The patient returned in June.  It was not clear that medical intervention had occurred.

Otoscopic inspection revealed mild cerumen accumulation in the left ear with a clear right ear canal.  As shown in the tympanograms below, there is negative pressure right and greater middle ear involvement left.  Ear canal volumes are 0.8 cc in each ear.  Otoacoustic emissions were absent in each ear.  Behavioral testing was attempted, but the patient would not condition.