1. Pretest Pop Quiz Hot Shots: How would you interact with a patient who is suspected to have Meniere’s Disease?

2. A. Shout really loud while filling out your chart.

3. B. Shout really loud through your chart rolled like a megaphone right into their left ear.

4. C. Make eye contact, speak slowly and clearly and at a volume the patient responds with.

5. Meniere’s Disease Also known as: “Men-ears” Disease

6. Meniere’s Disease No really…also known as: Endolymphatic Hydrops

7. …including bonus features… -Labyrinthitis-Tinnitus

8. What is Meniere’s Disease? Discovered by Dr. Prosper Meniere Discovered by Dr. Prosper Meniere Ages 30-60 most common Ages 30-60 most common A disease of the inner ear A disease of the inner ear Inner ear is also known as the: Inner ear is also known as the: Labyrinth Labyrinth

9. A&P Includes: Cochlear (hearing) Cochlear (hearing) Vestibule (senses changes in gravity, linear and angular acceleration) Vestibule (senses changes in gravity, linear and angular acceleration) Semicircular Canals (equilibrium, rotational and angular acceleration) Semicircular Canals (equilibrium, rotational and angular acceleration)

10. Inner Ear -The “end organs” of hearing -Boney Labyrinth which surrounds the membranous labyrinth and provides: -structure and protection -perilymph fluid

11. Inner Ear -Membranous Labyrinth -Specialized cells, “hair cells” -Endolymph Fluid

12. Inner Ear Endolymph fluid and “Hair Cells” Help transmit/ carry: -sound waves -positional signals

13. 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)

14. Labyrinthitis The membranous labyrinth also swells though its inflammation is due to an invading organism (viral or bacterial). The membranous labyrinth also swells though its inflammation is due to an invading organism (viral or bacterial).

15. 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

16. Tinnitus Most consider it to be ringing but also includes, roaring, sizzling, whistling, humming. As long as it originates within. Most consider it to be ringing but also includes, roaring, sizzling, whistling, humming. As long as it originates within. Unknown etiology Unknown etiology

17. Tinnitus and Meniere’s Disturbances anywhere in the ear can cause tinnitus. Disturbances anywhere in the ear can cause tinnitus. Increase of Endolymph fluid in the inner ear may cause increase of stimulation of “hair cells” 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) Causes increase of sensory impulses through the Cochlear (organ of hearing) Those sounds are what the inner ear sounds like? Those sounds are what the inner ear sounds like?

18. Vertigo and Meniere’s Inner ear contains the Semicircular Canals: Inner ear contains the Semicircular Canals: Equilibrium Equilibrium 3 endolymph and hair cell filled tubes 3 endolymph and hair cell filled tubes Positioned at right angles to the other 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 Head moves = fluid shifts between canals = stimulation of hair cells = impulses sent to brain = brain sends signals to maintain balance

19. Vertigo and Meniere’s If all canals are filled with fluid If all canals are filled with fluid Proliferation or absence of signals may occur Proliferation or absence of signals may occur Brain is over loaded with or not communicated with proper equilibrium maintenance information = Brain is over loaded with or not communicated with proper equilibrium maintenance information = VERTIGO = VERTIGO = Incapacitation Incapacitation

20. Hearing loss and Meniere’s Cochlear (organ of hearing) Cochlear (organ of hearing)

21. A&P It looks like that (pix of cochlear)

22. Hearing loss and Meniere’s Sound vibrations travel from middle ear to oval window into labyrinth. Sound vibrations travel from middle ear to oval window into labyrinth. Cause endolymph and hair cells to vibrate Cause endolymph and hair cells to vibrate Vibrations are transmitted into nerve impulses which are transmitted to the brain via the cochlear nerve Vibrations are transmitted into nerve impulses which are transmitted to the brain via the cochlear nerve

23. Hearing loss and Meniere’s The pathophysiology of the Disease: The pathophysiology of the Disease: Overproduction of Endolymph Fluid and failure to reabsorb the fluid. 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. Over production and under absorption of fluid = distended/swollen membranous labyrinth = ruptured membranous labyrinth = damaged pathways of auditory transmission = loss of hearing.

24. Meniere’s Disease Causes of over production and under absorption of fluid: Causes of over production and under absorption of fluid: Unknown exactly Unknown exactly Speculated to be: Speculated to be: Infection Infection Trauma Trauma Otosclerosis Otosclerosis Syphilis Syphilis Sodium retention Sodium retention

25. Meniere’s Disease and EMS How would you interact with a patient who is suspected to have Meniere’s Disease? How would you interact with a patient who is suspected to have Meniere’s Disease? A. Shout really loud while filling out your chart. 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. 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. C. Make eye contact, speak slowly and clearly and at a volume the patient responds with.

26. Meniere’s Disease and EMS Most patients encountered in EMS: Most patients encountered in EMS: Severe vertigo Severe vertigo ______________________ ______________________ Severe tinnitus Severe tinnitus ______________________ ______________________ Hearing impaired Hearing impaired ______________________ ______________________

27. Meniere’s Disease General Management: General Management: Bed rest Bed rest Low Sodium diet 1000-2000mg Low Sodium diet 1000-2000mg Restricted water, tobacco, alcohol, caffeine, and high triglycerides intake Restricted water, tobacco, alcohol, caffeine, and high triglycerides intake

28. Meniere’s Disease Treatment: Treatment: Antihistamines, steroids, diuretics, anticholinergics used to lower inner ear pressure. Antihistamines, steroids, diuretics, anticholinergics used to lower inner ear pressure. OTC motion sickness pills (meclizine, lorazepam) OTC motion sickness pills (meclizine, lorazepam) Surgery Surgery Insertion of Teflon shunt to decompress endolymph sac Insertion of Teflon shunt to decompress endolymph sac When symptoms of vertigo are not relieved and in only one ear. When symptoms of vertigo are not relieved and in only one ear. Surgical destruction of balance portion of ear (cutting of nerve) Surgical destruction of balance portion of ear (cutting of nerve)

29. Meniere’s Disease Extras: Extras: Alan B. Shepard, 1 st American astronaut. After dangerous and experimental yet successful surgery he was able again to return to space (the moon) on Apollo 14. Alan B. Shepard, 1 st 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) Emily Dickinson (poet), Jonathan Swift (author), and Steve Francis (NBA) Charles Darwin suspected Charles Darwin suspected

30. Meniere’s Disease Sources Berkow, Robert, and Mark H. Beers, eds. The Merck Manual of Medical Information : Home Edition. New York: Pocket, 2004. Berkow, Robert, and Mark H. Beers, eds. The Merck Manual of Medical Information : Home Edition. New York: Pocket, 2004. Bledsoe, Bryan E., Robert S. Porter, and Richard A. Cherry. Essentials of Paramedic Care. Upper Saddle River: Pearson Education, 2006. Bledsoe, Bryan E., Robert S. Porter, and Richard A. Cherry. Essentials of Paramedic Care. Upper Saddle River: Pearson Education, 2006. Exit-writer. Computer software. The StayWell Company, 2000. Exit-writer. Computer software. The StayWell Company, 2000. "Ménière's disease -." Wikipedia, the free encyclopedia. 05 Jan. 2009. "Ménière's disease -." Wikipedia, the free encyclopedia. 05 Jan. 2009. Thompson, June M., Gertrude K. McFarland, and Jane E. Hirsch. Clinical Nursing. Danbury: Mosby, Incorporated, 1997. 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. Venes, Donald. Taber's Cyclopedic Medical Dictionary : Non Thumb-Indexed Version. Boston: F. A. Davis Company, 2004.