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Ménière’s
Disease
OVERVIEW
Idiopathic disease an abnormal inner ear fluid
balance caused by a mal-absorption of fluid in the endolymphatic sac
a blockage in the endolymphatic duct
regardless what cause it, endolymphatic hydrops develops.
NORMAL
DILATED
OVERVIEW
more common in adults an average age of onset in the 40s with symptoms usually beginning
between the ages of 20 and 60 years
common in both genders the right and left ears are affected
with equal frequency
CLINICAL MANIFESTATIONS fluctuating, progressive
sensorineural hearing loss tinnitus or a roaring sound a feeling of pressure or fullness in
the ear episodic, incapacitating vertigo,
often accompanied by nausea and vomiting
2 SUBSETS OF MENIERE’S DISEASE
Cochlearfluctuating, progressive sensorineural hearing loss associated with tinnitus and aural pressure in the absence of vestibular symptoms or findings.
Vestibularcharacterized as the occurrence of episodic vertigo associated with aural pressure but no cochlear symptoms
PATHOPHYSIOLOGYRisk Factors
1.Age2.Gender3.Congenital4.High-sodium diet5.Conditions:
a.Syphilisb.Autoimmune Diseasec.Herpes Virus
Infection
Fluid imbalance in the endolymphatic
sac
Accumulation of fluid in the
endolymphatic sac
Burst into other duct channels
Feeling of fullness
Pressure in the ear
Membranes becomes dilated
Cochlear duct Saccule Utricle
Flactuating, progressive sensorineural hearing
loss
Compression of Organ of
Corti
Vertigo
Nausea and vomiting
ASSESSMENT & DIAGNOSTIC FINSINGS A careful history is taken to determine
the frequency, duration, severity, and character of the vertigo attacks.
Sounds from a tuning fork Weber Test
Audiogram Electronystagmogram
MEDICAL MANAGEMENT Can be successfully treated
with diet and medication therapy
Many patients can control their symptoms by adhering to a low-sodium (2,000 mg/day) diet
PHARMACOLOGIC THERAPY
1. Antihistamines2. Tranquilizers3. Antiemetics 4. Diuretic5. Vasodilators
meclizinediazepampromethazinehydrochlorothiazidepapaverine HClMethantheline Br
AntivertValiumPhenerganHydrodiuril PavabidBanthine
CLASS GENERIC
BRAND
SURGICAL MANAGEMENT
Endolymphatic Sac Decompression equalizes the pressure in the
endolymphatic space favored by many otolaryngologists as a
first-line surgical approach to treat the vertigo of Ménière’s disease
SURGICAL MANAGEMENT
Middle and Inner Ear Perfusion used to decrease vestibular function and
decrease vertigo ototoxic medications, such as streptomycin
or gentamicin, can be given to patients by infusion into the middle and inner ear
SURGICAL MANAGEMENT
Intraotologic Catheters catheters are being developed to provide a
conduit from the outer ear to the inner ear uses of these catheters include treatment
for sudden hearing loss and various disorders causing intractable vertigo
SURGICAL MANAGEMENT
Vestibular Nerve Section provides the greatest success rate
(approximately 98%) in eliminating the attacks of vertigo
cutting the nerve prevents the brain from receiving input from the semicircular canals
NURSING MANAGEMENT
Nursing Dx: Risk for injury related to altered mobility because of gait disturbance
1.Assess extent of disability in relation to activities of daily living.
2.Recommend that patient keep eyes open and stare straight ahead when lying down and experiencing vertigo.
2. Place pillow on each side of head to restrict movement.
3. Encourage patient to sit down when dizzy.
Nursing Dx: Risk for deficient fluid volume related to increased fluid output, altered intake and medications
1.Monitor intake and output.
2.Assess indicators of dehydration (e.g. pulse, skin turgor, blood pressure, mucous membranes).
3.Encourage oral fluids as tolerated; discourage beverages containing caffeine.
NURSING MANAGEMENT
SALAMAT SA
PAGPAMINAW!
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and history taking. (5th ed.). Philippines: Lippincott Williams & Wilkins Black, J.M. & Hawks, J.H. (2009). Clinical management for ositive outcomes. (8th ed.). Missouri: Saunders Elsevier, Inc. Bullock, B.L. & Henze, R.L. (2000). Focus on pathophysiology. Philadelphia: Lippincott Williams & Wilkins Dillon, P.M. (2007). Nursing Health Assessment: a critical thinking, case studies approach.(2nd ed. ). Philadelphia: F.A. Davis Company Hockenberry, M. & Wilson, D. (2007). Wong’s nursing
care of infants and children. (8th eds: .). Philippines: Elsevier
Hockenberry, M. & Wilson, D. (2007). Wong’s nursing care of infants and children. (8th eds: .). Philippines: Elsevier Huether, S. & McCane, K. (2005). Understanding pathophysiology. (3rd ed.). Philippines: Mosby Inc. Ignatavicius, D.D. & Workman, M.L. (2006). Medical – surgical nursing: critical thinking for collaborative care. (5th ed.). Singapore: Elsevier Pte Ltd. Kozier, B. (2004). Fundamentals of nursing. New Jersey: Pearson Education Inc. Lewis, S. M., et.al. (2004). Medical – surgical nursing: assessment and management of clinical problems. (6th ed.). Philadelphia: Mosby, Inc. Marieb, E. (2002). Essentials of human anatomy and physiology. (6th ed.). Philippines: Pearson Education Inc. SUCN Level II Procedure Manual