Which intervention would be included in the care plan for the client with an acute exacerbation of Ménière’s disease?
A. Instructing the client on the correct way to remove impacted cerumen.
B. Speaking slowly and distinctly in a low-pitched, clear voice without yelling
C. Providing a safe, quiet, dimly lit environment with enforced bed rest.
D. Instructing the client to pull the top of the ear and back to instill ear drops.
Correct Answer: C. Providing a safe, quiet, dimly lit environment with enforced bed rest.
Ménière’s disease is a chronic disorder of the inner ear involving sensorineural hearing loss, severe vertigo, and tinnitus. Typically, the client experiences sudden episodes of severe whirling vertigo with an inability to stand or walk, buzzing tinnitus that worsens before and during an episode, nausea, vomiting, and diaphoresis. The client’s safety must be ensured along with decreasing exposure to extraneous stimuli. This is accompanied by providing the client with a quiet, dimly lit environment and bed rest.
Option A: Instructions about removing cerumen are appropriate for a client with cerumen impaction. When treatment is appropriate, there are three recommended removal methods: cerumenolytic agents, irrigation, and manual removal. To prevent further accumulation of cerumen in patients with recurrent symptoms greater than one per year, patients may apply mineral oil to the external canal 10 to 20 minutes weekly.
Option B: Speaking slowly and distinctly in a low-pitched, clear voice without yelling is appropriate for clients experiencing hearing loss. Clients with Ménière’s disease are not deaf during acute exacerbations. However, hearing loss may occur after repeated episodes.
Option D: Ear drops are not the treatment of choice for an acute attack of Ménière’s disease. A Cochrane review found low-level evidence to support the use of betahistine with substantial variability between studies. Medical therapy in many medical centers often starts with betahistine orally.
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