Meniere’s disease ADAM MEZACHANTELLE EDMONSON GABRIELLA BURRIOLA TERESA RODRIGUEZ

Meniere’s disease  Meniere’s disease is a disorder of the inner ear that causes episodes in which the patient may experience balance and hearing impairment. The cause of the disease is not understood. One popular theory is that is it due to abnormal amounts of fluid in the inner ear.  Other possible factors : improper fluid drainage, abnormal immune response, allergies, viral infections, genetic predisposition, head trauma, migraines  Two types  Unilateral (most common)  bilateral

Pathophysiology  Disease may result from over production of endolymph in the labyrinth of the ear  Accumulation of endolymph leads to pressure increase that may break the membrane that separate the perilymph resulting in vestibular nerve malfunction leading to vertigo  Causes dilation of semicircular canal, utricle, and saccule causing degeneration of vestibular and cochlear hair cells  Overstimulation of the vestibular branch of cranial nerve VIII impairs postural reflex and stimulates vomiting.

Antecedents  Immune system  Genetic factors  Proper functioning neural system  Autonomic nervous system

Attributes  Hearing imbalance  Psychosocial  Physical imbalance

Interrelated Concepts  Safety  Coping  Communication  Interpersonal relationships  Immunity  Mobility  comfort

Risk Factors Autonomic nervous system dysfunction Family history Head trauma Immune disorder Middle ear infection Migraine headaches Stress Allergy High salt intake Chronic exposure to loud noise Premenstrual edema

Consequences  Positive  Patient education  Proper coping  Communication and family  Effective communications  Maintain balance  Less vertigo episodes  Negative  Impaired human development  Hearing impairment  Decreased quality of life  Balance impairment  Psychosocial

Signs and Symptoms of Meniere’s disease  Recurring episodes of vertigo  Hearing loss  Ringing in the ears (tinnitus)- ringing, buzzing, roaring, whistling, or hissing sound in the ear  Feeling of fullness in the ear- ( pressure in the affected ears (aural fullness) or on the side of their heads  Loss of balance  Headaches  Nausea, vomiting, and sweating caused by severe vertigo  After an episode, signs and symptoms improve and might disappear entirely. Episodes can occur weeks to years apart.

Diagnostic Screening/Tests  Imaging  Computed tomography scanning (brain) and magnetic resonance imaging are used to rule out acoustic neuroma or other neurological condition as a cause of symptoms.  Diagnostic Procedures  Audiometric test results show a sensorineural hearing loss and a loss of discrimination; low-frequency sounds are commonly affected.  Electronystagmography results show normal or reduced vestibular response on the affected side.  Cold caloric test results show impairment of the oculovestibular reflex.  Transtympanic electrocochleography results show an increased ratio of summating potential to action potential, usually > 35%.  Brain stem evoked response audiometry test is used to rule out acoustic neuroma, brain tumor, and vascular lesions in the brain stem.

Treatments  No cure exists for Meniere’s disease, but a number of treatments can help reduce the severity and frequency of vertigo episodes. There are no treatments for the hearing loss that occurs with Meniere’s disease. All of the treatments- some conservative, some aggressive-are to stop the spells of vertigo.  General  Hearing aids: a hearing aid in the ear affected by Meniere’s disease might improve your hearing. Your doctor can refer you to an audiologist to discuss what hearing aid options would be best for you  Diet  Avoidance of possible triggers, such as salt, caffeine, alcohol, nicotine, and monosodium glutamate  Activity  Lying down to minimize head movement, and avoiding sudden movements and glaring light to reduce dizziness (during an attack)  As tolerated between attacks

Treatments  Vestibular rehabilitation therapy: is an exercise based program for reducing the symptoms of disequilibrium and dizziness associated with vestibular pathology. The program may include exercises for: coordinating eye and head movements, stimulating the symptoms of dizziness in order to desensitize the vestibular system, improving balance and walking ability, and improving fitness and endurance (Exercises vary depending on the type of inner ear disorder and the associated symptoms)

Treatments  Surgery  Pressure treatment with low pressure pulse generator device (Meniett Device): safe minimally invasive method for managing Meniere’s disease symptoms. The device sends a series of computer controlled, low pressure pulses to the middle ear. Scientist believe these micro pressure pulses may reduce the inner ear fluid and swelling that are thought to cause Meniere’s disease symptoms.  Endolymphatic drainage and shunt procedures: is a surgical procedure in which a very small silicone tube is placed in the membranous labyrinth of the inner ear to drain excess fluid  Ventilation tube insertion via myringotomy with pressure producing instrument  Lateral semicircular canal plugging  Vestibular nerve resection/cochleovestibular nerve section: this procedure involves cutting the nerve that connects balance and movement sensors in your inner ear to the brain (vestibular nerve). This procedure usually corrects problems with vertigo while attempting to preserve hearing in the affected ear. It requires general anesthesia and an overnight hospital stay.  Labyrinthectomy: with this procedure, the surgeon removes the balance portion of the inner ear, thereby removing both balance and hearing function from the affected ear. This procedure is performed only if you already have near total or total hearing loss in your affected ear.  Vestibular ablation( removal of a body part or the destruction of its function)

Medications  Intratympanic infusion of gentamicin (for patients not responding to medication)  Acute Attack Management:  First-line agents: Atropine sulfate (AtroPen), diazepam (Valium), transdermal scopolamine (Transderm-Scop)  Second-line agents (I.V.): Droperidol (Inapsine), promethazine hydrochloride (Promethegan), diphenhydrAMINE hydrochloride (Benadryl)  Maintenance Therapy:  First-line agents: Meclizine hydrochloride (Antivert), diazepam (Valium)  Second-line agents: Dimenhydrinate (Dramamine), promethazine hydrochloride, diphenhydramine hydrochloride (Benadryl), intratympanic gentamicin or dexamethasone (oral; injection) (DexPak)

Nursing interventions  Independent treatment  Maintain a safe environment. Provide assistance when necessary  Give prescribed drugs as ordered  Obtain specimens for laboratory testing, such as serum electrolyte levels f the patient is receiving diuretics  During an acute attack, ensure bed rest with eyes closed  Review with the patient possible triggers for attacks; assist with identifying triggers as necessary  Have the patient limit his/her dietary intake during an attack. Anticipate the need for sodium restriction, if indicated.

Nursing interventions  Encourage the patient to verbalize feeling and concerns. Assist with relaxation techniques and positive coping strategies.  Allow the patient to participate in care and decision making to foster feelings of control  Encourage the patient to remain as active as possible between attacks  Reinforce vestibular rehabilitation, as indicated  Decrease visual and auditory stimulus during acute attacks; promote a quiet, calming environment

Nursing interventions  Dependent treatment  Psychosocial  Enlist the help of family members to assist the patient in eliminating risk factors for injury, especially in the home environment.  Doctors orders  Obtain a dietary consult as indicated.  Obtain a physical therapy consult as indicated.  Obtain a social services consult as indicated.  Nurse patient relationship  Refer to appropriate community agencies and groups that can assist in meeting needs.  Communication  Patient teaching  Drug administration

Patient Education  Encourage patient to express feelings of increased tolerance of activities and comfort.  Seek appropriate support to assist with coping  Have patient verbalize an understanding of the disease process and identify prescribed treatment plan to control his/her condition  Educate the patient on strategies to safeguard his home or environment to prevent falls.  Have patient remain free from injury and to participate in decisions about his/her care.  Need to avoid sudden movements or positions that make vertigo hazardous to the pt.  Lifestyle modification in diet to reduce salt intake, and avoid caffeine and nicotine substances

Prognosis  Meniere’s disease has no cure but can be managed with life style changes and stress management  As disease progresses hearing loss may progress but can be treated with hearing aid  In severe cases of Meniere’s surgical intervention

Nursing diagnosis  Activity intolerance  Related to: imbalance, impaired hearing, Patient claims of “dizzy spells”  Evidence by: vertigo, hearing loss, and tinnitus  Secondary to : Meniere's disease  Expected outcomes: patient will have stable vital signs while active. Patient knowledge of underlying cause. Tolerate increased activity. Express feeling.

Nursing diagnosis risk  Risk for injury  Related to: impaired balance and hearing. Patient claims of “dizzy spells”  Evidence by: vertigo and tinnitus  Secondary to : Meniere's disease  Expected outcomes: patient will remain free from injury, identify and reduce risk factors, and state environmental or lifestyle changes necessary to maintain safety.

Patient Goal  Increased activity intolerance presented by effective lifestyle changes and stress management. Episodes of vertigo decrease or stop. Patient is educated of their disorder, adapting life to it, and maintaining healthy communication with family and friends. Hearing loss is treated with hearing aid if needed. The patient remains free of injury.

Sources  Meniere's disease. (n.d.). Retrieved March 03, 2016, from disease/basics/definition/con  edu.lww.com/lna/document.do?bid=4&did=403473&hits=disease,m eniere,menieres edu.lww.com/lna/document.do?bid=4&did=403473&hits=disease,m eniere,menieres  Meniere’s Disease. (n.d.). Retrieved March 03, 2016, from  Meniere's Disease Information Center -- Extensive Information for Patients, Families, Doctors. (n.d.). Retrieved March 03, 2016, from