# A nurse is assessing a 38-year-old client who presents to the emergency department with complaints of severe rotatory vertigo that began suddenly 2 hours ago, accompanied by nausea and vomiting. The client reports similar episodes over the past 6 months, each lasting several hours with left ear fullness, ringing sounds, and temporary hearing loss. Which assessment finding would be most characteristic of Ménière's syndrome? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541708 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a 38-year-old client who presents to the emergency department with complaints of severe rotatory vertigo that began suddenly 2 hours ago, accompanied by nausea and vomiting. The client reports similar episodes over the past 6 months, each lasting several hours with left ear fullness, ringing sounds, and temporary hearing loss. Which assessment finding would be most characteristic of Ménière's syndrome? A 45-year-old client presents to the emergency department with complaints of severe rotatory vertigo that began suddenly 2 hours ago. The client reports feeling nauseated and has vomited twice. During the assessment, the client mentions experiencing similar episodes over the past 6 months, each lasting several hours and accompanied by a feeling of fullness in the left ear, ringing sounds, and temporary hearing loss. ## 보기 1. Bilateral hearing loss with bone conduction better than air conduction 2. Unilateral fluctuating sensorineural hearing loss with aural fullness **✔ 정답** 3. High-frequency hearing loss in both ears with normal tympanic membranes 4. Conductive hearing loss with visible cerumen impaction **정답: 2** ## 해설 Ménière's syndrome is characterized by unilateral fluctuating sensorineural hearing loss with aural fullness, matching the classic triad. Other options describe different types of hearing loss not typical for Ménière's. ## 심화 해설 Correct Answer: 2. Unilateral fluctuating sensorineural hearing loss with aural fullness Clinical Presentation Analysis The client's report of severe rotatory vertigo lasting hours, accompanied by left ear fullness, tinnitus (ringing sounds), and temporary hearing loss, is the classic tetrad of Ménière's disease (MD). The hallmark of this condition is its unilateral and episodic nature, which directly points to the characteristic assessment finding. Pathophysiology and Symptom Correlation The underlying histopathological finding in MD is endolymphatic hydrops (EH), a distension of the endolymphatic spaces in the inner ear [2]. While the exact trigger is considered multifactorial—involving immune, viral, genetic, and vascular mechanisms—the resulting pressure fluctuations and eventual rupture of the membranous labyrinth explain the episodic symptoms [2]. The sensation of aural fullness is a direct consequence of this increased endolymphatic pressure. The vertigo is caused by a sudden influx of potassium-rich endolymph into the perilymph, which depolarizes and temporarily paralyzes the vestibular nerve. The hearing loss and tinnitus result from the mechanical and chemical disruption of the cochlear hair cells. Crucially, because the pathological process is in the cochlea and vestibular apparatus, the resulting hearing loss is classified as sensorineural hearing loss (SNHL), not conductive [2,3]. Why Other Options Are Incorrect - Option 1: Bilateral hearing loss is not characteristic of classic MD, which is overwhelmingly unilateral in its early and middle stages. Furthermore, bone conduction better than air conduction describes a conductive hearing loss, which localizes the problem to the external or middle ear, not the inner ear pathology of MD [2]. - Option 3: While MD does cause sensorineural hearing loss, it is typically unilateral, not bilateral. More importantly, the classic audiometric pattern in early MD is a low-frequency "rising" curve, not a high-frequency loss . High-frequency loss is more characteristic of noise-induced hearing loss or presbycusis . - Option 4: Cerumen impaction is a cause of conductive hearing loss, which is a problem of sound transmission in the external auditory canal. This does not explain the vertigo, tinnitus, and aural fullness that define the Ménière's symptom complex [2]. Diagnostic Confirmation The most characteristic assessment finding is documented through pure-tone audiometry. In MD, the hearing loss is fluctuating, meaning it can worsen during an attack and improve between episodes, especially in the early stages. Over time, the low-frequency SNHL can become permanent and may progress to involve all frequencies, a pattern described as a "flat" curve in later disease stages . Advanced diagnostic tools, such as hydrops magnetic resonance imaging (MRI), can now visualize endolymphatic hydrops in vivo, and intracochlear electrocochleography (IC ECochG) can show an elevated summating potential to action potential ratio, reflecting the abnormal inner ear pressure [3,4]. These findings confirm that the primary dysfunction is within the cochlea, producing a unilateral, fluctuating sensorineural hearing loss, which is the assessment finding most specific to Ménière's syndrome [2,3].References (research sources) - [2]Understanding and Managing Ménière's Disease: A Comprehensive Case Report.Case reportEl Faham MM, Elrashidy R. (2026) · DOI: 10.7759/cureus.103960 ## 임상 시나리오 Ménière's Disease AssessmentClassic Triad and Unilateral Presentation The hallmark of Ménière's disease is unilateral fluctuating sensorineural hearing loss accompanied by aural fullness. This is part of the classic symptom tetrad: episodic vertigo lasting 20 minutes to 12 hours, tinnitus, and temporary hearing loss. The underlying pathology, endolymphatic hydrops, causes distension in the inner ear. A sensation of pressure or fullness is a direct clinical correlate. The hearing loss is sensorineural, not conductive, because the pathology is in the cochlea and vestibular apparatus. CautionDo not confuse with conductive loss. In Ménière's, tuning fork tests (Weber/Rinne) will lateralize to the unaffected ear, and air conduction will remain greater than bone conduction, confirming a sensorineural deficit. Bilateral or high-frequency loss points to other diagnoses. ## 핵심 개념 - **Endolymphatic hydrops** — Distension of the endolymphatic spaces in the inner ear, considered the underlying histopathological finding in Ménière's disease. - **Sensorineural hearing loss (SNHL)** — Hearing loss resulting from damage to the inner ear (cochlea) or the vestibulocochlear nerve; characteristic of Ménière's disease. - **Aural fullness** — A sensation of pressure or blockage in the ear, a direct consequence of increased endolymphatic pressure in Ménière's. - **Tinnitus** — The perception of sound (e.g., ringing, buzzing) without an external source, commonly associated with cochlear hair cell disruption. - **Rotatory vertigo** — A sensation of spinning or whirling of oneself or the environment, caused by sudden vestibular nerve dysfunction in Ménière's. ## 같은 주제 문제 - [A nurse is assessing a 52-year-old client who reports episodes of severe dizziness, hearin…](https://mymerci.kr/pages/nclex_q.php?qn_id=541707) - [A nurse is caring for a client with Ménière's syndrome who is experiencing an acute episod…](https://mymerci.kr/pages/nclex_q.php?qn_id=541709) - [A nurse is caring for a client with Ménière's syndrome who is experiencing an acute episod…](https://mymerci.kr/pages/nclex_q.php?qn_id=541710) - [A nurse is caring for a client with Ménière's syndrome who is experiencing an acute episod…](https://mymerci.kr/pages/nclex_q.php?qn_id=541711) - [A nurse is caring for a client with Ménière's syndrome who is experiencing an acute episod…](https://mymerci.kr/pages/nclex_q.php?qn_id=541712) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._