Nursing Care Plan for Meniere's Disease

Definition of Meniere's Disease

Meniere's Disease is a chronic disorder of the semicircular canal and the labyrinth of the inner ear, appear to be associated with over-production of endolymph in the inner ear (Elizabeth Corwin J: 2009).

Ménière's disease is a disease that affects the inner ear endolymphatic fluid pressure in the deeper parts of the ear that is responsible for balance and hearing function. Symptoms usually affect these functions and may differ from person to person. (Ananya Mandal: 2013)

Type of Meniere's Disease

1. Vestibular Meniere's disease
Vestibular Meniere's disease is characterized by episodic vertigo with respect to the pressure in the ears without cochlear symptoms.
Signs and symptoms:

• Merely episodic vertigo.
• Decrease in vestibular response or no response total pain in the ear.
• There was no cochlear symptoms.
• There was no hearing loss objective.
• Later may develop symptoms and signs of cochlear.

2. Classic Meniere's disease,
Signs and symptoms:

• Complained of vertigo
• Fluctuating sensorineural hearing loss
• Tinnitus
• Cochlear Meniere's disease

3. Cochlear Meniere's disease
Cochlear Meniere's disease identified with progressive sensorineural hearing loss with respect to tnitus and pressure in the ear without any findings or vestibular symptoms.
Signs and symptoms:

• Fluctuating hearing loss
• Aural pressure or full feeling
• Tinnitus
• Hearing loss seen in test results
• There was no vertigo
• Normal vestibular labyrinth test
• Later will suffer symptoms and signs of vestibular (Nn: 2011)

The degree of severity of Meniere's disease;

1. Grade I:
Early symptoms include vertigo accompanied by nausea and vomiting. Vagal disorders such as pale and sweating may occur. Before the attack of vertigo symptoms, the patient may feel a sensation in the ear, which lasted for 20 minutes to several hours. Among, the patient is normal.

2. Grade II:
Hearing loss deepened and fluctuate. Symptoms of the low-frequency sensorineural hearing loss.

3. Grade III:
Hearing loss is no longer fluctuating but progressive worsening. This time on both ears so deaf patients as having total. Vertigo began to decrease or disappear. (Nuzulul Zulkarnain Haq: 2009)


Etiology of Meniere's disease

The exact cause of Meniere's disease, until now not known with certainty, many experts have different opinions. Until now considered the cause of disease is caused by a disturbance in the physiology of the system, known as endolymph endolymph hydrops, a condition where the amount of endolymph fluid that resulted in an abrupt increase of the scale dilatation media. However, the cause of hydrops endolymph has yet to be ascertained.
There is some contention as to the cause of hydrops, among others:

• Increasing hydrostatic pressure at the arterial end.
• Reduced osmotic pressure in the capillaries.
• Increasing the osmotic pressure of the extra-capillary space.
• Way out sac endolimfatikus clogged, resulting in accumulation endolimfa.
• Middle ear infection.
• Upper respiratory tract infection.
• Head trauma.
• Consumption of foods that contain caffeine and high salt.
• Consumption of aspirin, alcohol, and cigarettes were prolonged.
• Herpesviridae virus infection group.
• Hereditary.

The following will explain the cause of Meniere's disease is considered to trigger:

1. Herpes virus (HSV)
Herpes viruses are found in patients with Meniere's. Once there was a report that 12 of the 16 patients there Meniere herpes simplex virus DNA in endolimfatikusnya sac. In addition it has been reported also in Meniere's patients who were given antiviral therapy are improved. But this assumption has not been proven entirely because they still need further research.

2. Hereditary
In the study found 1 in 3 patients had a parent who suffered from Meniere's disease as well. Hereditary predisposition is considered to have a relationship with anatomical abnormality or abnormalities in the channel endolimfatikus immune system.

3. Allergy
In patients with Meniere found that 30% of them have food allergies. Relationship between allergies with Meniere's disease are as follows: endolimfatikus sac may be the target organ of mediators that are released in the body when holding a reaction to certain foods. Antigen-antibody complexes may interfere with the ability of the sac endolimfatikus filtration. There is a relationship between allergy and viral infection that causes hydrops of endolimfatikus sac.

4. Head trauma
Scarring caused by trauma to the inner ear can be considered disturbing the hydrodynamic flow of endolimfatikus. This assumption is reinforced by the Meniere's patients who have a history of temporal bone fracture.

5. Autoimmune
There is also a presumption of experts stating that endolymph hydrops is not a cause of Meniere's disease. It is said by Honrubia in 1999 and Rauch in 2001 that the autopsy study found endolymph hydrops in 6% of people who do not suffer from Meniere's disease. Much research is now focused on immunologic function in endolimfatikus sac. Some experts argue Meniere's disease caused by an autoimmune disorder. Brenner conducted a study in 2004 said that in about 25% of patients with Meniere's disease is also found to thyroid autoimmune diseases. Additionally in 2002 Ruckenstein also getting in approximately 40% of patients with Meniere's disease obtained positive results in the examination of the blood such as autoimmune arthritis factor, antiphospholipid antibodies and Anti Sjoegren. (Nuzulul Zulkarnain Haq: 2009)