Meniere’s Disease
Abnormal inner ear fluid balance caused by malabsorption in the sac or blockage from the duct.
- Unknown cause – no cure
- Feeling of aura (pressure/fullness in ear)
- Episodic incapacitating vertigo with tinnitus (or roaring sounds)
- Attacks increase in frequency and symptoms
S&S of Meniere’s Disease
- sudden attacks of vertigo
- tinnitus
- hearing loss
- N/V
After attack:
- vertigo 2-4 hours
- dizziness
- unsteadiness
- gait changes
- depression
- moody
- VS within normal limits
- hearing loss
Management of Meniere’s Disease
- quiet, dark room
- low salt diet
- fluids 2500 cc/day
- avoid ETOH and caffeine
- safety: home, work, driving
- prevent attacks: avoid sudden head movement and flashing lights
- transmission of air waves into the fluid in the inner ear is having some success
- watch for potential hearing loss
- F&E balance
Medication for Meniere’s Disease
- sedations/tranquilzers
- antihistamines (AntiVert)
- vasodilators
- diuretics
- anti-seizure drugs
- ototoxic
Diagnosis of Meniere’s Disease
- Check symptoms
- perform Weber’s test
- Rule out other dz
Mastoiditis
Inflammation of the mastoid resulting from a middle ear infection (otitis media)
Acute mastoiditis is rare r/t antibiotics
Chronic mastoiditis leads to cholesteatoma, which is an ingrowth of skin of the external layer of the eardrum into the middle ear. – use Otoscope.
Clinical Picture of Mastoiditis
- postauricular pain and tenderness
- otorrhea: drainage
- mastoid area red and edematous
- fever, H/A
Treatment for Mastoiditis
- Diagnosis is related to symptomology
- Meds - Antibiotics
- Surgery - myringotomy, mastoidectomy
Tympanoplasty
- Common surgery for otitis media
- Surgical reconstruction of a perforated tympanic membrane, can also restore inner ear structures
- done Outpatient
- Improves hearing
Otosclerosis
- New abnormal bone fixates the stapes
- The stapes cannot vibrate and sound cannot be conducted
- Common in white women and worsened by pregnancy
Clinical Picture of Otosclerosis
- Progressive conductive hearing loss
- Tinnitus
- Bone conduction is better than air on Rinne test
- Audiogram indicates conductive hearing loss
Treatment for Otosclerosis
- Fluoride supplement may mature spongy bone growth
- Amplification: hearing aids
- Surgical: stapledectomy with graft or prosthesis
Acoustic Neuroma
- Slow growing benign tumor of the 8th cranial nerve
- In the internal auditory canal extending to press on the brain stem
- Equal in men and women at middle age
- Usually unilateral
Treatment for Acoustic Neuroma
- Diagnosis by MRI or CT
- Surgical removal
- Preserve facial nerve function
- Approach depends on if there is hearing loss
- Complications: facial nerve damange, cerebrospinal fluid leak, infection, cerebral edema
Cochlear Implant
- Profound sensorineural bilateral hearing loss
- Stimulates the auditory nerve
- The mic and signal processor is outside the body - implanted electrodes
- 1 year, adult with profound hearing loss, extensive rehab
- MRI will inactivate the device
Presbycusis
- Hearing loss due to aging.
- Caused by exposure to noise, diseases, poor nutrition, ototoxic drugs.
Conductive hearing loss
occurs in other and middle ear. Sound is impaired from outer to inner ear.
Most common cause: otitis media.
Hears better in noisy environment.
Sensorineural loss
Impairment of the vestibulocochlear nerve (CN 8)
- hereditary, noise trauma, syphilis, TB
- High pitch ability decreases first (so don’t shout)
- Hearing aids may not always be helpful
Nursing considerations for Presbycusis
- speak normally and slowly
- do not exaggerate facial expressions
- use simple sentences
- rephrase if not understood with different words
- do not shout
- do not cover mouth when speaking
- maintain eye contact
Rosacea
- affects middle age adults
- marked by erythemia (cheeks) and pustules
- have more sebaceous glands
Treat:
- topically hydrocortisone (MetroGel)
- PO tetracycline
Psoriasis
- chronic noninfectious inflammatory disease
- increase in epidermal cell production
- 15 - 50 years
- can be on scalp, elbows, knees, back and genitilia
- bilateral symmetry
- stress aggravates
Clinical Picture of Psoriasis
- red raised patches
- may or may not itch
- medical management: remove scales, emollient creams
- corticosteriods, occlusive dressings and VITAMIN D
- intralesional injections
- systemic methotrexate, cytotoxic
- UV light helps shedding
Nursing management for Psoriasis
- Anthran leaves brownish stains
- avoid sun exposure
- national psoriasis foundation
- self acceptance
- disease can generally be controlled but NOT CURED
Eczema/Dermatitis
- many variant forms
- hereditary, allergies
- any age
- lesions spread
- avoid irritants, moisturizers
- Complications: secondary infections and pruritis
