Menière Disease

The inner ear is both a hearing organ and a motion-sensing organ. Menière disease is associated with endolymphatic hydrops: abnormal accumulation of endolymph within the membranous labyrinth. The altered fluid pressure disrupts the hair cells that convert movement and sound into neural signals. When vestibular hair-cell signalling becomes unreliable, the brain receives mismatched information about movement and position, producing true spinning vertigo. Cochlear hair-cell disruption produces sensorineural hearing loss, tinnitus, and a sensation of pressure or fullness in the affected ear. The characteristic pattern is recurrent spontaneous vertigo with fluctuating unilateral sensorineural hearing loss, tinnitus, and aural fullness. An episode generally lasts 20 minutes to 12 hours. Nausea, vomiting, imbalance, and difficulty walking may accompany the spinning sensation. Hearing and aural symptoms may intensify around an attack and then partially improve; tinnitus or hearing loss can persist between attacks. The word spontaneous matters. Vertigo that occurs only when the patient rolls over, looks up, or changes head position points more strongly toward benign paroxysmal positional vertigo (BPPV) than Menière disease. The nurse should identify the timing and trigger pattern before...