History

Age: 4 years, 6 months

Gender: Male

The patient was seen in an ENT clinic setting. The boy’s mother reported that he has had chronic ear problems, mostly with his right ear, that the pediatrician believed would resolve with conservative medical treatment. This is their first visit to the ENT / audiology clinic.

Otoscopy:

The left ear appears relatively normal. A cone of light is seen, the shadow of the manubrium of the malleus is visible.  The right ear is grossly abnormal. There may be debris in front of the eardrum, or alternatively the eardrum may be buldging outward. The audiologist is unsure.

In this setting, the audiologist and ENT typically are seeing patients at the same time; however, the ENT has not yet arrived.  Normally, the audiologist would have asked the ENT to evaluate the external ear canal prior to testing, but that was not an option.  This was one of NSU’s student training clinics – the preceptor and student are testing the boy together.

The boy was very active – in a word a “handful.”