Patient:   J.S.

Age:  3 years 7 months

Gender:  Male

J.S. is seen due to parental concern about his hearing.  Testing was conducted at a not-for-profit clinic that sees patients on a sliding fee-for-service schedule (reduced costs based on financial limitations).

J.S. has a history of recurrent ear infections with no other significant health problems.  His parents are not concerned about his speech and language development and observation of his skills does not suggest cause for concern.  There is no family history of hearing loss.  J.S. appears healthy at today’s evaluation; he reportedly had a cold last week.

Otoscopic inspection does not reveal any reddening of the ear canals, but there is visualization of what looks like bubbles behind the eardrums.

Tympanometry –  right ear -250 daPa, static compliance 0.35, tympanometric width 290 daPa.  Left ear -400 daPa with a mounded peak, static compliance 0.25, tympanometric width 400 daPa.

Audiometrics are shown below.  8000 Hz was not tested because, although the child was VERY cooperative, and very bright, we didn’t want to “fatigue” him.  (In retrospect, it might have been better to omit 2k rather than 8k.)

WIPI – 10 select items each ear using words the mother indicated were in the child’s vocabulary.

The child’s mother was advised that “it looks as if  ’ear infection’ is lingering even after the cold has resolved, and the safest course of action is to take J.S. to the pediatrician.  The child’s mother indicates that she does not have insurance, the family’s income is above the state’s limits for qualifying for Medicaid, and that the family is having financial difficulties. The pediatrician will see the child if payment in full cannot be made but “she likes to be able to at least pay something on the bill each time she goes”.  She asks if it is really essential that J.S. see the pediatrician.

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