MedSurg: Ménière’s Disease, hearing loss, and vertigo
DISCLAIMER: Yes, I am a nursing student. Yes, I am a scuba diver. No, I am not yet a licensed nurse nor have I graduated as of the date of this publication. This information is derived from my nursing school notes and should not be seen as medical advice. Resources are provided whenever possible regarding both nursing information and scuba diving. You should consult with your physician before scuba diving, especially if you have a condition which may limit your scuba diving fitness.
Scuba diving can really freaking hurt your ears if you’re like me and you suck at equalizing. It can also cause damage and even hearing loss if you’re stubborn about it (Diver’s Alert Network [DAN]. n.d.). Hearing loss comes in a few different flavors:
- Conductive Hearing Loss is an external or middle ear problem, with impaired mechanical conduction of sound to the inner ear.
- Sensorineural Hearing Loss involves the inner ear or a brain or nerve problem (Hinkle, 2018). This may be caused by ototoxicity from antibiotics or aspirin – if aspirin is the cause, for example, ceasing to take aspirin should make the hearing loss go away (Banasik & Copstead, 2018).
- Hearing loss can be mixed – both conductive and sensorineural.
- Functional (psychogenic) hearing loss can also be attributed to an emotional problem (Hinkle, 2018) and if you’re negatively emotional while you’re scuba diving, you aren’t doing it right.
Ménière’s Disease is a form of sensorineural hearing loss:
- It is a chronic inner ear disease of abnormal inner ear fluid balance due to malabsorption of endolymph or blockage of the endolymphatic duct. Progressive unilateral hearing loss may become bilateral if it is left untreated for a long time (like 7 years).
- Etiology/Pathophysiology: Degeneration of neural end organs of cochlea (where it connects to the nerve). The cochlea is associated with balance. The cause could be unknown but is associated with excessive accumulation of endolymph.
- *Idiopathic: impairment of the ability of inner ear to regulate normal homeostatic systems
- Accumulation of endolymph in the scala media, where the cochlear (“organ of Corti”) is, causing degeneration of the neural end organs of the cochlea
- May be due to allergies, viral/bacterial infections (e.g., syphilis), chronic stress, metabolic derangement, or trauma
- Clinical Manifestations: episodic vertigo, tinnitus, fluctuating hearing loss, pressure – a feeling of “fullness” in the ear, nausea/vomiting. May have nystagmus in opposite eye.
- Early signs: hearing loss fluctuates, usually low tones
- Diagnostics: calorics, glycerol dehydration testing (connection with ICP?), & electrocochleography (can discover severity, SENSITIVITY)
- Low sodium diet (1000-1500 mg/day)
- Fluid restriction
- Diuretic therapy (hydrochlorothiazide) – acute phase, helps with diagnosis
- Meclizine (Antivert), tranquilizers (Valium), antiemetics (Promethazine)
- Avoid aspirin (tinnitus/dizziness), caffeine, soda, MSG
- Drink water, milk, and low sugar fruit juices
- Water follows salt! Watch for hidden salt (pickles, potato chips, Ramen soup)
- Considerations: avoid aspirin and aspirin-containing products (Banasik & Copstead, 2018)
- Diving Considerations: according to DAN (n.d.), a physician is likely to recommend against diving if you have unilateral or partial hearing loss because if diving were to cause further damage, you could lose the remaining functioning of the ear or ears. It isn’t necessarily all damning, but it’s something you should have a heart-to-heart talk about with an ENT specialist before you make the decision to go diving.
- For a referral in your area, email firstname.lastname@example.org, or call the DAN Medical Information Line at +1-919-684-2948.
Banasik, J.L. & Copstead, L.C. (2018). Pathophysiology (6th ed.). St. Louis, MO: Elsevier.
Diver’s Alert Network. (n.d.). Hearing loss/deafness. Retrieved from https://www.diversalertnetwork.org/health/ears/hearing-loss-deafness
Hinkle, J.L. & Cheever, K.H. (2018). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (14th ed.). Philadelphia: Wolters Kluwer.