# Situation: A 45-year-old woman is admitted with recurrent episodes of spinning vertigo lasting 2–4 hours, with nausea and vomiting. Between episodes she has roaring tinnitus and a feeling of fullness in the left ear. Otoscopy is normal. Which additional finding would complete the classic presentation of Ménière disease?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630343  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 45-year-old woman is admitted with recurrent episodes of spinning vertigo lasting 2–4 hours, with nausea and vomiting. Between episodes she has roaring tinnitus and a feeling of fullness in the left ear. Otoscopy is normal.

Which additional finding would complete the classic presentation of Ménière disease?

## 보기

1. Fluctuating low-frequency sensorineural loss in the left ear **✔ 정답**
2. Progressive high-frequency sensorineural loss in the left ear
3. Fluctuating low-frequency conductive loss in the left ear
4. Stable low-frequency sensorineural loss in both ears

**정답: 1**

## 해설

Ménière disease results from excess endolymph (endolymphatic hydrops). Its classic presentation is episodes of vertigo lasting 20 minutes to 12 hours, roaring tinnitus, aural fullness and fluctuating low-frequency sensorineural hearing loss in the affected ear.

## 심화 해설

Core mechanism

Ménière disease is caused by endolymphatic hydrops, meaning excess endolymph accumulates inside the membranous labyrinth of the inner ear . This abnormal fluid buildup distorts the cochlear and vestibular structures, producing the classic episodic symptoms. Because the distention initially affects the apex of the cochlea—where low-frequency sounds are processed—the hearing loss in early Ménière disease is typically fluctuating and sensorineural, with a low-frequency predominance . The hearing loss is sensorineural, not conductive, because the lesion lies in the cochlea and auditory nerve pathway rather than in the external or middle ear.

Why the other options are incorrect

A conductive hearing loss would point to a problem in the external auditory canal, tympanic membrane, or middle ear ossicles—structures that are normal in Ménière disease and were unremarkable on this patient’s otoscopy. Key point! Ménière disease produces sensorineural loss because the pathology is in the inner ear.

Progressive high-frequency sensorineural loss is more characteristic of presbycusis or noise-induced hearing loss, not early Ménière disease.

Bilateral involvement can occur in Ménière disease, but the classic initial presentation is unilateral, and this patient’s symptoms are localized to the left ear .

Clinical pattern

The full classic tetrad of Ménière disease includes episodic vertigo lasting 20 minutes to 12 hours, fluctuating sensorineural hearing loss, tinnitus, and aural fullness . This patient already has vertigo lasting 2–4 hours, roaring tinnitus, and left ear fullness. The missing element is the characteristic hearing loss. Watch out! The vertigo duration is diagnostically important: episodes shorter than 20 minutes suggest benign paroxysmal positional vertigo, while episodes lasting days suggest vestibular neuritis .

| Feature | Ménière disease | Acoustic neuroma | BPPV |
| --- | --- | --- | --- |
| Vertigo duration | 20 min–12 h | Usually gradual unsteadiness | Seconds to

## 임상 시나리오

Meniere Disease RecognitionClassic tetrad and hearing loss pattern
The hallmark auditory finding is fluctuating low-frequency sensorineural hearing loss in the affected ear, caused by endolymphatic hydrops distorting the cochlear apex.

Vertigo episodes last 20 minutes to 12 hours and are accompanied by roaring tinnitus and aural fullness. Otoscopy is typically normal because the pathology is in the inner ear.

CautionDo not mistake this for conductive loss; normal otoscopy and a sensorineural pattern confirm inner ear origin. Bilateral disease can occur but classic initial presentation is unilateral.

## 핵심 개념

- **Endolymphatic hydrops** — Excess endolymph accumulation within the membranous labyrinth, the underlying pathology of Meniere disease.
- **Sensorineural hearing loss** — Hearing loss due to cochlear or auditory nerve dysfunction, as opposed to conductive loss from external or middle ear problems.
- **Meniere disease tetrad** — Episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness.
- **Low-frequency hearing loss** — Early Meniere disease preferentially affects the cochlear apex where low-frequency sounds are processed.

## 같은 주제 문제

- [Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in t…](https://mymerci.kr/pages/nclex_q.php?qn_id=630316)
- [Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in t…](https://mymerci.kr/pages/nclex_q.php?qn_id=630317)
- [Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in t…](https://mymerci.kr/pages/nclex_q.php?qn_id=630318)
- [Situation: A 68-year-old man is on the medical ward on day 4 after an ischemic stroke in t…](https://mymerci.kr/pages/nclex_q.php?qn_id=630319)
- [Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medic…](https://mymerci.kr/pages/nclex_q.php?qn_id=630320)
- [Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medic…](https://mymerci.kr/pages/nclex_q.php?qn_id=630321)
- [Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medic…](https://mymerci.kr/pages/nclex_q.php?qn_id=630322)
- [Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medic…](https://mymerci.kr/pages/nclex_q.php?qn_id=630323)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._