LAUSR

AN ESTIMATED 10 to 150 per 100,000 persons have Meniere disease (MD).1 Various organizations put the number at around 615,000 people in the United States.2-4 It’s characterized by ear pressure or fullness, tinnitus, fluctuating hearing loss, and vertigo. Although usually unilateral, it can affect both ears and its underlying etiology is unknown.1-4 To help the patient with MD achieve an optimal quality of life, nurses need an understanding of MD’s pathophysiology and treatment approaches. This disease’s hearing and balance symptoms, especially vertigo, can cause significant morbidity. Managing the frequency and intensity of vertigo may be a challenge for some patients. A case study presented here describes a patient with MD who received intratympanic gentamicin (ITG) to manage intractable vertigo. Pathophysiology MD is a progressive disorder that leads to an accumulation of endolymph within the inner ear. (See Looking inside the ear.) It’s not clear why excess fluid builds up in the endolymphatic spaces of the inner ear. Several theories include vascular disorders, viral infections, immunologic mechanisms, and a genetic predisposition.2-4 Hearing and balance symptoms occur when the normal volume of endolymph is interrupted.5 Endolymph is stored and absorbed in the endolymphatic sac, which is believed to play an important role in inner ear immune responses.6 Overproduction, limited absorption, and obstructed flow of endolymph cause the endolymphatic sac to expand, leading to signs and symptoms of MD. Sometimes a distended endolymphatic sac is called endolymphatic hydrops, meaning increased C R IS T Y K R A M E S By Richard L. Pullen, Jr., EdD, MSN, RN, CMSRN Navigating the challenges of