West Visayas State b.
Benzodiazepines
University
COLLEGE OF
NURSING
La Paz, Iloilo City
NOTES ON MENIERE’S DISEASE
Prepared by: MARNI LIEZA G. TICAO
MENIERE’S DISEASE
also known as endolymphatic hydrops
 described in 1861 by a French physician,
Dr. Prosper Meniere
 a disorder of the inner ear due to
distention of the endolymphatic
compartment of the inner ear that can
affect hearing and balance
 usually affects adults, slightly more
males than females, between ages 30 and
60
ETIOLOGIC FACTORS
 Idiopathic; exact cause is unknown
 Possible causes:
• Viral infection of the inner ear
• Head injury/Trauma
• Immune disease
• Endocrine Disorders
• Vascular Disorders
• Autonomic nervous system dysfunction
producing a temporary constriction of blood
vessels supplying the inner ear
• Overproduction or decreased absorption of
endolymph
CLINICAL MANIFESTATIONS
Triad of Symptoms
 Vertigo - Attacks of spinning sensation
 Hearing loss
 Tinnitus - A roaring, buzzing, or ringing
sound in the ear
Other signs and symptoms
 Fullness or blocked feeling in the ear
 Giddiness
 Nystagmus
 Sweating
 Pallor
 Severe nausea
 Vomiting
DIAGNOSTIC PROCEDURES
a. History
b. Computed Tomography Scan
c. Magnetic Resonance Imaging
d. Electronystamography - A precise and
objective diagnostic method of evaluating
nystagmus eye movements
e. Electrocochleography - Recording the
electrical activity of the inner ear in
response to sound
f. Caloric Stimulation - Involves elevating the
head 30 degrees and irrigating each
external auditory canal separately with 30
to 50 ml ice water
g. Rotational Tests - Involves rotation using a
rotatable chair or motor-driven platform
MEDICAL MANAGEMENT
Pharmacologic Methods
 To suppress the illusion of motion
a. Antihistamines  meclizine, cyclizine,
dimenhydrinate, promethazine
b. Anticholinergics  scopolamine, atropine
 To relieve nausea and vomiting
a. Antidopaminergics  phenothiazines
• Administration of Otic Medication
- Have patient assume side-lying position with
ear to be treated facing up.
- Straighten patient’s ear canal:
Adult/3 y.o. & above  gently pull the pinna
of the ear up and back
Infant or Child under age 3  gently pull the
pinna down and back
- Instill prescribed drops holding dropper 1 cm
(1/2 in) above ear canal directly toward the
side.
- Ask patient to remain in side-lying
position for 5 to 10 minutes.
- Apply gentle massage or pressure to
tragus of ear with finger to allow
medication to move inward.
SURGICAL MANAGEMENT
a. Endolymphatic Sac Decompression
• equalizes the pressure in the
endolymphatic sac
• insertion of shunt or drain into the
endolymphatic sac through a postauricular
incision
b. Middle and Inner Ear Perfusion
• administration of ototoxic medications,
such as streptomycin or gentamicin, into
the middle and inner ear by infusion
• used to decrease vestibular function and
decrease vertigo
c. Intraotologic Catheters
• provide a channel from the outer ear to
the inner ear to deliver medication directly
to the inner ear
d. Labyrinthectomy
• removal of the inner ear sense organ to
effectively control vertigo
• sacrifices hearing and is reserved for
patients with nonfunctional hearing in the
affected ear
e. Vestibular Neurectomy
• selectively severing a nerve from the
affected inner ear organ
• usually controls the vertigo while
preserving hearing, but carries surgical
risks
NURSING DIAGNOSES & MANAGEMENT
Nursing Diagnoses
• Risk for Injury related to tendency to lose
balance
• Risk for Fluid Volume Deficit related to
decreased oral intake and loss of fluid
through emesis
• Risk for Trauma related to impaired balance
• Self-Care Deficit: Feeding, Bathing/Hygiene,
Dressing/Grooming, Toileting related to
labyrinth dysfunction and episodes of
vertigo
• Impaired Adjustment related to a required
change in lifestyle
•Anxiety related to threat of, or change in,
health status and disability effects of vertigo
• Powerlessness related to feelings of loss of
control
Nursing Management
 Teach the patient what to do and not to do
during an attack to reduce dizziness and
prevent injury.
DO’s
 • Keep the side rails of the bed up to
prevent falls because an attack can begin
quite rapidly.
• Lie on the unaffected ear and look in the
direction of the affected ear to decrease
signs and symptoms.
DONT’s
• Don’t read or expose yourself to glaring
light to reduce dizziness.
• Don’t make sudden position changes or do
any tasks that vertigo makes hazardous.
• Don’t get out of bed or walk without
assistance.

 Nursing Considerations Before and After Surgery:

Before Surgery
• Record fluid intake and output and
characteristics of vomitus if the patient is
vomiting. Give an antiemetic, as necessary,
and small amounts of fluid frequently.
After Surgery
• Record fluid intake and output carefully.
• Tell the patient to expect dizziness and
nausea for 1 to 2 days after surgery.
• Give an antibiotic and an antiemetic as
prescribed.
• Provide patient teaching information.
 Follow a low-sodium diet.
 Avoid tobacco, alcohol, and caffeine as
directed.
 Practice stress management to help
reduce the frequency and severity of
vertiginous attacks.
 Maintain your diversionary and social
activities.
 Try not to let the fear of vertigo stop you
from participating in daily activities
when vertigo is absent.