Menieres 200 Project
General Questions
1.
Would you be prepared to join our Menieres 200 testing programme ? If so please answer questions 2 and 3 with your name and email address
Yes
No
2.
What is your name
3.
What is your email address
4.
What region and country do you live in
5.
How old were you when you were diagnosed with MD
Under 18
18-24
25-34
35-44
45-54
55-64
65+
6.
What is your gender?
Female
Male
7.
What is your height
under 5 feet
5 feet to 5 feet 5 inches
5 feet 6 inches to 5 feet 9 inches
5 feet 10 inches to 6 feet
over 6 feet
8.
What is your current weight
Under 9 stone (126 lb)
9 stone to 11 stone (126 lb to 154 lb)
11 stone to 13 stone (154 lb to 182 lb)
13 stone to 15 stone (182 lb to 210 lb)
over 15 stone (210 lb)
9.
Were you diagnosed by GP, ENT Consultant or someone else
GP
ENT Consultant
Someone else
10.
What is your history of vertigo attacks and current status
11.
Is your Meniere’s unilateral or bi lateral
unilateral
bilateral
12.
What is the current status of hearing in each affected ear
13.
What is the current status of balance in each affected ear
14.
Do you suffer from Tinnitus
Yes
No
15.
Do you suffer from motion sickness?
Yes
No
16.
Do you have any balance issues relating to light-headedness, poor balance or anything that makes walking difficult?
Yes
No
17.
Do you have any difficulties with concentrating or reading?
Yes
No
18.
Do you suffer from extreme fatigue
Yes
No
19.
Do you suffer from brain fog
Yes
No
20.
Do you experience mood swings, irritability or low mood?
Yes
No
21.
Do you have any sleep issues e.g. disturbed, too little or too much sleep, or early waking? Has this worsened since your diagnosis with Ménière’s?
Sleep issues before Menieres
Sleep issues with Menieres
Worse since Menieres
No sleep issues
22.
Does anyone else in your family have Ménière’s Disease?
Yes
No
23.
Did you experience any stress or illness, life change or a house move prior to your Ménière’s diagnosis? If yes, what and how long before?
24.
Has anything helped or worsened your MD symptoms?
Current Progress,
0 of 62 answered