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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from Trevor. You are not required to examine him. The results of an appropriate examination will be available from the facilitator on request. Outline the most likely diagnosis to the patient and initial suggestions for management.

Scenario

Trevor Watts is a 41-year-old man. For the last few months he has noticed a ringing sound in his right ear and sometimes there is ringing in his left ear. At first it did not bother him but now he is finding it very hard to live with. It is beginning to interfere with his sleep and it is getting him down.

He has no known deafness, balance problems or pain in his ears.

He is otherwise well.

The following information is on his summary sheet:

  • Past medical history

  • Laceration left leg following motorcycle accident aged 20

  • Medication

  • Nil

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date. Last immunisation three years ago; ADT

  • Social history

  • Office manager.

INSTRUCTIONS FOR THE PATIENT, TREVOR WATTS

You are 41 years old and work as an office manager. For the last few months you have noticed a ringing sound in your right ear, and more recently an occasional ringing also in your left ear. At first it did not bother you but now you are finding it very hard to live with. It is beginning to interfere with your concentration and sleep and it is getting you down.

You have no known deafness, balance problems, vertigo or pain in your ears. You are otherwise well. You do not take any medication.

In your late teens and early twenties, you were a drummer in a successful rock and roll band. ‘The louder the music the better’ was your motto. You have always worked in an office environment in one capacity or another.

You live with your girlfriend and her two children from a previous relationship. You smoke 20 cigarettes a day and drink 10 stubbies of beer every Friday and Saturday night.

The following information is on your summary sheet:

  • Past medical history

  • Laceration left leg following motorcycle accident aged 20

  • Medication

  • Nil

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date. Last immunisation three years ago; ADT

  • Social history

  • Office manager.

INFORMATION FOR THE FACILITATOR

Clinical examination findings

Pulse 68 regular

BP 132/82 mmHg

No objective tinnitus

Inspection of the ears, including otoscopy: normal pinnas, external auditory canal and eardrums

Hearing—normal whisper test, normal Rinné and Weber tests

Balance—normal Romberg’s test

Audiometry—bilateral sensorineural high frequency deafness

Cranial nerves normal.

SUGGESTED APPROACH TO THE CASE

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