ENT Station 1

Setting:

You are a doctor working in GP/family medicine. This patient presented with hearing loss.

Name: Amelia Sheikh

Tasks:

1. Take a history from the patient.

2. Counsel the patient on the next steps of investigation

3. Give your preferred diagnosis to the examiner.

4. Please answer the examiners question.

You are not required to examine the patient.

Briefing

Diagnosis: Otosclerosis presenting with hearing loss
You are Amelia Sheikh, a 31 year old female.
In this scenario we are asking you to role play a patient attending your GP after you noticed some hearing loss.

Appearance and Behaviour

Nil significant, occasional problems hearing but do not stop the progression of the history.

Opening statement

“It’s very strange, I’ve noticed my hearing seems to be reducing. I do listen to music when I’m running or at the gym but don’t feel the volume is particularly loud. I’ve stopped using headphones but it doesn’t seem to be making a difference.”

Information to Give Freely

It started a couple of months ago, and now I find myself struggling to hear children when I am teaching. I don’t know what’s going on…. but I hope I don’t need hearing aids!”

Presenting Complaint

Site - both ears are affected and both seem to be equally affected.
Onset - gradual onset. Progressing over the past 8 months.
Character - the hearing loss is persistent. It impacts both low and high pitch sounds.
Associated symptoms -

Infection - no discharge, no erythema, no pain, no throat / cough or cold symptoms

Inner ear symptoms - some tinnitus (not pulsatile), no vertigo / dizziness, no fullness in the ear

Head and neck lesions - no swallowing issues, no neck lumps, no nose bleeds

Exacerbating/relieving factors - nothing has trigger it. No recent head injury/falls or trauma/cotton bud use. Popping your ears doesn’t help.
Severity - deny complete hearing loss, but you are a teacher and you are struggling to hear children in class.

Past Medical History

Previous similar episodes - None
Other medical conditions - None
Previous surgeries - None

Drug History

Prescribed - None
Over the counter - Nil, specifically no aspirin/diuretic use
Allergies - None

Family History

Mother had hearing loss at the age of 40. You are not sure of her formal diagnosis.

Social History

Smoking - Nil
Alcohol - Nil
Job - Teacher
ADLs - fully independent
Travel - no recent flights
Hobbies - NO scuba diving or swimming

Systems Review

ENT - as above
Infective - Nil
Headache / vision - Nil
Neurology - Nil peripheral weakness or numbness
Voice / Swallow - Nil
Chest / Abdo / Resp / Urinary - Nil other symptoms

Ideas / Concerns / Expectation

Ideas - “Is it something to do with headphone use?”
Concerns - “I am too young to have hearing loss, is this normal?”
Expectations - “I want a solid plan on how we are going to get to the bottom of this please. I want to know what is going on!”

Discussion / Questions

After the history is complete the doctor will discuss further tests and plans, you should be receptive to this.