Meniere’s Disease Nursing Management

Meniere’s disease is a chronic disorder of the inner ear involving sensorineural hearing loss, severe vertigo and tinnitus.

Meniere’s disease appears to involve overproduction or decreased absorption of endolymph, with resultant degeneration of vestibular and cochlear hair cells.
Recurrent attacks result in progressive sensorineural hearing loss (especially low tones), usually unilateral in nature.

Sudden episodes of severe whirling vertigo, with an inability to stand or walk; episode may last up to several hours
Buzzing tinnitus (worsens before and during an episode)
Nausea, vomiting, and diaphoresis
Possibly, brief loss of consciousness with nystagmus

Goal of treatment may include recommendations for changes in lifestyle and habits or surgical treatment. The treatment is designed to eliminate vertigo or to stop the progression of or stabilizes the disease.
Treatment approaches are rehabilitative, dietary, medical and surgical.
Psychological evaluation may be indicated if patient is anxious, uncertain, fearful or depressed.

Tranquilizers and antihistamines such as meclizine (Antivert) to control vertigo and to suppress the vestibular system; antiemetics for nausea and vomiting.
Diuretics to lower pressure in the endolymphatic system
Vasodilators are often used in conjunction with other therapies
Middle and inner ear perfusion or systemic injections of ototoxic medications: streptomycin, gentamicin to eliminate vertigp; procedure is highly successful in decreasing vertigo but is accompanied by a significant risk for hearing loss.

Endolymphatic sac decompression or shunt
Middle and inner ear perfusion with placement of intraotologic catheters for drainage and infusion of medication
Labyrinthectomy (destruction of inner ear)
Vestibular nerve section (8th cranial nerve)

Risk for injury related to altered mobility because of gait disturbed and vertigo.
Impaired adjustment related to disability requiring change in lifestyle because of unpredictability of vertigo.
Risk for fluid volume imbalance and deficit related to increased fluid output, altered intake, and medications.
Anxiety related to threat of, or change in, health status and disabling effects of vertigo.
Ineffective coping related to personal vulnerability and unmet expectations stemming from vertigo.
Feeding, bathing/hygiene, dressing/grooming, and toileting self-care deficits related to labyrinth dysfunction and episodes of vertigo.

Provide nursing care during acute attack.
- Provide a safe, quiet, dimly lit environment and enforce bed rest
- Provide emotional support and reassurance to alleviate anxiety
- Administer prescribed medications, which may include antihistamines, antiemetics, and possibly, mild diuretics
Instruct the client on self-care instructions to control the number of acute attacks.
- Discuss the nature of the disorder
- Discuss the need for a low-salt diet
- Explain the importance of avoiding stimulants and vasoconstrictions (e.g. caffeine, decongestants, alcohol)
- Discuss medications that may be prescribed to prevent attacks or self-administration of appropriate medications during an attack, which may include anticholinergics, vasodilation, antihsitamines, and possibly, diuretics or nicotinic acid.
Discuss, prepare and assist the client with surgical options.
- A labyrinthectomy is the most radical procedure and involves resection of the vestibular nerve or total removal of the labyrinth performed by the transcanal route, which results in deafness in that eat.
- An endolynmphatic decompression consists of draining the endolymphatic sac and inserting a shunt to enhance the fluid drainage

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