LABYRINTHITIS , MÉNIÈRE’S DISEASE ,Ototoxicity , ACOUSTIC NEUROMA ( Tumors

1. DISORDERS OF INNER EAR
Mr.Veerabhadra.B.B
Asst Professor
Medical Surgical Nsg Dept.

2. ANATOMY OF INNER EAR

3. LABYRINTHITIS
Labyrinthitis, an inflammation of the inner ear,
caused be
Bacteria
 Streptococcus pneumoniae,
 Haemophilus influenzae,
Virus (Mumps, Rubella, Rubeola, and Influenza.)
 Bacterial labyrinthitis usually occurs as a
complication of otitis media.
 Labyrinthitis may occur as a complication of acute
or chronic otitis media.

4. CLINICAL MANIFESTATION
 Sudden onset of incapacitating vertigo,
 Nausea and vomiting
 Various degrees of hearing loss.
 Tinnitus.
 Nystagmus to the affected side
 Meningitis is a common complication of
labyrinthitis.

5. MANAGEMENT
Treatment of bacterial labyrinthitis includes
 Intravenous antibiotic therapy
 Antivertiginous drugs, such as
Dimenhydrinate and meclizine relieve
symptoms.
 Antiemetic medications.
 Fluid replacement

6. MÉNIÈRE’S DISEASE
Ménière’s disease is a collection of abnormal inner ear fluid
balance caused by a malabsorption in the endolymphatic
sac.
Causes: Exact cause is unknown, but it often occurs with
 Infections,
 Allergic reactions
 Fluid imbalances in endolympatic sac.
Ménière’s disease has three features: tinnitus, one-sided
sensorineural hearing loss, and vertigo

8. PATHOPHYSIOLOGY
Ménière’s disease is an excess of endolymphatic fluid that
distorts the entire inner-canal system.
This distortion decreases hearing by dilating the cochlear
duct, causes vertigo
Because of damage to the vestibular system, and stimulates
tinnitus.
At first, hearing loss is reversible
Repeated damage to the cochlea from increased fluid
pressure leads to permanent hearing loss

9. CLINICAL MANISFESTATION:
 Varying degree of earing loss
 Hearing loss
 Tinnitus or a roaring sound
 A feeling of pressure or fullness in the ear
 Vertigo
 Nausea and vomiting

10. DIAGNISTIC STUDIES.
History collection: Frequency, duration, severity,
and character of the vertigo attacks.
Physical examination:
 Weber test
 Audiogram typically reveals a sensorineural hearing
loss in the affected ear.

11. Weber Test
Audiogram

12. MEDICAL MANAGEMENT
Most patients with Ménière’s disease can be successfully
treated with diet and medicines
Diet :
 Low-sodium diet, Sodium and fluid resuscitation helps in
balance between endolymph and perilymph in the inner
ear.
 low-sodium (2,000 mg/day) diet

13. MEDICATION THERAPY
Antihistamines such as Diphenhydramine
hydrochloride and Dimenhydrinatemeclizine which
suppress the vestibular system.
Tranquilizers such as diazepam to control
vertigo.
Anti-emetics
Diuretic therapy: Mild diuretics are
prescribed to decrease endolymph
volume,

14. IMAGE
 Meniett device
This device applies low-pressure micro-pulses to the
inner ear (for 5 minutes three times daily. )
This action displaces inner ear fluid and relieves
manifestations.

15. MENIETT DEVICE

16. SURGICAL MANAGEMENT.
Endolymphatic Sac Decompression.
Middle and Inner Ear Perfusion.
Intraotologic Catheters
Vestibular Nerve resection.
Labyrinthectomy: Total removal of the
labyrinth

17. OTOTOXICITY
Toxic to the ear specifically the cochlea or auditory
nerve and sometimes the vestibular system,
Causes :
Ototoxicity is caused as a result of side effect of a
drug
Clinical Features:
Hearing loss , Vertigo, Tinnititis
Ringing of the ears, Difficulty walking, Balance and
orientation issues.

18. NURSING DIAGNOSIS
 Risk for injury related to altered mobility because of gait
disturbed and vertigo.
 Risk for fluid volume imbalance and deficit related to
increased fluid output, altered intake, and medications.
 Anxiety related to threat of, or change in, health status and
disabling effects of vertigo.
 Ineffective coping related to personal vulnerability and
unmet expectations stemming from vertigo.

19. NURSING INTERVENTION
 Provide a safe, quiet, dimly lit environment and
enforce bed rest
 Provide emotional support and reassurance to
alleviate anxiety
 Discuss the nature of the disorder
 Discuss the need for a low-salt diet
 Administer prescribed medications, which may
include antihistamines, antiemetics, and
possibly, mild diuretics

20. OTOTOXIC DRUGS
 Diuretics: ethacrynic acid, furosemide, acetazolamide
 Chemotherapeutic agents: cisplatin, nitrogen mustard
 Antimalarial agents: quinine, chloroquine
 Anti-inflammatory agents: salicylates (aspirin), indomethacin
 Chemicals: alcohol, arsenic
 Aminoglycoside antibiotics: amikacin, gentamicin,
kanamycin, netilmicin, neomycin, streptomycin, tobramycin
 Other antibiotics: erythromycin, minocycline, polymyxin B,
vancomycin
 Metals: gold, mercury, lead

21. PREVENTION OF OTOTOXICITY
To prevent loss of hearing or balance,
 Patients receiving potentially ototoxic
medications should be counseled about the side
effects of these medications.
 Blood levels of the medications should be
monitored
 Patients receiving long-term intravenous
antibiotics should be monitored with an
audiogram twice each week during therapy.

22. MANAGEMENT OF OTOTOXICITY
Cochlear Implant or hearing aid
.

23. ACOUSTIC NEUROMA ( TUMORS)
 An acoustic neuroma is a slow-growing, benign
tumor of cranial nerve VIII, usually arising from
the Schwann cells of the vestibular portion of the
nerve
 Account for 5% to 10% of all intracranial tumors
and seem to occur with equal frequency in men
and women at any age

24. Clinical features of acoustic neuroma.
 Unilateral tinnitus and hearing loss with or without
vertigo.
Diagnostics studies
 Audiovestibular test
 MRI Brain with a contrast agent
 CT scan with contrast dye is performed(If the patient is
claustrophobic)

25. MANAGEMENT
 Surgical removal of acoustic tumors is the treatment of
choice because these tumors do not respond well to
irradiation or chemotherapy.
Complications of surgery for acoustic neuroma include
 Facial nerve paralysis,
 Cerebrospinal fluid leak,
 Meningitis, and
 Cerebral edema.

26. Thank You..