Menieres 200 Project General Questions Question Title * 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 OK Question Title * 2. What is your name OK Question Title * 3. What is your email address OK Question Title * 4. What region and country do you live in OK Question Title * 5. How old were you when you were diagnosed with MD Under 18 18-24 25-34 35-44 45-54 55-64 65+ OK Question Title * 6. What is your gender? Female Male OK Question Title * 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 OK Question Title * 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) OK Question Title * 9. Were you diagnosed by GP, ENT Consultant or someone else GP ENT Consultant Someone else OK Question Title * 10. What is your history of vertigo attacks and current status OK Question Title * 11. Is your Meniere’s unilateral or bi lateral unilateral bilateral OK Question Title * 12. What is the current status of hearing in each affected ear OK Question Title * 13. What is the current status of balance in each affected ear OK Question Title * 14. Do you suffer from Tinnitus Yes No OK Question Title * 15. Do you suffer from motion sickness? Yes No OK Question Title * 16. Do you have any balance issues relating to light-headedness, poor balance or anything that makes walking difficult? Yes No OK Question Title * 17. Do you have any difficulties with concentrating or reading? Yes No OK Question Title * 18. Do you suffer from extreme fatigue Yes No OK Question Title * 19. Do you suffer from brain fog Yes No OK Question Title * 20. Do you experience mood swings, irritability or low mood? Yes No OK Question Title * 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 OK Question Title * 22. Does anyone else in your family have Ménière’s Disease? Yes No OK Question Title * 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? OK Question Title * 24. Has anything helped or worsened your MD symptoms? OK NEXT