Hearing loss Flashcards
Introduction
- *W**ash hands
- *I**ntroduce yourself
- *P**atient’s consent
- *E**xplain procedure/purpose for Hx
PC
“What brought you in today?”
HPC
Establishes unilateral deafness/ right ear (both for G one for A) - “is the hearing loss just in your right ear or is it in both ears?”
Establishes gradual onset /6 weeks (both for P one for B) - “did it start gradually or suddenly?”, “how long have you noticed the hearing loss in your right ear?”
Ascertains has been using cotton buds - “Did you use any cotton buds in your ear?”
No recent vertigo, dizziness, tinnitus (2 for G 1 for A) - “Did you have any recent vertigo - which is when you feel like the room is spinning?”, “any dizziness?”, “any ringing in your ear?”
Asks about discharge and itch - “did you get any discharge?”, “is there any itching inside your ear?”
No recent fever/systemic illness - “are you otherwise well in yourself?”, “did you get any fever or recent illness like a cold or flu?”
ICE
Ideas - “do you have any thoughts on what could be causing your hearing loss?”
Concerns - “is there anything that’s worrying you about the hearing loss?”
Expectations - “what were you hoping we would do for you today?”
PMH
No past history of deafness, wax, tinnitus, vertigo, ear problems (4 for G ,3 for A) - “Do you have a medical history of deafness, wax in your ears, ringing in your ears, any ear problem?” (ask the questions one at a time)
DH
- “Have you tried anything for the ear?”*
- “Are you on any medications that have been prescribed by your doctor?”, “do you take any over the counter medications?”*
- “Do you have any allergies to any medications? What happens when you take the medication?”*
SH
Past History of exposure to loud noises -gunfire in army and clay pigeon shooting (both for G one for A)
“Have you ever been exposed to loud noises in the past?”
Alcohol, smoking, recreational drugs (including IVDU) - “do you smoke?”, “how much do you smoke each day?”, “how long have you smoked for?”, “have you ever smoked? How much did you smoke and for how long?”(if the patient said they don’t smoke),”do you drink?”, “how much/what do you drink each day?”, “do you use recreational drugs?”, “have you ever injected drugs or shared needles with other people?”
Occupation - “do you work?”, “what do you do for work?”, “is the hearing loss impacting your work? How?”
Home situation - “what’s your home situation like?”, “do you need help with things like cooking, washing/cleaning yourself?”
FH
“Does anyone else in your family have hearing loss or any ear problems?”
Examination
Asks to examine patient - “Would it be ok if I examine you?”
Explains to patient what procedure (Examination of ear) involves and checks patient happy to proceed ( Both for G one for A) - “I’ll be putting this probe inside your ear to get a better view of your ear canal. I’ll also be pulling up on outer ear to allow me to get the best view. This shouldn’t be painful, but if you get any pain and would like to stop the examination please let me know. Is this ok with you? Are you ready to start the examination?”
Examines ear model:
Able to switch on otoscope and correctly fit specula (Both for G)
Acceptable grip + gentle insertion of otoscope. (Both for G)
Pulls back ear lobe /explains what doing (correct method G attempts but technique poor A)
“Thank you for letting me examine you”
Counselling
Explains cause is wax and that wax is a common problem (G for both) - “From the examination I can see that you have wax in your right ear, which is a common problem that can cause some hearing loss in the affected ear”
Do not use cotton buds and why. (Both for P one for B) - “From the history, you told me that you use cotton buds. We would strongly recommend that you try not to use cotton buds in your ear as it can irritate your ear canal and push the ear wax further into your ear, which can make the problem worse”
Mentions wax softening drops (G if name used e.g. Eurax, olive oil) - “To treat this, you can use olive oil drops in your right ear, which you can get at the pharmacy/over the counter”
Guidance on using drops (e.g. head position) - “When you’re using the olive oil drops, keep your head tilted towards the opposite side as you apply the drop. After lie down on the opposite side for about 5-10 minutes after you’ve applied the drops to allow the olive oil to reach the waxy areas of your ear, then wipe off any excess oil”
Suggests syringing may not be indicated (and if so only after course of drops for softening (G for both, A for one) - “At this point you may not need synringing. And if you did need syringing, it would be done after you’ve used the olive oil drops to soften the ear wax for at least 14 days twice a day”
Syringing undertaken by either nurse by appointment or to arrange privately - “The syringing will be done by a nurse and you’ll need to book an appointment for this, or you can do this privately too”
Considers implications of possible acoustic neuroma as differential in safetynetting - “We would normally think about referring someone with one sided hearing loss for more than 3 weeks without wax, but as you have wax this can be managed without a referral”
Safety-netting
“If you notice any further symptoms like sudden ear loss in the other ear, any ringing in the ear, become very unwell, feeling like the room is spinning or if you’re worried about anything, it’s important that you come back to the surgery for a review”
Close consultation
“Thank you so much for speaking with me today. Before you go I’d like to give you a patient information leaflet. A great website to go to is NHS choices, which I’ll right on a piece of paper for you to take home with you.”
