PretestPretest

Pop Quiz Hot Shots:Pop Quiz Hot Shots:How would you interact with a How would you interact with a

patient who is suspected to have patient who is suspected to have Meniere’s Disease?Meniere’s Disease?

A. Shout really loud while A. Shout really loud while filling out your chart.filling out your chart.

B. Shout really loud through B. Shout really loud through your chart rolled like a your chart rolled like a

megaphone right into their left megaphone right into their left ear. ear.

C. Make eye contact, speak C. Make eye contact, speak slowly and clearly and at a slowly and clearly and at a

volume the patient responds volume the patient responds with.with.

Meniere’s DiseaseMeniere’s Disease

Also known as: “Men-ears” Also known as: “Men-ears” DiseaseDisease

Meniere’s DiseaseMeniere’s Disease

No really…also known No really…also known as: as:

Endolymphatic HydropsEndolymphatic Hydrops

……including bonus including bonus features…features…

-Labyrinthitis-Labyrinthitis

-Tinnitus-Tinnitus

What is Meniere’s What is Meniere’s Disease? Disease?

Discovered by Dr. Prosper Discovered by Dr. Prosper Meniere Meniere

Ages 30-60 most commonAges 30-60 most common A disease of the A disease of the inner earinner ear

Inner ear is also known as the:Inner ear is also known as the: LabyrinthLabyrinth

A&PA&P

Includes:Includes: Cochlear (hearing) Cochlear (hearing) Vestibule (senses changes in gravity, Vestibule (senses changes in gravity,

linear and angular acceleration)linear and angular acceleration) Semicircular Canals (equilibrium, Semicircular Canals (equilibrium,

rotational and angular acceleration)rotational and angular acceleration)

Inner EarInner Ear

-The “end organs” of hearing -The “end organs” of hearing

--Boney LabyrinthBoney Labyrinth which which surrounds the membranous surrounds the membranous labyrinth and provides:labyrinth and provides:-structure and protection -structure and protection

-perilymph fluid-perilymph fluid

Inner EarInner Ear

--Membranous LabyrinthMembranous Labyrinth

-Specialized cells, “hair cells”-Specialized cells, “hair cells”

-Endolymph Fluid-Endolymph Fluid

Inner EarInner EarEndolymph fluid and “Hair Cells”Endolymph fluid and “Hair Cells”

Help Help transmittransmit/ carry:/ carry:-sound -sound waveswaves

-positional -positional signalssignals

Meniere’s Disease and Endolymph Meniere’s Disease and Endolymph fluidfluid

-Production of Endolymph Fluid increases-Production of Endolymph Fluid increases

-Causes membranous labyrinth to dilate-Causes membranous labyrinth to dilate

-Causes abnormal fluid balance of labyrinth-Causes abnormal fluid balance of labyrinth

-Causes problems:-Causes problems:

--TinnitusTinnitus (noises originating (noises originating within the within the ear)ear)

--VertigoVertigo (whirling sensation) (whirling sensation)

--Hearing lossHearing loss (loss of hearing) (loss of hearing)

LabyrinthitisLabyrinthitis The membranous labyrinth also swells The membranous labyrinth also swells

though its inflammation is due to an though its inflammation is due to an invading organism (viral or bacterial).invading organism (viral or bacterial).

LabyrinthitisLabyrinthitis- Is rare because the membranous labyrinth is Is rare because the membranous labyrinth is

surrounded by a boney structure, which is surrounded by a boney structure, which is effective in detouring would be invaders.effective in detouring would be invaders.

- If an infection occurs it is most likely due to an If an infection occurs it is most likely due to an erosion of the boney labyrinth allowing for erosion of the boney labyrinth allowing for passage of invaders. However, invaders may passage of invaders. However, invaders may also gain access through the oval and round also gain access through the oval and round window. Causing inflammation of labyrinthine window. Causing inflammation of labyrinthine stucturesstuctures

TinnitusTinnitus

Most consider it to be ringing but Most consider it to be ringing but also includes, roaring, sizzling, also includes, roaring, sizzling, whistling, humming. As long as it whistling, humming. As long as it originates within.originates within.

Unknown etiologyUnknown etiology

Tinnitus and Meniere’sTinnitus and Meniere’s

Disturbances anywhere in the ear can Disturbances anywhere in the ear can cause tinnitus.cause tinnitus.

Increase of Endolymph fluid in the inner Increase of Endolymph fluid in the inner ear may cause increase of stimulation ear may cause increase of stimulation of “hair cells”of “hair cells” Causes increase of sensory impulses Causes increase of sensory impulses

through the through the CochlearCochlear (organ of hearing) (organ of hearing) Those sounds are what the inner ear sounds Those sounds are what the inner ear sounds

like?like?

Vertigo and Meniere’sVertigo and Meniere’s

Inner ear contains the Inner ear contains the Semicircular Canals:Semicircular Canals: EquilibriumEquilibrium 3 endolymph and hair cell filled tubes3 endolymph and hair cell filled tubes Positioned at right angles to the otherPositioned at right angles to the other

Head moves = fluid shifts between canals = Head moves = fluid shifts between canals = stimulation of hair cells = impulses sent to stimulation of hair cells = impulses sent to brain = brain sends signals to maintain brain = brain sends signals to maintain balancebalance

Vertigo and Meniere’sVertigo and Meniere’s

If all canals are filled with fluidIf all canals are filled with fluid Proliferation or absence of signals may Proliferation or absence of signals may

occuroccur Brain is over loaded with or not Brain is over loaded with or not

communicated with proper equilibrium communicated with proper equilibrium maintenance information =maintenance information =

VERTIGO = VERTIGO = Incapacitation Incapacitation

Hearing loss and Hearing loss and Meniere’sMeniere’s

Cochlear (organ of hearing)Cochlear (organ of hearing)

A&PA&P

It looks like thatIt looks like that

(pix of cochlear)(pix of cochlear)

Hearing loss and Hearing loss and Meniere’sMeniere’s

Sound vibrations travel from middle Sound vibrations travel from middle ear to oval window into labyrinth.ear to oval window into labyrinth.

Cause endolymph and hair cells to Cause endolymph and hair cells to vibratevibrate

Vibrations are transmitted into nerve Vibrations are transmitted into nerve impulses which are transmitted to impulses which are transmitted to the brain via the cochlear nervethe brain via the cochlear nerve

Hearing loss and Hearing loss and Meniere’sMeniere’s

The pathophysiology of the Disease:The pathophysiology of the Disease: Overproduction of Endolymph Fluid and Overproduction of Endolymph Fluid and

failure to reabsorb the fluid.failure to reabsorb the fluid. Over production and under absorption Over production and under absorption

of fluid = distended/swollen of fluid = distended/swollen membranous labyrinth = ruptured membranous labyrinth = ruptured membranous labyrinth = damaged membranous labyrinth = damaged pathways of auditory transmission = pathways of auditory transmission = loss of hearing.loss of hearing.

Meniere’s DiseaseMeniere’s Disease Causes of over production and under Causes of over production and under

absorption of fluid:absorption of fluid: Unknown exactlyUnknown exactly Speculated to be:Speculated to be:

InfectionInfection TraumaTrauma OtosclerosisOtosclerosis Syphilis Syphilis Sodium retention Sodium retention

Meniere’s Disease and Meniere’s Disease and EMSEMS

How would you interact with a How would you interact with a patient who is suspected to have patient who is suspected to have Meniere’s Disease?Meniere’s Disease?

A. Shout really loud while filling out your chart.A. Shout really loud while filling out your chart. B. Shout really loud through your chart rolled B. Shout really loud through your chart rolled

like a megaphone right into their left ear.like a megaphone right into their left ear. C.C. Make eye contact, speak slowly and Make eye contact, speak slowly and

clearly and at a volume the patient clearly and at a volume the patient responds with.responds with.

Meniere’s Disease and Meniere’s Disease and EMSEMS

Most patients encountered in EMS:Most patients encountered in EMS: Severe vertigoSevere vertigo

____________________________________________ Severe tinnitus Severe tinnitus

____________________________________________ Hearing impaired Hearing impaired

____________________________________________

Meniere’s DiseaseMeniere’s Disease General Management:General Management:

Bed restBed rest Low Sodium diet 1000-2000mgLow Sodium diet 1000-2000mg Restricted water, tobacco, alcohol, Restricted water, tobacco, alcohol,

caffeine, and high triglycerides intakecaffeine, and high triglycerides intake

Meniere’s DiseaseMeniere’s Disease Treatment:Treatment:

Antihistamines, steroids, diuretics, Antihistamines, steroids, diuretics, anticholinergics used to lower inner ear anticholinergics used to lower inner ear pressure.pressure.

OTC motion sickness pills (meclizine, lorazepam)OTC motion sickness pills (meclizine, lorazepam) SurgerySurgery

Insertion of Teflon shunt to decompress endolymph sac Insertion of Teflon shunt to decompress endolymph sac When symptoms of vertigo are not relieved and in only When symptoms of vertigo are not relieved and in only

one ear.one ear. Surgical destruction of balance portion of ear (cutting Surgical destruction of balance portion of ear (cutting

of nerve)of nerve)

Meniere’s DiseaseMeniere’s Disease Extras:Extras:

Alan B. Shepard, 1Alan B. Shepard, 1stst American astronaut. American astronaut. After dangerous and experimental yet After dangerous and experimental yet successful surgery he was able again to successful surgery he was able again to return to space (the moon) on Apollo 14.return to space (the moon) on Apollo 14.

Emily Dickinson (poet), Jonathan Swift Emily Dickinson (poet), Jonathan Swift (author), and Steve Francis (NBA)(author), and Steve Francis (NBA)

Charles Darwin suspectedCharles Darwin suspected

Meniere’s Disease Meniere’s Disease SourcesSources

Berkow, Robert, and Mark H. Beers, eds. Berkow, Robert, and Mark H. Beers, eds. The Merck Manual of The Merck Manual of Medical Medical Information : Home EditionInformation : Home Edition. New York: Pocket, 2004.. New York: Pocket, 2004.

Bledsoe, Bryan E., Robert S. Porter, and Richard A. Cherry. Bledsoe, Bryan E., Robert S. Porter, and Richard A. Cherry. Essentials of Essentials of Paramedic CareParamedic Care. Upper Saddle River: Pearson . Upper Saddle River: Pearson Education, 2006.Education, 2006.

Exit-writerExit-writer. Computer software. The StayWell Company, 2000.. Computer software. The StayWell Company, 2000.

"Ménière's disease -." "Ménière's disease -." Wikipedia, the free encyclopediaWikipedia, the free encyclopedia. 05 Jan. 2009 . 05 Jan. 2009 <http://en.wikipedia.org/wiki/Menieres_disease>.<http://en.wikipedia.org/wiki/Menieres_disease>.

Thompson, June M., Gertrude K. McFarland, and Jane E. Hirsch. Thompson, June M., Gertrude K. McFarland, and Jane E. Hirsch. Clinical Clinical NursingNursing. Danbury: Mosby, Incorporated, 1997.. Danbury: Mosby, Incorporated, 1997.

Venes, Donald. Venes, Donald. Taber's Cyclopedic Medical Dictionary : Non Thumb-Taber's Cyclopedic Medical Dictionary : Non Thumb-Indexed VersionIndexed Version. Boston: F. A. Davis Company, 2004.. Boston: F. A. Davis Company, 2004.