Hearing problem

Question 1

Differential diagnosis

Answer 1

Ear wax
Otitis externa
Presbycusis
Acoustic neuroma

Question 2

HPC

Answer 2

SOCRATES:

• Gradual and ears feel blocked- more likely wax
• Tried anything for it (e.g. drops)?
• Ears feel full
• Itching?
• Pain
• Tinnitus
• Vertigo
• Facial numbness or weakness (think acoustic neuroma)
• Discharge (OE)
• Recent fever/systemic illness
• Putting anything in your ears? Cotton buds?
• Any exposure to loud noises in life?

Question 3

PMH

Answer 3

• Deafness
• Tinnitus
• Wax
• Vertigo
• Ear problems

Question 4

Examination

Answer 4

Otoscope

Question 5

Treatment of Ear wax

Answer 5

Don’t use cotton buds - push wax in further
Olive oil drops 3-4 x day for a week- explain how to use

• Could consider syringing in the future if symptoms persist (CI deafness in other ear, perforated eardrum) - done by nurse at GP
• We would consider referral if unilateral hearing loss for more than 3 weeks without any wax
• Leaflet

Question 6

SN

Answer 6

Return if hearing hasn’t improved at all in 2 weeks

Come back sooner if get new symptoms e.g. tinnitus, vertigo, or facial numbness

Question 7

Otitis externa treatment

Answer 7

• Avoid cotton buds
• Keep ears dry, use a hairdryer after shower
• Avoid swimming or water sports until symptoms are gone
• Paracetamol+/- ibuprofen for pain
• Topical antibiotic and steroid for at least 7d (e.g. quinolone and corticosteroid)

Question 8

Presbycusis

Answer 8

Progressive bilateral hearing loss at high frequencies

Refer for an audiogram test, then for hearing aids if needed