Ménière's Disease

  1. General information
    1. Disease of the inner ear resulting from dilation of the endolymphatic system and increased volume of endolymph; characterized by recurrent and usually progressive triad of symptoms: vertigo, tinnitus, and hearing loss
    2. Incidence highest between ages 30 and 60
    3. Cause unknown; theories include allergy, toxicity, localized ischemia, hemorrhage, viral infection, or edema.
  2. Medical management
    1. Acute: atropine (decreases autonomic nervous system activity), diazepam (Valium), fentanyl, and droperidol (Innovar)
    2. Chronic
      1. Drug therapy: vasodilators (nicotinic acid), diuretics, mild sedatives or tranquilizers (diazepam [Valium]), antihistamines (diphenhydramine [Benadryl], meclizine [Antivert])
      2. Low-sodium diet, restricted fluid intake, restrict caffeine and nicotine.
    3. Surgery
      1. Surgical destruction of labyrinth causing loss of vestibular and cochlear function (if disease is unilateral)
      2. Intracranial division of vestibular portion of cranial nerve VIII
      3. Endolymphatic sac decompression or shunt to equalize pressure in endolymphatic space
  3. Assessment findings
    1. Sudden attacks of vertigo lasting hours or days; attacks occur several times a year
    2. Nausea, tinnitus, progressive hearing loss
    3. Vomiting, nystagmus
    4. Diagnostic tests
      1. Audiometry: reveals sensorineural hearing loss
      2. Vestibular tests: reveal decreased function
  4. Nursing interventions
    1. Maintain bed rest in a quiet, darkened room in position of choice; elevate side rails as needed.
    2. Only move the client for essential care (bath may not be essential).
    3. Provide an emesis basin for vomiting.
    4. Monitor IV therapy; maintain accurate I&O.
    5. Assist with ambulation when the attack is over.
    6. Administer medications as ordered.
    7. Prepare the client for surgery as indicated (post-op care includes using above measures).
    8. Provide client teaching and discharge planning concerning
      1. Use of medication and side effects
      2. Low-sodium diet and decreased fluid intake
      3. Importance of eliminating smoking