
inner ear disorders.

ASSESSMENT
Psychosocial History:
Reports anxiety during vertigo episodes.
Difficulty concentrating and performing daily tasks during
flare-ups.
No history of psychiatric illness.
Lifestyle History:
High-sodium diet, occasional caffeine intake.
Non-smoker, rarely drinks alcohol.
Stress at work may worsen symptoms.
Limited physical activity due to fear of vertigo attacks.

NURSING DIAGNOSIS
Impaired Physical Mobility related to vertigo, dizziness, and balance issues as
evidenced by difficulty standing or walking, unsteady gait, and fear of falling.
Acute Pain related to ear pressure, fullness, or discomfort from fluid buildup
as evidenced by complaints of ear fullness, pressure, or sharp pain.
Risk for Injury related to dizziness, vertigo, and impaired balance as
evidenced by a history of falls, dizziness, and disorientation.
Disturbed Sensory Perception: Auditory related to hearing loss due to fluid
buildup and pressure changes in the inner ear as evidenced by fluctuating
hearing loss, difficulty understanding speech, and a sensation of fullness in the
ear.
Anxiety related to fear of vertigo episodes and unpredictable hearing loss as
evidenced by restlessness, worry about the next episode, and verbalized fear
of losing hearing or balance.

PLANNING
1.The client will remain free from injury during hospitalization and
demonstrate safety measures to manage vertigo.
2. The client will report a decrease in vertigo and tinnitus episodes and adapt
to sensory changes.
3. The client will demonstrate reduced anxiety levels through verbal and
nonverbal behavior.
4.The client will verbalize understanding of Ménière’s disease and
demonstrate correct self-care practices.

NURSING INTERVENTIONS
1.Ensure safety during vertigo episodes:
Assist with ambulation and activities.
Keep bed in low position with side rails up.
Remove tripping hazards and provide call light within reach.
2.Monitor vital signs regularly:
Check blood pressure, pulse, and respiratory rate every shift
or as needed.
Monitor for orthostatic hypotension, especially when standing.
Observe for signs of dehydration if vomiting occurs.

3. Manage sensory disturbances:
Provide a quiet, dimly lit environment.
Encourage rest in a comfortable position during vertigo
attacks.
Administer medications as ordered (e.g., meclizine,
diazepam, diuretics)
4. Reduce anxiety:
Stay with the patient during acute attacks.
Use calm and reassuring communication.
Teach relaxation techniques like deep breathing.

5. Educate the patient and family:
Instruct on avoiding triggers (e.g., caffeine, salt, alcohol,
stress).
Teach proper use of medications.
Encourage a low-sodium diet and fluid management.
6. Promote hydration and nutrition:
Offer small, frequent meals to reduce nausea.
Monitor input and output.
Avoid food and drinks that can worsen symptoms

SURGICAL
Endolymphatic Sac Decompression / Shunt Surgery
Relieves pressure by draining excess endolymph fluid.
Goal: Reduce frequency and severity of vertigo.
Vestibular Nerve Section
The vestibular nerve is cut to stop vertigo while preserving
hearing.
Requires general anesthesia; used in severe cases.
Labyrinthectomy
Entire balance portion of the inner ear is removed or
destroyed.
Note: Hearing is lost in the affected ear.
Used when hearing is already poor and vertigo is disabling.

LABORATORY
Audiometry (Hearing Test):
Detects sensorineural hearing loss, especially in low
frequencies.
Electrocochleography (ECoG):
Measures electrical activity in the inner ear; detects
increased endolymphatic pressure.
Vestibular Evoked Myogenic Potentials (VEMP):
Assesses balance-related inner ear function.
Glycerol Test:
Temporary improvement in hearing after glycerol ingestion
supports the diagnosis.

IMAGING AND DIAGNOSTIC
TESTS:
MRI of the Brain and Inner Ear:
Rules out other causes of vertigo (e.g., acoustic
neuroma, multiple sclerosis).
Videonystagmography (VNG):
Evaluates eye movements and balance function.
Rotary Chair Testing:
Assesses inner ear and brain coordination.

Drug Class Examples Purpose
Diuretics
Hydrochlorothiazide,
Furosemide
Reduces fluid buildup in the inner ear (lowers
pressure)
Antivertigo
Agents
Meclizine, Dimenhydrinate Relieves dizziness and vertigo
Antiemetics Promethazine, Ondansetron Controls nausea and vomiting during vertigo attacks
Benzodiazepines Diazepam (Valium), Lorazepam Reduces vertigo symptoms and anxiety
Corticosteroids Prednisone, Dexamethasone
Reduces inner ear inflammation (oral or
intratympanic)
Antihistamines
Betahistine (not FDA-approved
in US)
Improves circulation and reduces vertigo (commonly
used abroad)
PHARMACOLOGY

DIET
✅Recommended Diet
Low-sodium diet (1,500–
2,000 mg/day)
Increase water intake
(evenly throughout the
day)
Fresh fruits and
vegetables
Whole grains
Lean protein (chicken, fish,
tofu)
❌ Avoid
Salted and processed foods
Caffeine (coffee, tea,
chocolate, energy drinks)
Alcohol
Sugar and refined
carbohydrates
MSG (monosodium
glutamate)

PROGNOSIS
Chronic condition – no cure, but symptoms can be managed.
Vertigo episodes often decrease in frequency over time.
Hearing loss may worsen gradually and become permanent.
Tinnitus and ear fullness may persist.
Most patients adapt and maintain quality of life with treatment
and lifestyle changes.
Some may require surgical or chemical treatment if symptoms are
severe and unresponsive.

Medical Surgical Nursing - Meniere's Disease

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