Free BCEN Certified Emergency Nurse (CEN) Practice Question

Intratympanic gentamicin injection is the most appropriate long-term management for this patient, who likely has Ménière's disease. This treatment involves injecting gentamicin into the middle ear, which selectively damages vestibular hair cells, reducing vertigo episodes while potentially preserving hearing.

The patient's symptoms of recurrent vertigo, fluctuating hearing loss, and tinnitus are characteristic of Ménière's disease. The positive head impulse test suggests peripheral vestibular dysfunction.

While vestibular rehabilitation can be beneficial for many vestibular disorders, it's not the primary treatment for Ménière's disease. Oral steroids might help in acute attacks but aren't typically used for long-term management. Endolymphatic sac decompression is a surgical option but is generally considered after less invasive treatments have failed.

Understanding advanced management options for complex vestibular disorders is crucial for emergency nurses, as they often coordinate care with specialists and provide patient education on treatment plans.