What You Don’t Know About Meniere’s Disease

Meniere’s Disease: Causes, Symptoms, Treatment

Meniere’s disease is an abnormal inner ear fluid balance caused by malabsorption in the endolymphatic sac. Evidence indicates that many people with Meniere’s disease may have a blockage in the endolymphatic duct. Regardless of the cause, endolymphatic hydrops, dilation in the endolymphatic space, develops.

Either increased pressure in the system or rupture of the inner ear membrane occurs, producing symptoms of Meniere’s disease. It is the disorder of Inner ear that causes episodes of vertigo, ringing in the ear (Tinnitus), and one-sided sensory hearing loss that causes by increase endolymph fluid pressure inside the inner ear canal system.

Meniere’s disease incidence:-

  • Meniere’s disease affects more than 2.4 million people in the United States.
  • More Common in adults, it has an average age of onset in the 40s, with symptoms usually beginning between the ages of 20 and 60 years.
  • The disease has been reported in children as young as age 4 years and in adults up to the 90s.
  • Meniere’s disease appears to be equally common in both genders,
  • The right and left ears are affected with equal frequency.
  • The disease has occurred bilaterally in about 20% of patients.

Meniere’s disease causes:-

Exact cause unknown.

Meniere’s disease Risk factor:-

  • Allergic reaction.
  • Viral or bacterial infection.
  • Fluid imbalance ( Malabsorption in the endolymphatic sac).
  • Blockage in the endolymphatic duct.
  • Head injury.
  • Long term stress.

Meniere’s Disease Pathophysiology:-

  • Increase endolymph fluid pressure.
  • Membranous labyrinth dilated like a balloon when the pressure increase.
  • Distorts the entire inner ear canal system. further, if it causes dilation of the cochlear duct which results in hearing loss. or If it causes damage to the vestibule system which results in Vertigo and tinnitus.

Meniere’s disease Sign and Symptoms:-

Meniere’s disease is characterised by a triad of symptoms:-

  • Episodic, Incapacitating Vertigo.
  • Tinnitus or roaring sound.
  • Sensorineural hearing loss.
  • Pressure in the Ear or fullness of the ear.
  • Headache, Nausea, Vomiting.
  • Nystagmus (rapid involuntary eye movement).

A few clinicians accept that there are two subsets of the disease, known as atypical Ménière’s disease: cochlear and vestibular. Cochlear Ménière’s disease is recognized as a fluctuating, progressive sensorineural hearing misfortune related to tinnitus and aural pressure within the nonattendance of vestibular indications or findings. Vestibular Ménière’s infection is characterized as the event of episodic vertigo related to aural pressure but no cochlear symptoms. In a few patients, cochlear or vestibular Ménière’s disease creates, to begin with. In most patients, be that as it may, all of the symptoms develop in the long run.

Meniere’s Disease Investigation:-

  1. Physical Examination.
  2. Weber test.
  3. Electronystaga gram.
  4. Electrocochleography.
  5. Audiometry test:- Measurement of acuity by the audiologist or audiology technician and trained skilled nurse.
  • Frequency:- Express in Hertz. High frequency means greater the number of vibration per second. Low frequency means fewer the number of vibration per second.
  • The intensity in Decibel (DB):- Intensity table is given below –
Sound Intensity D.B. Safe Exposure
Threshold 0
Whispering 20 db
Average 40 db
Conversation 60 db
Car traffic 70 db 3 hour
Motor cycle 90 db 3 hour
Rock Concert 120 db 3 hour
Jet Engine 140 db Immediately
Danger
Rocket Launching 180 dbImmediately
Danger
Table:- Intensity in decibel(DB).

Meniere’s Disease Management:-

Meniere’s Disease Non Surgical Management:-

  • Teach the patient to e head slowly to prevent worsening of vertigo.
  • Encourage patients to stop smoking.

Nutritional Therapy:-

  • Avoid foods and fluid high in salt and sugar.
  • adequate intake of fluid daily, water, milk, and low sugar fluid juice are recommended.
  • Limit intake of coffee, tea, and soft drinks ( Avoid caffeine because of its diuretics effect).
  • Limiting alcohol intake.
  • Avoid monosodium glutamate ( MSG ), containing food.

Meniere’s Disease Surgical Management:-

  1. Endolymphatic Sac Decompression. Endolymphatic sac decompression, or shunting, theoretically equalizes the pressure in the endolymphatic space. A shunt or drain is inserted in the endolymphatic sac to drain fluid from the membranous labyrinth. Equalizes the pressure in the endolymphatic space. This procedure is favored by many otolaryngologists as a first-line surgical approach to treat the vertigo of Meniere’s disease because it is relatively simple and safe and can be performed on an outpatient basis.
  2. Vestibular Nerve Sectioning. (Cutting the nerve prevents the brain from receiving input from the semi-circular canals and eliminating the attacks of vertigo). Vestibular nerve section provides the greatest rate of approximately 98% in eliminating the attacks of vertigo. It can be performed by a trans labyrinthine approach that is through the hearing mechanism or in a manner that can conserve hearing i.e. suboccipital or middle cranial fossa, depending on the degree of hearing loss. Most patients with incapacitating Meniere’s disease have little or no effective hearing. Cutting the nerve prevents the brain from receiving input from the semicircular canals. This procedure requires a brief hospital stay.
  3. Labyrinthectomy.
  4. Middle and Inner ear perfusion. Ototoxic medications, such as streptomycin or gentamicin, can be given to patients by infusion into the middle and inner ear. These medicines are used to decrease vestibular function and decrease vertigo. The success rate for killing vertigo is high, almost 85%, but the chance of critical hearing loss is additionally high. This method of inner ear perfusion ordinarily requires an overnight remain within the clinic. After the procedure, numerous patients have a period of awkwardness that lasts several weeks.

Meniere’s Disease Nursing Management:-

  1. The risk of injury related to altered mobility because of vertigo and Gait disturbance.
  2. Altered communication related to impaired hearing.
  3. Impaired adjustment related to disability requiring a change in lifestyle due to unpredictability of vertigo.
  4. The risk for deficient fluid volume related to increased fluid output, altered intake, and medications.
  5. Anxiety-related to the threat of, or change in, health status and disability effects of vertigo.
  6. Ineffective coping is related to personal vulnerability and disabling effects of vertigo.

Reference:-

  1. Brunner and Suddarth’s, Textbook of Medical-Surgical nursing, 10th edition, chapter-59, assessment and management of patient with hearing and balance disorder.

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