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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 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 Inner ear contains the Semicircular Canals: Equilibrium 3 endolymph and hair cell filled tubes Positioned at right angles to the other Head moves = fluid shifts between canals = stimulation of hair cells = impulses sent to brain = brain sends signals to maintain balance Vertigo and Meniere’s If all canals are filled with fluid 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 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 ______________________ ______________________ Hearing impaired ______________________ Meniere’s Disease General Management: Bed rest Low Sodium diet 1000-2000mg Restricted water, tobacco, alcohol, caffeine, and high triglycerides intake Meniere’s Disease Treatment: Antihistamines, steroids, diuretics, anticholinergics used to lower inner ear pressure. OTC motion sickness pills (meclizine, lorazepam) Surgery 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 Extras: 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 Exit-writer. Computer software. The StayWell Company, 2000. "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.