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Meniere's Disease
Meniere's disease is an inner ear disorder characterized by episodes of vertigo, tinnitus, and fluctuating hearing loss. It was first described in 1861 by Prosper Meniere and is caused by endolymphatic hydrops, or a buildup of fluid in the inner ear. Risk factors include family history, head injuries, viral infections, and allergies. Symptoms include vertigo, tinnitus, and hearing loss. Treatment involves medications, diet modifications, vestibular rehabilitation therapy, and in severe cases surgery. Nursing management focuses on safety, administering medications, education, and rehabilitation exercises.
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Meniere's Disease
- 1. MENIERE’s BY: Delma JoieD. Magtubo
- 2. MENIERE’S DISEASE i. Introduction ii.Definition iii. Risk Factors iv. Clinical Manifestations v. Medical Management vi. Nursing Management
- 3. HISTORYHISTORY • In 1861the French physician Prosper Ménière theorized that attacks of vertigo, ringing in the ear (tinnitus) and hearing loss came from the inner ear rather than from the brain, as was generally believed at the time. Once this idea was accepted, the name of Dr. Prosper Ménière began its long association with this inner ear disease and with inner ear balance disorders in general.
- 4. HISTORYHISTORY • The existenceof peripheral vestibular disorders was proposed by Meniere in 1861. • PROSPER MENIERE, as director of a large deaf-mute institution in Paris, saw patients develop both vertigo and deafness immediately after trauma to the ear. • He concluded that both symptoms have a common inner ear origin.
- 5. •MENIERE - Autopsyof a young girl who developed sudden hearing loss and acute vertigo. •Brain was normal but the inner ear was filled with blood. •It was commonly believed well into the 20th century that Meniere's disease was caused by haemorrhage. HISTORY
- 6. In 1926PORTMAN, believing Meniere’s disease was secondary to Endolymphatic hypertension, performed the first drainage operation of the endolymphatic sac. HISTORY
- 7. HISTORY In 1938 Hallpikeand Cairns described the underlying pathology of Meniere’s disease as being endolymphatic hydrops, but the precise etiology still remains elusive.
- 8. Caucasian 7to 10 % family history (Osbourne, 2011) 1:2,000 and 1:20,000 population are affected Any age: between the ages of 20 and 50 years I. Introduction
- 9. II. Definition idiopathicendolymphatic hydrops Resulting in the clinical triad of: vertigo, tinnitus, and hearing loss Three of the most recognizable indication of Meniere’s disease are tinnitus, vertigo, and fluctuating hearing loss.
- 10. Middle stage ThreeStages of Meniere’s disease Early stage Late stage
- 11. Normal membranous labyrinthDilated membranous labyrinth in Meniere's disease (Hydrops)
- 14. PATHOGENESIS • EL hydropsoccurs through over production or inadequate absorption. ENDOLYMPH VEST. AQ. END SAC HYDROPS Normal OBSTRUCTION Fundamental problem is ENDOLYMPHATIC MALABSORPTIVE DYSFUNCTION LONGITUDINAL FLOW
- 15. III. RISK FACTORS Head injury Middle or inner ear infection Alcohol use, Allergies, Family history, Recent cold or viral illness, Smoking, Stress & certain medicines Other risk factors include: Some cases, may be related to:
- 16. RISK FACTORS Meniere’s Autoimmune CONTRALATERAL DELAYED HYDROPS- developmentof Abs to inner ear antigens Metabolic Hypothyroidism’ Genetic (chr 6) Infectious Syphilis, Mumps, Herpes infection Neurogenic Cogan’s syndrome (Hearing loss vertigo Psychogenic psychological vulnerability and obsession Vascular Allergic 50% association Inner ear acting as shock organ
- 17. IV. CLINICAL MANIFESTATION Theprinciple symptoms include: Vertigo - usually the most striking symptom, which includes: o Dizziness & Spinning Motion o Irregular heartbeats (palpitations) o Nausea, Sweating & Vomiting
- 18. IV. CLINICAL MANIFESTATION Tinnitus - you sense noise or ringing, buzzing, roaring, whistling or hissing in your ear. The principle symptoms include: You will be more aware of it either during quiet times or when you are tired.
- 19. Hearing loss- hearing loss may fluctuate, especially early on in the course of the disease. IV. CLINICAL MANIFESTATION The principle symptoms include: sensitive to loud sounds degree of long-term hearing loss
- 20. • Episodic vertigowithout hearing loss or • Sensorineural hearing loss, fluctuating or fixed, with disequilibrium: without definite episodes • Other causes excluded Diagnosis Possible Meniere’s disease
- 21. • One definitiveepisode of vertigo • documented SNHL by audiogram at least once • Tinnitus or sense of aural fullness in the presumed affected ear • Other causes excluded Diagnosis Probable Meniere’s disease
- 22. • Two ormore definitive spontaneous episodes of vertigo lasting at least 20 minutes • Documented Audiometric hearing loss on: one occasion • Tinnitus or sense of aural fullness in the affected ear • Other causes excluded Definite Meniere’s disease Diagnosis
- 23. EARLY Stageof Meniere’s disease sudden/unpredictable episodes of vertigo nausea, dizziness and vomiting 20 minutes to a full 24 hours During: hearing loss • may feel uncomfortable and blocked ear • a sense of fullness or pressure (aural fullness). Tinnitus is also common
- 24. MIDDLE Stageof Meniere’s disease periods of remission can last several months Vertigo episodes CONTINUE usually less severe Tinnitus and hearing loss get worse periods of complete remission symptoms just go away & seem to have gone forever
- 25. LATE Stageof Meniere’s disease Typically Hearing and Tinnitus less frequent: vertigo episodes in some cases never come back balance problem, may continue. unsteady when it is dark and they have less visual input to maintain balance. progressively worse
- 26. Anxiety SECONDARY SYMPTOMS Stress Depression
- 28. V. MEDICAL MANAGEMENT 1.Dietary management 2. Physiotherapy 3. Psychological support 4. Pharmacological intervention
- 29.
- 30. V. MEDICAL MANAGEMENTUse of medications: Medications for vertigo: E.G. meclizine (antivert) or diazepam (valium) Anti-nausea medications (e.g. promethazine) Prescribe long-term medications like water pills (diuretics). potassium content, potassium supplements may be prescribed
- 31. V. MEDICAL MANAGEMENT Non-invasivetherapies and procedures used: Rehabilitation: Vestibular rehabilitation therapy. Hearing aid: Audiologist Meniett device: ‘Meniett pulse generator’
- 32. Meniett Device orMeniett Pulse Generator DEVICE DEMONSTRATIONDEMONSTRATION
- 33. 1. Dietary andLifestyle Modifications Hearing aid may be used Complete bed rest during vertigo attacks Minimize dietary sugar and salt consumption Avoid caffeine, aspirin, alcohol, and smoking Masking devices: to reduce the effect of tinnitus Practice relaxation techniques to cope with stress Adopt safety measures to avoid falling due to a sudden loss of balance
- 34. 2. Surgical procedures A.Endolymphatic Sac Decompression procedure -regulating fluid levels portion of bone near the endolymphatic sac, is removed. accompanied by the placement of a tube
- 35. 2. Surgical procedures B.Vestibular Nerve Section - surgeon cuts the nerve, which connects the balance and movement sensors in the inner ear to the brain center C. Labyrinthectomy - removes a portion of, or all of the inner ear - both the balance and hearing function are removed from the affected ear - complete loss of hearing in he affected ear
- 36. VI. NURSING MANAGEMENTExpected Outcomes 1. Use prescription drugs 2. Fear and anxiety is reduced. 3. Not to fall due to impaired balance. 4. Keep the head remained silent when dizzy. 5. Conduct training in accordance with the provisions. 6. Immediately perform a horizontal position when dizzy. 7. Identify the nature of feeling full or pressure before the attack.
- 37. General ManagementVI. NURSINGMANAGEMENT 1.Assess vertigo which includes history, onset, description of the attack, duration, frequency, and the presence of symptoms related ear hearing loss, tinnitus, a feeling of fullness in the ear.
- 38. General ManagementVI. NURSINGMANAGEMENT 2. Assess the extent of disability in connection with the activities of daily living. Rationale: The extent of disability lowers the risk of falling. 3. Teach vestibular therapy or stress / balance in accordance with the provisions. Rationale: This exercise can speed up the compensation maze reduce vertigo and impaired way street.
- 39. General ManagementVI. NURSINGMANAGEMENT 4. Give or teach how anti-drug or vertigo and vestibular sedatives and give instructions to patients about the side effects. Rationale: Eliminate the symptoms of acute vertigo. 5. Encourage the patient to lie down if feeling dizzy, with fence bed is raised. Rationale: Reduces the possibility of falls and injuries.
- 40. 6. Put apillow on both sides to limit motion first. Rationale: Movement will aggravate vertigo. General ManagementVI. NURSING MANAGEMENT 7. Instruct the patient to keep his eyes open and looked straight ahead while lying down and experiencing vertigo. Rationale: The feeling of vertigo and reduced eye movement when experiencing decelerations remained on guard in a fixed position.
- 41. General ManagementVI. NURSINGMANAGEMENT 8. Help patients locate and determine the aura (the aural symptoms) that precedes the occurrence of any attack. Rationale: The introduction of the aura can help determine when the need for drugs before the attack so as to minimize the severity of the effects.