During a routine cranial nerve examination of a different patient, the following results were obtained:
Rinne’s test: Air conduction > bone conduction in both ears
Weber’s test: Localises to the left side
What do these test results indicate?
A 20-year-old woman complains of hearing difficulties over the last six months. She initially suspected it was due to earwax, but her hearing has not improved after ear syringing. You conduct an auditory system examination, including Rinne’s and Weber’s tests:
Rinne’s test: Left ear: air conduction > bone conduction
Right ear: air conduction > bone conduction
Weber’s test: Lateralises to the left side
What is the significance of these test results?
A 24-year-old-man schedules an appointment due to a nose injury he sustained while playing soccer two days ago. He reports that his nose bled for a few minutes after the injury but has not bled since. He also mentions that his nose did not appear deformed after the incident. He has not sought medical attention before this appointment and is generally healthy with no long-term medications.
During the examination, you notice no signs of nasal bone deviation, but there is significant swelling in the surrounding soft tissue. On anterior rhinoscopy, you observe a bilateral fluctuant swelling of the nasal septum that almost blocks the nostrils.
What is the most suitable course of action?
A 35-year-old man comes to the clinic complaining of vertigo that has been ongoing for 5 days. He reports having a recent viral upper respiratory tract infection. The patient is in good health overall and experiences nausea but no hearing loss or tinnitus. During the examination, the doctor observes fine horizontal nystagmus. What is the probable diagnosis?
A 26-year-old man presents to your emergency clinic with worsening pain in his right ear. He had previously been diagnosed with otitis externa and started on antibiotic ear drops by another physician four days ago. However, he reports that the pain has only gotten worse and he has been unable to apply the drops for the past 24 hours due to swelling of the canal. Upon examination, you notice that the right external auditory canal is completely swollen shut and you are unable to see any further. The patient’s vital signs are normal.
What is the most appropriate course of action for management?
Sarah is an 80-year-old woman who visits your clinic with complaints of hearing difficulty. During the examination, you observe that she has impacted earwax in both ear canals. You suggest using olive oil ear drops, but she informs you that she has previously tried them without success.
What would be your next course of action in managing the earwax?
A 15-year-old girl comes to your clinic with her father for an urgent appointment. Yesterday, while playing basketball, she injured her left ear. Initially, she didn’t feel much discomfort and continued playing. However, this morning she woke up with a swollen left ear. She reports no hearing loss or discharge from the ear. She appears to be in good health.
Upon examination, you notice a significant hematoma on her left ear. Otoscopy reveals no damage to the eardrum, and basic hearing tests are normal.
What is the most appropriate course of action?
A 6-year-old-girl presents with persistent hearing loss. Her mother reports concerns from her teachers that she doesn’t seem to pay attention in class. She reports the girl often turns up the volume of the television while at home. On examination, the right eardrum is retracted and there is loss of the light reflex. You suspect otitis media with effusion and arrange pure tone audiometry which reveals moderate hearing loss particularly at low frequencies. She presented to your colleague 10 weeks previously with similar symptoms, with similar audiometry findings.
What is the next most appropriate management in primary care according to the current NICE CKS guidance?
A 9-year-old patient had a tonsillectomy 4 days ago. His father has brought him to the clinic as earlier today he noticed a small amount of bright red bleeding from his mouth. He is otherwise recovering well and has been eating and drinking normally.
What is the best course of action for managing this patient’s bleeding?
A 7-year-old girl comes to the GP with her mother because she has been experiencing hearing difficulties in her left ear. She has a history of glue ear and has had grommets inserted in the past. During an otoscopy of the left ear, there is a significant buildup of earwax in the external auditory canal, and although the grommet is visible, the tympanic membrane is obscured. The right ear appears normal.
What would be the best course of action for management?