Transcript Meniere`s Disease - faculty at Chemeketa

Pretest
Pop Quiz Hot Shots:
How would you interact with a patient
who is suspected to have Meniere’s
Disease?
A. Shout really loud while filling
out your chart.
B. Shout really loud through your
chart rolled like a megaphone right
into their left ear.
C. Make eye contact, speak slowly
and clearly and at a volume the
patient responds with.
Meniere’s Disease
Also known as: “Men-ears”
Disease
Meniere’s Disease
No really…also known as:
Endolymphatic Hydrops
…including bonus
features…
-Labyrinthitis
-Tinnitus
What is Meniere’s Disease?
Discovered by Dr. Prosper
Meniere
 Ages 30-60 most common


A disease of the inner ear

Inner ear is also known as the:

Labyrinth
A&P
Includes:



Cochlear (hearing)
Vestibule (senses changes in gravity, linear
and angular acceleration)
Semicircular Canals (equilibrium, rotational
and angular acceleration)
Inner Ear
-The “end organs” of hearing
-Boney Labyrinth which surrounds
the membranous labyrinth and
provides:
-structure and protection
-perilymph fluid
Inner Ear
-Membranous Labyrinth
-Specialized cells, “hair cells”
-Endolymph Fluid
Inner Ear
Endolymph fluid and “Hair Cells”
Help
transmit/
carry:
-sound
waves
-positional
signals
Meniere’s Disease and Endolymph fluid
-Production of Endolymph Fluid increases
-Causes membranous labyrinth to dilate
-Causes abnormal fluid balance of labyrinth
-Causes problems:
-Tinnitus (noises originating within the
ear)
-Vertigo (whirling sensation)
-Hearing loss (loss of hearing)
Labyrinthitis

The membranous labyrinth also swells though its
inflammation is due to an invading organism
(viral or bacterial).
Labyrinthitis
-
-
Is rare because the membranous labyrinth is
surrounded by a boney structure, which is
effective in detouring would be invaders.
If an infection occurs it is most likely due to an
erosion of the boney labyrinth allowing for
passage of invaders. However, invaders may
also gain access through the oval and round
window. Causing inflammation of labyrinthine
stuctures
Tinnitus


Most consider it to be ringing but also
includes, roaring, sizzling, whistling,
humming. As long as it originates within.
Unknown etiology
Tinnitus and Meniere’s

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Disturbances anywhere in the ear can
cause tinnitus.
Increase of Endolymph fluid in the inner
ear may cause increase of stimulation of
“hair cells”

Causes increase of sensory impulses through
the Cochlear (organ of hearing)

Those sounds are what the inner ear sounds like?
Vertigo and Meniere’s
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Inner ear contains the Semicircular
Canals:
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Equilibrium
3 endolymph and hair cell filled tubes
Positioned at right angles to the other
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Head moves = fluid shifts between canals =
stimulation of hair cells = impulses sent to brain =
brain sends signals to maintain balance
Vertigo and Meniere’s
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If all canals are filled with fluid
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
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Proliferation or absence of signals may occur
Brain is over loaded with or not
communicated with proper equilibrium
maintenance information =
VERTIGO =

Incapacitation
Hearing loss and Meniere’s

Cochlear (organ of hearing)
A&P
It looks like that
(pix of cochlear)
Hearing loss and Meniere’s



Sound vibrations travel from middle ear to
oval window into labyrinth.
Cause endolymph and hair cells to vibrate
Vibrations are transmitted into nerve
impulses which are transmitted to the
brain via the cochlear nerve
Hearing loss and Meniere’s
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The pathophysiology of the Disease:


Overproduction of Endolymph Fluid and
failure to reabsorb the fluid.
Over production and under absorption of
fluid = distended/swollen membranous
labyrinth = ruptured membranous
labyrinth = damaged pathways of
auditory transmission = loss of hearing.
Meniere’s Disease

Causes of over production and under
absorption of fluid:


Unknown exactly
Speculated to be:
Infection
 Trauma
 Otosclerosis
 Syphilis
 Sodium retention

Meniere’s Disease and
EMS

How would you interact with a
patient who is suspected to have
Meniere’s Disease?
A. Shout really loud while filling out your chart.
 B. Shout really loud through your chart rolled like a
megaphone right into their left ear.

 C.
Make eye contact, speak slowly and
clearly and at a volume the patient responds
with.
Meniere’s Disease and
EMS

Most patients encountered in EMS:

Severe vertigo


Severe tinnitus
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______________________
______________________
Hearing impaired
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______________________
Meniere’s Disease
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General Management:
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Bed rest
Low Sodium diet 1000-2000mg
Restricted water, tobacco, alcohol, caffeine,
and high triglycerides intake
Meniere’s Disease

Treatment:
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Antihistamines, steroids, diuretics, anticholinergics
used to lower inner ear pressure.
OTC motion sickness pills (meclizine, lorazepam)
Surgery
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
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Insertion of Teflon shunt to decompress endolymph sac
When symptoms of vertigo are not relieved and in only one
ear.
Surgical destruction of balance portion of ear (cutting of
nerve)
Meniere’s Disease
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Extras:
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Alan B. Shepard, 1st American astronaut.
After dangerous and experimental yet
successful surgery he was able again to return
to space (the moon) on Apollo 14.
Emily Dickinson (poet), Jonathan Swift
(author), and Steve Francis (NBA)
Charles Darwin suspected
Meniere’s Disease Sources

Berkow, Robert, and Mark H. Beers, eds. The Merck Manual of
Information : Home Edition. New York: Pocket, 2004.
Medical

Bledsoe, Bryan E., Robert S. Porter, and Richard A. Cherry.
Paramedic Care. Upper Saddle River: Pearson Education, 2006.
Essentials of
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Exit-writer. Computer software. The StayWell Company, 2000.
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"Ménière's disease -." Wikipedia, the free encyclopedia. 05 Jan. 2009
<http://en.wikipedia.org/wiki/Menieres_disease>.

Thompson, June M., Gertrude K. McFarland, and Jane E. Hirsch. Clinical
Nursing. Danbury: Mosby, Incorporated, 1997.

Venes, Donald. Taber's Cyclopedic Medical Dictionary : Non Thumb-Indexed Version.
Boston: F. A. Davis Company, 2004.