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NB/ perform otoscopy and inspection on the mannikin and tuning fork on the patient |
| Patient info |
Hearing loss on the left side for 4months. You also have balance problem, dizziness, and numbness in your face. Your father had a similar condition but you don’t know the problem. You have noticed that when you close your eyes or when it gets dark you become dizzy and unsteady on your feet (Romberg +). Patient must demonstrate sensorineural hearing loss on the left side |
| Intro |
How can I help you today? |
| History |
Explore hearing loss (complete or partial/ ringing sensation (what does it like? How often does it happen? any particular time?) + Cardinal symptoms |
| Concern |
Apart from that, what’s your main concern? |
| D.D |
DD of ear, Red flags: rash, fever, vomiting |
| P2 |
Have you ever had such condition before? Previous medical conditions |
| Р3 |
DESA, MAFTOSA (occupation) |
| Finishing Hx |
Thank you for the information you gave me |
| Expectations |
What do you expect from today’s visit? |
| Examination |
Observations + Ear (full exam) + throat + Romberg’s test (+) + CN7,8,5 |
| Ideas |
Do you have any idea what might be causing your hearing loss? |
| Provisional diagnosis |
It is a growth in the nerve that is responsible for hearing and balance and it comes with hearing loss on the affected side and the other symptoms. It is not cancerous |
| Management |
Urgent referral to ENT: they would reassess you and perform more investigations like MRI of the brain and Audiometer (special hearing test). if diagnosis is confirmed then surgery is the 1st line as treatment Investigations: Routine bloods CBC Advice: stop driving, don’t go in the dark alone because of balance problem. Safety netting: discharge, fever |
| Please at any time if you have questions or concerns, let us know |
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| Questions |
Sudden hearing loss: One ear: ear wax, ear infection, perforated TM, Meniere’s disease. Both ears: damage from the very loud noise, taking certain meds. Gradual hearing loss: One ear: something inside the ear (fluids), bony growth (otosclerosis), build up skin cells (cholesteatoma) Both ears: aging, exposure to loud noises over years |