DISORDERS OF THE INNER EAR

Meniere Disease

clinical manefestation

Patients have sudden attacks of vertigo that usually last for 1 to 6 h but that can (rarely) last up to 24 h

nausea and vomiting.

include diaphoresis, diarrhea, and gait unsteadiness

Tinnitus in the affected ear may be constant or intermittent, buzzing or roaring

Pathophisiology

Meniere's Diseases is characterized during its active phase with the characteristic symptom triad, of episodic vertigo and tinnitus with fluctuations in hearing, followed by a symptom‐free period, ultimately resulting in a more permanent dysfunction of the above symptoms. Any theory attempting to explain the pathophysiology of Meniere's Diseases has to account for processes that result in a reversible dysfunction of both the cochlea and vestibule, with long‐term chronic deficits. Examples of reversible causes include noise, toxins such as salicylates, viral infections and immune‐mediated mechanisms, most of which do not show morphological changes unless they turn permanent.

Causes

Feeling of fullness in the ear. People with Meniere's disease often feel pressure in an affected ear (aural fullness).

Improper fluid drainage, perhaps because of a blockage or anatomic abnormality

Abnormal immune response

Viral infection

Genetic predisposition

Management

Lifestyle and home remedies

Sit or lie down when you feel dizzy. During an episode of vertigo, avoid things that can make your signs and symptoms worse, such as sudden movement, bright lights, watching television or reading. Try to focus on an object that isn't moving.

Rest during and after attacks. Don't rush to return to your normal activities.

Be aware you might lose your balance. Falling could lead to serious injury. Use good lighting if you get up in the night. A cane for walking might help with stability if you have chronic balance problems.

Limit salt. Consuming foods and beverages high in salt can increase fluid retention. For overall health, aim for less than 2,300 milligrams of sodium each day. Experts also recommend spreading your salt intake evenly throughout the day.

Limit caffeine, alcohol and tobacco. These substances can affect the fluid balance in your ears.

Nursing Management

admister sadation and antimetics for motion sickness

keep the patient kept in a quet in the dark room in a corfortable position

instruct the patient to avoid sudden head movement or changes in position to prevent falling

administer antihastamines, anticholinergics and benzodiazepines to suppres the production of endolymph

vestibular neuritis

pathophisiology

Vestibular neuritis is a disorder that affects the nerve of the inner ear called the vestibulocochlear nerve. This nerve sends balance and head position information from the inner ear to the brain. When this nerve becomes swollen (inflamed), it disrupts the way the information would normally be interpreted by the brain.

Clinical manefestation

Sudden, severe vertigo (spinning/swaying sensation)

Dizziness

Balance difficulties

Nausea, vomiting

Concentration difficulties

causes

viral infection of the inner ear, swelling around the vestibulocochlear nerve (caused by a virus),

viral infections in other areas of the body include herpes virus (causes cold sores, shingles, chickenpox), measles, flu, mumps, hepatitis and polio. (Genital herpes is not a cause of vestibular neuritis.)

Management

To reduce dizziness, drugs such as meclizine (Antivert), diazepam (valium), compazine and lorazepam (Ativan) are prescribed.

Vestibular suppressants should be used no longer than three days.

Drugs to reduce nausea include ondansetron (Zofran®) and metoclopramide

Encourage patient to maintain sense of
control by making decisions and assuming more responsibility for care

Treatment of bacterial labyrinthitis includes intravenous antibiotic
therapy

. Encourage oral fluids as tolerated; discourage beverages containing caffeine
(a vestibular stimulant).

Administer, or teach administration of,
antiemetics