pretest pop quiz hot shots: how would you interact with a patient who is suspected to have...
TRANSCRIPT
PretestPretest
Pop Quiz Hot Shots:Pop Quiz Hot Shots:How would you interact with a How would you interact with a
patient who is suspected to have patient who is suspected to have Meniere’s Disease?Meniere’s Disease?
A. Shout really loud while A. Shout really loud while filling out your chart.filling out your chart.
B. Shout really loud through B. Shout really loud through your chart rolled like a your chart rolled like a
megaphone right into their left megaphone right into their left ear. ear.
C. Make eye contact, speak C. Make eye contact, speak slowly and clearly and at a slowly and clearly and at a
volume the patient responds volume the patient responds with.with.
Meniere’s DiseaseMeniere’s Disease
Also known as: “Men-ears” Also known as: “Men-ears” DiseaseDisease
Meniere’s DiseaseMeniere’s Disease
No really…also known No really…also known as: as:
Endolymphatic HydropsEndolymphatic Hydrops
……including bonus including bonus features…features…
-Labyrinthitis-Labyrinthitis
-Tinnitus-Tinnitus
What is Meniere’s What is Meniere’s Disease? Disease?
Discovered by Dr. Prosper Discovered by Dr. Prosper Meniere Meniere
Ages 30-60 most commonAges 30-60 most common A disease of the A disease of the inner earinner ear
Inner ear is also known as the:Inner ear is also known as the: LabyrinthLabyrinth
A&PA&P
Includes:Includes: Cochlear (hearing) Cochlear (hearing) Vestibule (senses changes in gravity, Vestibule (senses changes in gravity,
linear and angular acceleration)linear and angular acceleration) Semicircular Canals (equilibrium, Semicircular Canals (equilibrium,
rotational and angular acceleration)rotational and angular acceleration)
Inner EarInner Ear
-The “end organs” of hearing -The “end organs” of hearing
--Boney LabyrinthBoney Labyrinth which which surrounds the membranous surrounds the membranous labyrinth and provides:labyrinth and provides:-structure and protection -structure and protection
-perilymph fluid-perilymph fluid
Inner EarInner Ear
--Membranous LabyrinthMembranous Labyrinth
-Specialized cells, “hair cells”-Specialized cells, “hair cells”
-Endolymph Fluid-Endolymph Fluid
Inner EarInner EarEndolymph fluid and “Hair Cells”Endolymph fluid and “Hair Cells”
Help Help transmittransmit/ carry:/ carry:-sound -sound waveswaves
-positional -positional signalssignals
Meniere’s Disease and Endolymph Meniere’s Disease and Endolymph fluidfluid
-Production of Endolymph Fluid increases-Production of Endolymph Fluid increases
-Causes membranous labyrinth to dilate-Causes membranous labyrinth to dilate
-Causes abnormal fluid balance of labyrinth-Causes abnormal fluid balance of labyrinth
-Causes problems:-Causes problems:
--TinnitusTinnitus (noises originating (noises originating within the within the ear)ear)
--VertigoVertigo (whirling sensation) (whirling sensation)
--Hearing lossHearing loss (loss of hearing) (loss of hearing)
LabyrinthitisLabyrinthitis The membranous labyrinth also swells The membranous labyrinth also swells
though its inflammation is due to an though its inflammation is due to an invading organism (viral or bacterial).invading organism (viral or bacterial).
LabyrinthitisLabyrinthitis- Is rare because the membranous labyrinth is Is rare because the membranous labyrinth is
surrounded by a boney structure, which is surrounded by a boney structure, which is effective in detouring would be invaders.effective in detouring would be invaders.
- If an infection occurs it is most likely due to an If an infection occurs it is most likely due to an erosion of the boney labyrinth allowing for erosion of the boney labyrinth allowing for passage of invaders. However, invaders may passage of invaders. However, invaders may also gain access through the oval and round also gain access through the oval and round window. Causing inflammation of labyrinthine window. Causing inflammation of labyrinthine stucturesstuctures
TinnitusTinnitus
Most consider it to be ringing but Most consider it to be ringing but also includes, roaring, sizzling, also includes, roaring, sizzling, whistling, humming. As long as it whistling, humming. As long as it originates within.originates within.
Unknown etiologyUnknown etiology
Tinnitus and Meniere’sTinnitus and Meniere’s
Disturbances anywhere in the ear can Disturbances anywhere in the ear can cause tinnitus.cause tinnitus.
Increase of Endolymph fluid in the inner Increase of Endolymph fluid in the inner ear may cause increase of stimulation ear may cause increase of stimulation of “hair cells”of “hair cells” Causes increase of sensory impulses Causes increase of sensory impulses
through the through the CochlearCochlear (organ of hearing) (organ of hearing) Those sounds are what the inner ear sounds Those sounds are what the inner ear sounds
like?like?
Vertigo and Meniere’sVertigo and Meniere’s
Inner ear contains the Inner ear contains the Semicircular Canals:Semicircular Canals: EquilibriumEquilibrium 3 endolymph and hair cell filled tubes3 endolymph and hair cell filled tubes Positioned at right angles to the otherPositioned at right angles to the other
Head moves = fluid shifts between canals = Head moves = fluid shifts between canals = stimulation of hair cells = impulses sent to stimulation of hair cells = impulses sent to brain = brain sends signals to maintain brain = brain sends signals to maintain balancebalance
Vertigo and Meniere’sVertigo and Meniere’s
If all canals are filled with fluidIf all canals are filled with fluid Proliferation or absence of signals may Proliferation or absence of signals may
occuroccur Brain is over loaded with or not Brain is over loaded with or not
communicated with proper equilibrium communicated with proper equilibrium maintenance information =maintenance information =
VERTIGO = VERTIGO = Incapacitation Incapacitation
Hearing loss and Hearing loss and Meniere’sMeniere’s
Cochlear (organ of hearing)Cochlear (organ of hearing)
A&PA&P
It looks like thatIt looks like that
(pix of cochlear)(pix of cochlear)
Hearing loss and Hearing loss and Meniere’sMeniere’s
Sound vibrations travel from middle Sound vibrations travel from middle ear to oval window into labyrinth.ear to oval window into labyrinth.
Cause endolymph and hair cells to Cause endolymph and hair cells to vibratevibrate
Vibrations are transmitted into nerve Vibrations are transmitted into nerve impulses which are transmitted to impulses which are transmitted to the brain via the cochlear nervethe brain via the cochlear nerve
Hearing loss and Hearing loss and Meniere’sMeniere’s
The pathophysiology of the Disease:The pathophysiology of the Disease: Overproduction of Endolymph Fluid and Overproduction of Endolymph Fluid and
failure to reabsorb the fluid.failure to reabsorb the fluid. Over production and under absorption Over production and under absorption
of fluid = distended/swollen of fluid = distended/swollen membranous labyrinth = ruptured membranous labyrinth = ruptured membranous labyrinth = damaged membranous labyrinth = damaged pathways of auditory transmission = pathways of auditory transmission = loss of hearing.loss of hearing.
Meniere’s DiseaseMeniere’s Disease Causes of over production and under Causes of over production and under
absorption of fluid:absorption of fluid: Unknown exactlyUnknown exactly Speculated to be:Speculated to be:
InfectionInfection TraumaTrauma OtosclerosisOtosclerosis Syphilis Syphilis Sodium retention Sodium retention
Meniere’s Disease and Meniere’s Disease and EMSEMS
How would you interact with a How would you interact with a patient who is suspected to have patient who is suspected to have Meniere’s Disease?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 B. Shout really loud through your chart rolled
like a megaphone right into their left ear.like a megaphone right into their left ear. C.C. Make eye contact, speak slowly and Make eye contact, speak slowly and
clearly and at a volume the patient clearly and at a volume the patient responds with.responds with.
Meniere’s Disease and Meniere’s Disease and EMSEMS
Most patients encountered in EMS:Most patients encountered in EMS: Severe vertigoSevere vertigo
____________________________________________ Severe tinnitus Severe tinnitus
____________________________________________ Hearing impaired Hearing impaired
____________________________________________
Meniere’s DiseaseMeniere’s Disease General Management:General Management:
Bed restBed rest Low Sodium diet 1000-2000mgLow Sodium diet 1000-2000mg Restricted water, tobacco, alcohol, Restricted water, tobacco, alcohol,
caffeine, and high triglycerides intakecaffeine, and high triglycerides intake
Meniere’s DiseaseMeniere’s Disease Treatment:Treatment:
Antihistamines, steroids, diuretics, Antihistamines, steroids, diuretics, anticholinergics used to lower inner ear anticholinergics used to lower inner ear pressure.pressure.
OTC motion sickness pills (meclizine, lorazepam)OTC motion sickness pills (meclizine, lorazepam) SurgerySurgery
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 When symptoms of vertigo are not relieved and in only
one ear.one ear. Surgical destruction of balance portion of ear (cutting Surgical destruction of balance portion of ear (cutting
of nerve)of nerve)
Meniere’s DiseaseMeniere’s Disease Extras:Extras:
Alan B. Shepard, 1Alan B. Shepard, 1stst American astronaut. American astronaut. After dangerous and experimental yet After dangerous and experimental yet successful surgery he was able again to successful surgery he was able again to return to space (the moon) on Apollo 14.return to space (the moon) on Apollo 14.
Emily Dickinson (poet), Jonathan Swift Emily Dickinson (poet), Jonathan Swift (author), and Steve Francis (NBA)(author), and Steve Francis (NBA)
Charles Darwin suspectedCharles Darwin suspected
Meniere’s Disease Meniere’s Disease SourcesSources
Berkow, Robert, and Mark H. Beers, eds. Berkow, Robert, and Mark H. Beers, eds. The Merck Manual of The Merck Manual of Medical Medical Information : Home EditionInformation : Home Edition. New York: Pocket, 2004.. New York: Pocket, 2004.
Bledsoe, Bryan E., Robert S. Porter, and Richard A. Cherry. Bledsoe, Bryan E., Robert S. Porter, and Richard A. Cherry. Essentials of Essentials of Paramedic CareParamedic Care. Upper Saddle River: Pearson . Upper Saddle River: Pearson Education, 2006.Education, 2006.
Exit-writerExit-writer. Computer software. The StayWell Company, 2000.. Computer software. The StayWell Company, 2000.
"Ménière's disease -." "Ménière's disease -." Wikipedia, the free encyclopediaWikipedia, the free encyclopedia. 05 Jan. 2009 . 05 Jan. 2009 <http://en.wikipedia.org/wiki/Menieres_disease>.<http://en.wikipedia.org/wiki/Menieres_disease>.
Thompson, June M., Gertrude K. McFarland, and Jane E. Hirsch. Thompson, June M., Gertrude K. McFarland, and Jane E. Hirsch. Clinical Clinical NursingNursing. Danbury: Mosby, Incorporated, 1997.. Danbury: Mosby, Incorporated, 1997.
Venes, Donald. Venes, Donald. Taber's Cyclopedic Medical Dictionary : Non Thumb-Taber's Cyclopedic Medical Dictionary : Non Thumb-Indexed VersionIndexed Version. Boston: F. A. Davis Company, 2004.. Boston: F. A. Davis Company, 2004.