Scenario 1

Question

You are going over the chief complaint with Benita Hernandez who states she was recently
diagnosed with Meniere’s disease, was seen in the emergency room a week ago, and is here
today for a follow-up visit.
1. What are the common signs and symptoms of Meniere’s disease?
2. What questions should you ask the patient for the chart note regarding the follow-up?
3. What is the common treatment for Meniere’s disease?
.
Scenario 2
A 24-year-old male patient is being seen in the office for treatment of an upper respiratory
infection. During your interview he proudly announces that he has quit smoking. In the process
of your assessment you notice his teeth are quite stained, especially on one side. He explains to
you that he is using a little smokeless tobacco to satisfy his need for nicotine.
1. What should you tell him about his new habit?
2. Where can you obtain some written materials for him?
3. What should you question about his dental care?

Answer 1

Scenario 1: Meniere’s Disease

1. Common Signs and Symptoms of Meniere’s Disease:

   • Episodes of vertigo (spinning sensation) that last from 20 minutes to several hours.
   • Tinnitus (ringing or buzzing noise in the ear).
   • Hearing loss, which may fluctuate or become permanent over time.
   • A feeling of fullness or pressure in the affected ear.

2. Questions to Ask the Patient for the Chart Note:

   • How often do you experience vertigo, and how long do these episodes last?
   • Have you noticed any changes in your hearing or any episodes of tinnitus since your last visit?
   • Have you made any lifestyle changes since your diagnosis, such as dietary adjustments or stress management?
   • Are you experiencing any new symptoms since your last visit?
   • Have you had any recent changes in medications or treatments?

3. Common Treatment for Meniere’s Disease:

   • Dietary changes, such as reducing salt intake to help manage fluid retention.
   • Medications to help control nausea and vertigo (e.g., meclizine, antiemetics).
   • Diuretics to help reduce inner ear fluid buildup.
   • Therapy options such as vestibular rehabilitation.
   • In more severe cases, procedures such as intratympanic steroid injections or surgery may be considered.

Scenario 2: Smokeless Tobacco Use

1. What to Tell Him About His New Habit:

   • While quitting smoking is a positive step for his health, using smokeless tobacco is not a safe alternative. It can still cause oral health issues, increase the risk of gum disease, tooth decay, and certain cancers (especially oral cancers). Encourage him to consider stopping all forms of tobacco use and discuss the importance of seeking help and alternative methods to handle cravings.

2. Where to Obtain Some Written Materials for Him:

   • Written materials can be obtained from several sources including:
     • The American Cancer Society (ACS) website.
     • The Centers for Disease Control and Prevention (CDC) tobacco control page.
     • Local health departments or quitline services that provide resources for quitting tobacco.
     • Printed brochures available in the healthcare office, focusing on the risks of smokeless tobacco and resources for quitting.

3. Questions About His Dental Care:

   • How often do you visit the dentist for cleanings and check-ups?
   • Are you experiencing any pain or discomfort in your mouth or gums?
   • Have you noticed any changes in your teeth or gums since starting smokeless tobacco?
   • What is your oral hygiene routine like? How often do you brush and floss?
   • Have you discussed your tobacco use with your dentist? If so, what recommendations did they provide?