The patient was referred to ENT.  The ENT’s notes are below.

Medical Evaluation Notes

Preoperative notes: Right TM has a dimeric zone but is intact. Otitis media with conductive hearing loss. Left has near total perforation.

• What is a dimeric zone?

Operative report: Left tympanoplasty and ossicular chain reconstruction.  Tympanosclerosis leading to fixation; stapes is mobile.  Reconstructed incus on top of stapes in anatomic position. Tip of malleus trimmed to free it from adhesion to promontory.  A medial onlay graft created from fascia.

Postoperative notes:  Patient reports numbness of pinna, audiological evaluation shows continued improvement.  Patient has psychological problems, wants to continue on Tylenol #3.  Informed him that this is his last refill.  Is trying tricyclic antidepressant with primary care physician. Reports decreased taste on left side of mouth.  Has a peculiar feeling as if his ear is contracting or blocking out when head turns left, in cold, or when chewing. Suspect cross mingling of the nerve fibers between chorda tympani fibers which come off of facial nerve and those that are part of V or III, the other sensory distributions within the pinna itself.

Subsequent event: Patient returned demanding another refill of Tylenol #3, became threatening when physician refused.  Patient removed from hospital by security.

• What is “tylenol #3″?