Ankyloglossia, which is also referred to as tongue-tie, is a condition where the tongue cannot move normally because it is attached to the floor of the mouth by the frenulum, which is too tight.

The lingual frenulum is the band of tissue that attaches the undersurface of your tongue to the bottom part of the mouth. Adequate tongue movement is necessary for swallowing and speech. When tongue movement is restricted, evaluation by an ENT (ear, nose, and throat) specialist, or otolaryngologist, may be necessary to check for ankyloglossia or other conditions that can affect oral and tongue function. In infants and children, ankyloglossia can sometimes cause breastfeeding and speech problems. Mild restrictions of tongue movement may not cause any speech or swallowing difficulties.

In recent years, the number of infants and children being diagnosed with and undergoing treatment for ankyloglossia has been on the rise as the condition has become more known. However, high-quality research on ankyloglossia is limited, and currently there is controversy on this topic. There are two types of ankyloglossia commonly described: anterior (when the frenulum inserts farther out toward the tip of the tongue) and posterior ankyloglossia (when the frenulum is widened at the insertion of the tongue into the floor of the mouth). Experts have failed to reach agreement on a formal classification system and management strategies. This highlights the need for individual evaluation and treatment discussions based on each patient’s circumstances. Ankyloglossia is usually identified from infancy through childhood. Some infants with ankyloglossia may have problems breastfeeding, but there are many other causes of latching difficulty that need to be considered.

The typical treatment of symptomatic ankyloglossia is a frenotomy, a surgery that involves cutting the band of tissue between the tongue and floor of mouth to release the tongue and help it move more freely. Not all patients with ankyloglossia require or would benefit from surgery, so it is critical that each patient is evaluated based on their individual symptoms to avoid unnecessary surgery. For example, an infant who has a frenulum that attaches farther out on the tongue but is feeding well does not necessarily require surgery. See the “What Are the Treatment Options?” section for more details.

What are the Symptoms of Ankyloglossia?

Symptoms of ankyloglossia may include:

  • Nipple pain or irritation when breastfeeding experienced by mothers of newborn infants
  • Problems latching on to the nipple during feeding experienced by infants

Ankyloglossia does not cause sleep apnea or snoring and does not typically affect speech, but it can occasionally cause problems with articulation in school-aged children. In older children and adolescents, ankyloglossia can cause social/mechanical issues including difficulty licking, difficulty keeping teeth clean, and a sense of social embarrassment. Adults with ankyloglossia may have difficulty cleaning their teeth with their tongue and problems playing wind instruments.

What Causes Ankyloglossia?

A tight lingual frenulum can cause ankyloglossia by limiting the motion of the tongue. In some cases, this band of tissue inserts too far out toward the tip of the tongue or is widened at the back of the tongue, causing problems with tongue motion. While the exact cause of ankyloglossia is still unknown, there tends to be a higher number of males with the diagnosis and is occasionally present in multiple family members. Ankyloglossia has also been associated with other genetic syndromes.

What Are the Treatment Options?

When considering treatment options for ankyloglossia and breastfeeding difficulty, it is important to remember that there is no one-size-fits-all solution. Factors such as patient age, types of symptoms experienced, other medical conditions, and surgical risks all affect the decision process between you and your doctor. Successful nonsurgical options focus on symptom management, such as working with a breastfeeding specialist on adaptive positioning and assistive devices in infants, or working with a speech therapist for articulation improvement in children.

If nonsurgical interventions do not resolve the problem or ankyloglossia is moderate to severe, a lingual frenotomy may be recommended. The procedure involves cutting the restricted frenulum with scissors, laser, or cautery device depending on the preference of the treating physician. The frenulum is divided until mobility is improved. In young infants, the procedure is often done in the doctor’s office, while older children may require anesthesia. More severe cases may require a frenuloplasty.

While many infants benefit from frenotomy, not all infants with ankyloglossia experience symptoms or require any intervention. Also, frenotomy does not resolve or improve symptoms in all patients. A few rare risks of frenotomy may include bleeding, infection, scarring, salivary duct injury, and airway obstruction. Your doctor should understand the multiple factors than can impact successful breastfeeding. An ENT specialist, speech language pathologist, lactation consultant, and other breastfeeding specialists may be needed.

What Questions Should I Ask My Doctor?

  1. Are there any other factors, besides tongue-tie, that may be impacting breastfeeding in my child?
  2. Are there nonsurgical options available to help with breastfeeding?
  3. Is a frenotomy necessary?
  4. What if ankyloglossia is not the cause of the breastfeeding difficulty?
  5. When is the best time for a frenotomy to be performed?
  6. What are the risks of frenotomy for my child?
  7. Does my child have any conditions that that may increase the risks associated with having a frenotomy?
  8. Will my medical insurance cover this procedure?

Dysgeusia is a condition where a person’s perception of taste is altered; everything seems sweet, sour, bitter, or metallic.

Taste disorders are common in adults. A study performed on adults in the United States indicated that up to 17 percent of those tested had some impairment in taste. Impaired taste can take many forms, including:

  • Hypogeusia, which is a reduced or diminished sense of taste
  • Ageusia, which is a complete loss of taste
  • Aliageusia, when a typically pleasant-tasting food or drink begins to taste unpleasant
  • Phantogeusia, which refers to tasting something that is not actually there, or hallucinating a particular taste

The tongue and throat have many taste receptors. Three different nerves contribute to the sensation of taste depending on where in the mouth the taste receptors are located. The front of the tongue is innervated, or supplied, by cranial nerve VII, called the facial nerve, through the chorda tympani; the back part of the tongue is innervated by cranial nerve IX, called the glossopharyngeal nerve; and the palate and throat are innervated by cranial nerve X, called the vagus nerve.

Completely losing taste due to injury of a nerve is rare since several nerves are involved. What some people consider a “taste,” such as “hot and spicy” or “chemical,” may be detected through pain and other receptors working through a completely different nerve, cranial nerve V, called the trigeminal nerve. There are even some taste receptors in the nose, but doctors are still figuring out exactly what role they play.

Humans can detect five different tastes: sweet, salty, bitter, sour, and savory, or umami. It is important to recognize the difference between taste and flavor. Flavor is a multisensory experience that combines both the smell and taste of foods and drinks. While eating, the smell of food is detected through both the front of the nose and the back of the throat. Depending on the path the smell takes, it can have a different effect. When people lose their sense of smell, they often complain of a loss of taste but what they really mean is that they have lost that combination of smell and taste, or flavor.

What are the Symptoms of Dysgeusia?

The symptoms of dysgeusia can include:

  • Food has lost its characteristic sweetness or saltiness
  • Foods that used to taste good now taste bad (sour or rotten)
  • Foods taste metallic
  • A taste is present despite not eating anything

What Causes Dysgeusia?

Taste disorders are common in adults and can be caused by several factors, such as:

Infection—Bacterial, viral, or fungal infections of the teeth or gums, mouth, and throat can cause swelling, reduce blood flow to taste buds, and/or produce chemicals that alter taste. Some genetic disorders can also make some people crave sweet foods, which can then lead to dental infections that can cause even more taste issues.

Inflammation—Swelling of the tongue can cause the taste pores on it to close. This can sometimes indicate vitamin deficiencies, such as lack of B12.

Vitamin or mineral deficiencies—Deficiencies in the B vitamins, especially B12, as well as certain minerals like zinc have been associated with loss of taste. Supplements can usually reverse this.

Dry mouth—Dry mouth, or xerostomia, can be a result of certain diseases, like Sjogren’s syndrome where the body attacks its only saliva glands, common medications such as water pills, or diuretics, or from radiation therapy for cancer. Without adequate amount of saliva, food may not dissolve enough to stimulate the taste receptors.

Medication side effects—A variety of medications can cause taste issues. Common ones include angiotensin-converting-enzyme (ACE) inhibitors such as lisinopril or captopril; antibiotics such as amoxicillin, clarithromycin, and metronidazole; diuretics such as acetazolamide and hydrochlorathiazide; and chemotherapy agents, such as bleomycin and carbo/cisplatin.

Nerve damage or trauma—The nerve that supplies the front part of the tongue travels through the ear and splits off from the facial nerve. As a result, Bell’s palsy and some ear surgeries can cause a loss of taste. Also, any injury to the other nerves that are responsible for taste due to trauma or surgery in the neck may also cause this problem.

Neurologic disorders—As seen with loss of smell, certain neurologic disorders such as multiple sclerosis, Alzheimer’s disease, and Parkinson’s disease have been associated with decreased taste.

Metabolic disorders—Kidney disease, diabetes, and hypothyroidism can all cause taste disturbances that can be reversed when treated.

Tobacco use—Active chemicals in tobacco as well as the changes that take place on the surface of the tongue and throat from tobacco use can change the perception of taste.

Acid reflux or GERD—Stomach acid and stomach enzymes can affect how well the taste buds work. Often, people with acid reflux or GERD complain of a “brackish” or sour taste.

Aging—The sense of taste can decrease with age, although this is less common than the loss of smell.

What Are the Treatment Options?

The treatment options for an impaired sense of taste depend on the exact cause for the dysgeusia or hypogeusia. With mineral or vitamin deficiencies, simply supplementing with a multi- or specific vitamin (B12, B-complex, and zinc) may be helpful. If due to medications, switching to a different medication may help restore a normal sense of taste. Managing other disorders that can trigger loss of taste, such as diabetes, thyroid disorders, or kidney problems, may also lead to improvement.

Reducing or stopping smoking or other forms of tobacco use as well as managing acid reflux either with medications or dietary modifications cannot be overemphasized. Drinking plenty of water can also help with dry mouth due to Sjogren’s, radiation treatment, or age-related loss of taste.

What Questions Should I Ask My Doctor?

  1. Do I have a loss of taste or is it from a loss of smell?
  2. Could my medications be causing this?
  3. Could my impaired taste be a sign of some other disease?
  4. Are there supplements that might help?
  5. What other things can I do to help improve my sense of taste?

Labyrinthitis is a disorder associated with inflammation of the inner ear. The labyrinth is a fluid-filled compartment that consists of the cochlea and the vestibular organs.

The cochlea is the hearing organ and the vestibular organs are responsible for balance and spatial orientation.

Labyrinthitis has several potential causes, and patients of any age and gender may be affected. Patients with labyrinthitis can experience hearing loss in the affected ear, imbalance, dizziness, and nausea. When the balance organ’s input to the brain is suddenly changed, patients experience vertigo, feeling like you are spinning or moving when you are still. Severe symptoms may limit activities of daily living, the ability to work, and restrict recreational activities.

Labyrinthitis is a self-limiting illness that usually gets better in several weeks. Symptom can begin suddenly and gradually worsen over the course of hours to days before improvement is noticed. Failure to seek treatment may put patients at higher risk for permanent hearing loss and imbalance. Although uncommon, it is possible to have some permanent hearing loss despite treatment. While most patients with imbalance and mild dizziness with head movement recover, sometimes it may take months to years to fully recover. Patients with substantial balance issues may benefit from physical therapy, specifically vestibular physical therapy.

What are the Symptoms of Labyrinthitis?

The symptoms of labyrinthitis can include:

  • Hearing loss, often in high frequency pitch range
  • Decreased ability to understand speech
  • Tinnitus, or ringing or buzzing sensation in the ear
  • Imbalance and unsteadiness, falling or swaying to one side while walking
  • Vertigo, or feeling like you are spinning when you are still
  • Involuntary twitching or jerking of the eyeball, called nystagmus
  • Nausea and vomiting

What Causes Labyrinthitis?

Viral infection—Viral infections of the inner ear or activation of a virus that is normally inactive and stays within nerve endings are thought to be the most common cause of labyrinthitis. The specific virus that causes this is usually unknown in most cases. A unique type of labyrinthitis may be caused by reactivation of the varicella-zoster virus, called Ramsay Hunt syndrome, or herpes zoster oticus. This is like shingles of the ear and can occur with labyrinthitis in addition to ear pain, facial weakness, and blisters around the ear, ear canal, and eardrum.

Bacterial infection—A bacterial infection of the middle ear (the space behind the ear drum) can spread to the inner ear and cause bacterial labyrinthitis. Children with inner ear deformities are at a higher risk for bacterial labyrinthitis either from a middle ear infection or from the spread of bacterial meningitis to the inner ear. Severe bacterial labyrinthitis can occur with ear pain, ear infection, drainage of pus from the ear, fevers, or chills. Patients may require hospitalization. This type of infection has a higher risk for permanent hearing loss and may also lead to labyrinthitis ossificans, where there is bone formation in the inner ear after the infection.

Autoimmune—Autoimmune labyrinthitis is a rare cause of labyrinthitis and may come and go. It is often associated with other autoimmune disorders such as systemic lupus erythematosus, inflammatory bowel disease, rheumatoid arthritis, or other autoimmune disorders.

Trauma and surgery—Inner ear trauma puts patients at risk for developing labyrinthitis. Fractures involving the inner ear, concussion of the head and inner ear, or bleeding in the inner ear can cause labyrinthitis.

A tumor of the nerves supplying the inner ear, such as a schwannoma (acoustic neuroma), may also involve hearing loss, vertigo, or labyrinthitis. Your ENT (ear, nose, and throat) specialist, or otolaryngologist, may order an MRI to rule out this condition.

Other potential risk factors include allergies, stress, alcohol and tobacco consumption, and certain medications.

What Are the Treatment Options?

Treating most cases of labyrinthitis includes observation, bed rest, and hydration. Steroids, such as prednisone, are typically prescribed to minimize inner ear inflammation. In some cases, steroids may be injected through the eardrum into the middle ear space. Antivirals may also be prescribed. Severe nausea and vomiting may be treated with anti-nausea medications. Vertigo may be treated with antihistamines or sedatives, such as benzodiazepines, although long-term use will impair the recovery of balance function.

The treatment of bacterial labyrinthitis is to control the primary infection, which is usually a middle ear infection. This may require antibiotics, placement of an ear tube, or more advanced ear surgery. Treatment for autoimmune labyrinthitis addresses the underlying autoimmune condition with steroids or other immune modulating medications usually directed by the rheumatologist.

A multidisciplinary team involving your ENT specialist, audiologist, and vestibular therapist is important to evaluate your hearing, minimize the potential long-term effects of labyrinthitis, and discuss options for possibly restoring your hearing. For severe hearing loss, the patient may be a candidate for a bone-conduction hearing aid or a cochlear implant. When the balance organs are damaged, the brain needs time to adjust to improve balance function again. Vestibular therapy and balance exercises help many patients regain their balance.

Although labyrinthitis is not life-threatening, vertigo may rarely be a sign of a more serious disorder such as a stroke or brain tumor. Patients with sudden, persistent vertigo or additional worsening symptoms such as double vision, slurred speech, facial droop, limb weakness, or numbness should seek immediate medical attention.

What Questions Should I Ask My Doctor?

  1. What are my treatment options?
  2. When should I get a repeat hearing evaluation?
  3. What tests should I have performed?
  4. Do I need an MRI?
  5. What are the options for hearing restoration?
  6. Should I seek vestibular therapy?

Vestibular schwannoma is a benign (non-cancerous) tumor that grows on the eighth cranial nerve, which is responsible for hearing and balance.

The tumors are rare, accounting for only five to seven percent of all brain tumors. However, for the part of the brain where they are located, called the cerebellopontine angle, it is the most common tumor type.

The annual incidence of being diagnosed with a vestibular schwannoma is one per 100,000 people, with approximately 3,000 newly diagnosed tumors each year in the United States. This number may be rising as our ability to detect smaller tumors has improved. The tumor grows on the eighth cranial nerve, which travels from the inner ear to the brainstem to communicate hearing and balance information to the brain. The nerve has three distinct parts that connect to the inner ear: the superior and inferior vestibular (balance) nerves and the cochlear (hearing) nerve, which come together at the brainstem.

Vestibular schwannomas are also referred to as acoustic neuromas. It was once believed that the tumor originated on the cochlear portion of the eighth cranial nerve because hearing loss is often the first symptom. We now know that the tumor most often arises from one of the vestibular portions of the eighth cranial nerve, therefore the more accurate name is vestibular schwannoma. Both names are still commonly used and refer to the same tumor.

Vestibular schwannomas come in different sizes and cause a variety of problems. This tumor does not spread (metastasize) nor does it invade the brain, but if large enough, it can push on and squeeze the brain.

What Are the Symptoms of a Vestibular Schwannoma?

The symptoms of a vestibular schwannoma may include:

  • Sudden or gradual hearing loss (sensorineural hearing loss)
  • Ringing, roaring, buzzing, or hissing in the ears or head, known as tinnitus
  • Ear fullness
  • Vertigo, or feeling like you are spinning when you are still
  • Imbalance, or unsteadiness
  • Headache
  • Facial weakness
  • Facial numbness

What Causes a Vestibular Schwannoma?

The exact cause of most vestibular schwannomas is unknown. Ninety-five percent of tumors occur spontaneously and are found on one side (unilateral) only. A small subset of vestibular schwannomas is associated with a genetic condition called Neurofibromatosis Type 2 (NF2). NF2 is rare and results in bilateral vestibular schwannomas. Regardless of the cause, the tumor originates from Schwann cells, which insulate nerves allowing them to transmit their neural signal quickly. When a tumor develops, the Schwann cells grow too quickly and can damage the nerve. In general, vestibular schwannomas grow slowly with an average growth rate of one to two millimeters per year. However, some tumors do not grow for several years and others grow rapidly.

Researchers continue to look for potential causes of vestibular schwannomas. High-dose therapeutic radiation to the head may increase the risk. Overall, there is no clear evidence that environmental factors, such as cell phones, cause these tumors. The rising incidence of vestibular schwannomas likely relates to improvements in magnetic resonance imaging (MRI) and increased screening for concerning symptoms.

What Are the Treatment Options?

Management of vestibular schwannomas centers around three different options: observation with repeated imaging, radiation, and surgery. The decision is complex and must account for tumor size, hearing status, symptoms, patient health, patient preference, and physician preference. Weighing these factors requires a thorough discussion with your ENT (ear, nose, and throat) specialist, or otolaryngologist, and often referral to additional specialists in neurotology, neurosurgery, and/or radiation-oncology.

Tumors can be classified as small, medium, or large. In general, small tumors are less than 1.5 cm, medium tumors are between 1.5 – 2.5 cm, and large tumors are greater than 2.5 cm. As tumors grow, they tend to cause more problems including hearing loss and compression on the brainstem.

Observation—The “wait and scan” approach may be an option for small tumors or patients for whom treatment carries increased risk. Repeat imaging can help determine the tumor’s growth rate and whether symptoms are changing over time, both of which may influence eventual treatment decisions. In some patients, the tumor may grow at such a slow rate that treatment within their life expectancy is unlikely. With this option, continuing to monitor the tumor with MRIs is critical.

Radiation—Stereotactic radiosurgery (SRS) can be delivered in a single dose or the radiation may be divided into three to five treatment sessions. Radiation is often reserved for growing small- to medium-sized tumors, but other factors should be discussed with your treating physician(s). Different technologies can deliver SRS, such as Gamma Knife®, CyberKnife®, and Triology®. Research has not shown that one radiation technology is better than another. So far, proton beam technology has not been recommended for vestibular schwannoma treatment. In general, the goal of radiation is to stop tumor growth. For some patients, after radiation the tumor may enlarge or swell before it stabilizes or shrinks. Also, long-term hearing often gets worse after radiation. With this option, continuing to monitor the tumor with MRIs is critical.

Surgery—The goal of microsurgery is to remove the tumor while preserving the function of nearby nerves and the brainstem. This option may be selected for a variety of reasons, including large, symptomatic tumors or small tumors with a chance of hearing preservation. There are three primary approaches—behind (retrosigmoid/suboccipital), above (middle cranial fossa), or through (translabyrinthine) the ear—all of which require opening the skull to reach the tumor. The specific approach depends on tumor size, hearing function, and surgeon preference. After surgery, patients can expect a three- to five-day hospital stay. Further details about hospitalization and the risks of surgery should be discussed with the surgeon.

If removing the tumor jeopardizes facial function or brainstem health, a portion of the tumor may be left behind. If the portion of tumor left behind is very small, it can be monitored and sometimes does not grow. If it does grow, radiation or revision surgery may be recommended. If a larger portion of the tumor is left behind, there is an increased likelihood of needing additional treatment.

What Questions Should I Ask My Doctor?

General Questions

  1. How big is my tumor? Is it growing?
  2. How is my tumor affecting my hearing?
  3. What options do I have for treating my hearing loss?
  4. Are my family members at risk for also having a vestibular schwannoma?
  5. What kind of specialists might be needed to help manage my tumor and symptoms?

Observation Questions

  1. What are the risks and benefits of observation (“wait and scan”)?
  2. How frequently do I need repeat MRIs?
  3. How frequently do I need hearing tests?
  4. What will our plan be if the tumor grows?
  5. What should I do if I experience new symptoms?

Radiation Questions

  1. What are the risks and benefits of radiation?
  2. What type of radiation would you use?
  3. How frequently do I need repeat MRIs?
  4. How frequently do I need hearing tests?
  5. In my tumor, do you think radiation will stop its growth?
  6. What is the plan if the tumor grows despite radiation?

Surgery Questions

  1. What are the risks and benefits of surgery?
  2. What type of surgical approach would you recommend?
  3. How frequently do I need repeat MRIs?
  4. How frequently do I need hearing tests?
  5. Can you describe the process for surgical treatment including hospitalization and recovery?
  6. What is the plan if some tumor is left behind after surgery?

Autoimmune inner ear disease (AIED) is an inflammatory condition caused by an uncontrolled immune system response that attacks the inner ear causing progressive sensorineural hearing loss (SNHL) that usually starts in one ear and then affects the other ear.

The body thinks a part of the inner ear should not be there and makes antibodies and immune, also called antigen-antibody, complexes that attack the inner ear. This causes blood vessel inflammation, inner ear tissue damage, and hearing loss. Antigens are the molecules that cause an immune response and antibodies are proteins that protect the body against these antigens.

AIED is rare and diagnosed only when all other causes have been ruled out. The estimated prevalence of AIED is about 15 out of 100,000 people. AIED is felt to be responsible for less than one percent of all SNHL cases, realizing many AIED cases might not be diagnosed due to lack of specific tests.

AIED is considered “primary” when the inner ear is the only organ affected. However, in 15 to 30 percent of cases, AIED is “secondary” when it occurs as part of a larger autoimmune disorder that affects the whole body, such as rheumatoid arthritis, lupus, scleroderma, ulcerative colitis, or Sjogren’s syndrome. AIED is more common among middle-aged women.

Diagnosing AIED is challenging because there is no definite blood or imaging criteria to measure. Timing the progression of hearing loss over weeks to months is an important diagnostic clue for AIED. If AIED is suspected, early corticosteroid and immunosuppressive treatment may prevent irreversible hearing loss. A multidisciplinary team approach between an ENT (ear, nose, and throat) specialist, or otolaryngologist, an audiologist, and a rheumatologist is recommended to manage the condition.

What Are the Symptoms of AIED?

Common symptoms of AIED can include:

  • Progressive SNHL in both ears that occurs over weeks to months that is not always the same in both ears
  • Fluctuating hearing
  • Dizziness or imbalance (approximately 50 percent of AIED cases)
  • Ringing in the ears, or tinnitus
  • Ear fullness (approximately 25 to 50 percent of AIED cases)
  • Conductive hearing loss may be present due to Eustachian tube obstruction from inflamed middle ear lining and/or if AIED is because of systemic autoimmune diseases
  • Symptoms of systemic autoimmune diseases, such as fatigue, achy muscles, swelling and redness, low-grade fever, and more

What Causes AIED?

The causes of AIED can include:

  • The body’s uncontrolled immune system attacks the inner ear protein, forming immune complexes and antibodies and causing progressive hearing loss in both ears.
  • Cochlin is a protein located in the inner ear that is attacked by the immune system.
  • Endolymphatic sac, a structure of the inner ear, can become dilated as the immune response of the inner ear.

What Are the Treatment Options?

If you are having hearing loss that is getting worse in both ears over weeks to months, you should see an ENT specialist who can make a diagnosis after reviewing your hearing tests and imaging scans. If your doctor suspects that you may have AIED, you may respond well to medical therapy—steroid and immunosuppressive medication—if started early.

Corticosteroid is the main treatment to suppress the immune response to reduce inner ear swelling and inflammation. Early detection of AIED and prompt steroid treatment may help reverse your SNHL. If you cannot tolerate steroid treatment, there are alternative medications, such as cyclophosphamide, methotrexate, azathiorprine, and rituximab.

Your doctor may also evaluate you for a hearing aid or other assistive listening devices. If hearing loss is substantial, your doctor may recommend a hearing device called a cochlear implant. Speak with your doctor about other specific treatment options.

What Questions Should I Ask My Doctor?

  1. Do I have a systemic autoimmune disorder?
  2. What tests should I have performed to evaluate my hearing loss?
  3. Do I need to get an MRI to rule out other inner ear disorders?
  4. What are my treatment options for AIED?
  5. What medications are available to me?
  6. What other healthcare professionals should I see for AIED?