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(n). A ringing or similar sensation of sound in the ears

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

By: Ashley Koehler

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Reference: Mayo Clinic (Director). (2019, February 5). Mayo Clinic Minute: Is Tinnitus Causing that Ringing in your Ear? [Video file]. Retrieved March 28, 2019, from https://www.youtube.com/watch?v=IlGVzRBBQFM

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Mayo Clinic Minute: Is tinnitus causing that ringing in your ear?

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- Symptom of an underlying disorder of the ear that is associated with hearing loss
- Ranges from Mild --> Severe
- Affects approximately 25 million individuals in the U.S.
- Most prevalent in adults

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

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Roaring, Buzzing, Hissing, etc. in 1 OR both ears

Reference: Hearing HealthCare Centre (Director). (2018, May 2). What Does Tinnitus Sound Like? [Video file]. Retrieved March 28, 2019, from https://youtu.be/83laYgUtbv8

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What Contributes to the Development of Tinnitus?

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What Contributes to the Development of Tinnitus?

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- Cardiovascular Disease
- Thyroid Disease
- Hyperlipidemia
- Vitamin B12 Deficiency
- Psychological Disorders... Ex. Depression, Anxiety
- Fibromyalgia
- Otological Disorders... Ex. Meniere's Disease, Acoustic Neuroma
- Neurological Disorders... Ex. Head injury, MS
- Ototoxic Substances (Listed below)

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

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- Physical Exam... To determine the cause
- Diagnostic Testing... To determine if hearing loss is present
- Audiograph Speech Discrimination Test... Helps determine the cause
- Tympanogram... Helps determine the cause

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

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- Some forms are irreversible
- Treatment will determine on the cause and level of hearing loss and tinnitus
- Education & Counseling on ways to adjust to treatment and how to cope and deal with tinnitus

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

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(n). An abnormality in inner ear fluid balance caused by malabsorption in the endolymphatic sac or a blockage in the endolymphatic duct

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

By: Ashley Koehler

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The endolymphatic space dilates (Endolymphatic Hydrops) THEN pressure increases in the system OR the inner ear membrane ruptures...
Producing S/S of Meniere's...

Triad of Symptoms:
1. Episodic Vertigo
2. Tinnitus (Unwanted noises in the head or ear)
3. Fluctuating Sensorieneural hearing loss
Also may include:
- Feeling of pressure or fullness in the ear
- Incapacitating vertigo (Often with nausea & vomiting)

Usually 1-2 S/S manifest at the onset of the disease
S/S have a WIDE range of severity (Especially concerning with the vertigo attacks)

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

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Sometimes, it is classified into two types...

1. Cochlear Meniere
Fluctuating, progressive sensorineural hearing loss associated with tinnitus and aural pressure in the absence of vestibular symptoms or findings
2. Vestibular Meniere
Occurrence of episodic vertigo associated with aural pressure but no cochlear symptoms

These 2 types are classified by their S/S

HOWEVER ALL S/S eventually develop...
Hence why the two types are not distinctly classified

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

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- Detailed history surrounding the vertigo attacks (Frequency, duration, character, severity, etc.)
Vertigo attacks = the most troublesome complaint (Can last minutes - hours!)
Nausea & Vomiting may also occur with vertigo
- Patients may even be awoken at night with feelings of imbalance and disequilibrium, diaphoresis (And these feelings can last days!)
Most patients feel well between attacks of the disease
- Hearing loss also fluctuates... Tinnitus & Aural Pressure comes and goes as well
^ These feelings may occur before or during attacks OR be constant

- Physical Exam
- Findings usually normal EXCEPT CRANIAL NERVE VIII
- Performing the Weber Test utilizing a tuning fork... May result in the
sounds lateralizing to the ear affected with Meniere's Disease (the ear
opposite the hearing loss)
- Electronystagmogram... May be normal or exhibit reduced vestibular response
- Audiogram... Usually reveals a sensourineral hearing loss in the affected ear (Occurs in the low frequencies with progression of the disease)
- Visualized as a hill/mountain, commonly called "Pike's Peak"... visualized
below...

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

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DIET and MEDICATION are the two big factors that can successfully manage most cases
Psychosocial Evaluation & Cognitive Therapy if the patient is anxious, uncertain, fearful, depressed, etc.
Conservative Therapy works well for most patients but some may have a severe case and elect to undergo surgery for relief (Endolymphatic Sac Decompression or Vestibular Nerve Sectioning)

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

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Low Sodium is key!
Amount of sodium helps regulate the fluid balance within the ear and body...
Sodium & Fluid retention disrupts the balance...
(Delicate balance between Endolymph & Perilymph in the inner ear)

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

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- Antihistamines... Shorten the attack
Ex. Meclizine
- Tranquilizers... Acute instances to help control vertigo
Ex. Diazepam (Valium)
- Antiemetic Agents... Help control nausea, vomiting, vertigo
Ex. Promethazine suppositories (Phenergan)
- Diuretic Therapy... Helps relieve symptoms by lowering the pressure in the endolymphatic system
Ex. Hydrochlorothiazide (Dyazide), Triamterene, Spironolactone
- Intratympanic Injection... Ablation of the vestibular hair cells
Ex. Gentamicin (Garamycin) Injection
*Risk of significant hearing loss is high with these injections*

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

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Meniere's Disease Interactive Case Study

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Meniere's Disease Interactive Case Study

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Want some extra practice? An interactive case study can be found in our book on Page 1933

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

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(n). A disturbance of equilibrium caused by constant motion

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

By: Ashley Koehler

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Reference: TED-Ed (Producer). (2014, January 13). The Mystery of Motion Sickness - Rose Eveleth [Video file]. Retrieved March 27, 2019, from https://youtu.be/gKhE3CMz7Sk

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The mystery of motion sickness - Rose Eveleth

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Vestibular Overstimulation results in...
- Sweating
- Pallor
- Nausea
- Vomiting

Can these S/S continue even if the motion and stimulation is stopped?
Yes, the S/S may persist for several hours after...

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

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Motion sickness is a syndrome of some or all of these S/S repeatedly occurring together in situations such as riding in a car, enjoying (or trying to enjoy) a boat ride, flying in a plane, having fun (or not a lot of fun in this case) on Kentwood rides, etc.

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- OTC Anti-Histamines... For relief of nausea/vomiting via blocking the inner ear vestibular pathway conduction
Example: Dimenhydrinate (Dramamine) or Meclizine (Antivert)

- Anticholinergic Medications... Antagonize the Histamine Response
Example: Scopolamine Patches (Transderm Scop)
*Must be applied several hours before the motion causing the sickness occurs & Can cause drowsiness (Don't take if you're driving the car) & dry mouth

Reference: Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing(14th ed.). Retrieved March 28, 2019, from the point.lww.com

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Non-Pharmacological Measures to Combat Motion Sickness

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Non-Pharmacological Measures to Combat Motion Sickness