General Questions

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* 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

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* 2. What is your name 

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* 3. What is your email address

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* 4. What region and country do you live in

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* 5. How old were you when you were diagnosed with MD

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* 6. What is your gender?

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* 7. Were you diagnosed by GP, ENT Consultant or someone else

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* 8. What is your history of vertigo attacks and current status

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* 9. Is your Meniere’s unilateral or bi lateral

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* 10. What is the current status of hearing in each affected ear

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* 11. What is the current status of balance in each affected ear

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* 12. Do you suffer from Tinnitus

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* 13. Do you suffer from motion sickness?

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* 14. Do you have any balance issues relating to light-headedness, poor balance or anything that makes walking difficult?

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* 15. Do you have any difficulties with concentrating or reading?

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* 16. Do you suffer from extreme fatigue

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* 17. Do you suffer from brain fog

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* 18. Do you experience mood swings, irritability or low mood?

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* 19. 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?

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* 20. Does anyone else in your family have Ménière’s Disease?

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* 21. 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?

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* 22. Has anything helped or worsened your MD symptoms?

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