MÉNIÈRE'S DISEASE

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MÉNIÈRE'S DISEASE (MD) OR ENDOLYMPHATIC HYDROPS
DEFINITION
It is an imbalance of inner ear fluid caused by malabsorption in the endolymphatic sac possibly due to blockage of the endolymphatic duct, leading to dilation of endolymphatic space.

CAUSE
·        exact cause is unknown
·        It is more common in adults (average age at onset is in the 40s) with symptoms usually beginning between ages 20- 60 years.
·        the disease has also been reported in children as young as 4years and adults up to 90s
·        It occurs equally in both genders
·        right and left ears are affected equally and the disease affects both ears at the same time in about 20% of patients
·        about 20% of the patients had a positive family history

PATHOPHYSIOLOGY
It is a state of hearing loss characterized by tingling and vertigo caused by excessive accumulation of endolymph in the cochlear duct and possible leakage of endolymph into the perilymph caused by increased capillary permeability.
Mixture of the endolymph and perilymph chemically alters the homeostasis of both fluids thus causing the symptoms of the disease.

CLINICAL MANIFESTATIONS
  •           vertigo (imbalance and dizziness)
  •         tinnitus (ringing sound in the ear)
  •         ‍one sided fluctuating hearing loss


These are the three major manifestations, others are
·        Nausea and vomiting associated with the vertigo
·        Aura which precedes the vertigo
·        Nystagmus; repetitive and involuntary movement of the eyeballs
·        Diaphoresis; increased sweating. It occurs during the attack
·        feeling of fullness in the ear
Symptoms are frequently at their worst during the first attack which may last from a few minutes to 6hours, subsequently attacks are less severe birth over time may affect both ears and cause permanent bilateral hearing loss
Attacks may be precipitated by weather changes, stress, dietary influences such as consumption of caffeine, alcohol, salt etc., menstruation, pregnancy, and smoking

DIAGNOSITIC EVALUATION
·        This is easily made based on the patient's report of symptoms
·        Tuning fork test or weber test is done to note extent of hearing loss
·        Audiogram to reveal sensorineural hearing loss
·        Electronystagmogram to detect normal or reduced vestibular response
Note that there is no absolute diagnostic test
 
MEDICAL MANAGEMENT                                           
·        low sodium diet (2000mg/day) to regulate the fluid within the body
·        antihistamines eg Meclizine (antivert) to suppress the vestibular system
·        tranquilizers eg Diazepam (valium) used in acute conditions to control vertigo
·        antiemetics eg Promethazine (phenergan)suppositories to suppress nausea and vomiting and vertigo because they also have antihistamine effect
·        diuretic therapy e.g. hydrochlorothiazide sometimes relieves symptoms by lowering the pressure in the endolymphatic system
·        intake of food containing potassium because the diuretic cause potassium loss from the body
·        vasodilators eg Nicotinic acid, Papaverine hydrochloride(pavapid) and Methanetheline bromide(banthine) have no scientific basis for relieving symptoms but are often used together with other above therapies
Surgeries include;
·        endolymphatic sac decompression to equalize the pressure in the endolymphatic           system
·        Middle and inner ear perfusion where ototoxic medications eg streptomycin or gentamycin are given by infusion into the middle and inner ear so as to decrease vestibular function and decrease vertigo. Effective rate is 85%
·        intraotologic catheters used to deliver medication into the inner ear
·        vestibular nerve section, provides success rate of 98% in eliminating vertigo
There is no cure for this disease, because there is no known cause,the symptoms are managed

NURSING MANAGEMENT
·        advice patient against reading and use of glaring lights
·     instruct patient against sudden change of position and to ask for assistance when getting out of bed or when ambulating
·        keep side rails and attention switches close by for the patient's use
·        provide psychological care
·        examine for other abnormalities in the ear such as tumors, drainage, blockage
·        assess for factors such as patient's occupation that contribute to hearing loss
·        assess head and neck for possible lymph node enlargement

NURSING DIAGNOSES
        activity intolerance related to severe dizziness evidenced by patient not being able to perform activities of daily living

·        deficient knowledge related to sudden onset and unknown progression of disease evidenced by patient asking too many questions

·        risk for injury related to dizziness
 
COMPLICATION
Permanent hearing loss

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