Dead Ear

A 25 year old male student who fell over whilst drunk. He sustained a temporal bone fracture and right dead ear. His ambition is to join the Navy. CT scan and audiogram will be provided. Please explain the results to the patient and answer any questions or concerns he may have.

Setting

  • WIPER  (wash hands, introduce yourself, permission, expose patient, reposition)
  • Ask if happy to see you
  • Introduce Head and Neck Specialist Nurse
  • Ask if wants any family/friends presen

Perception

  • Recap on past events – symptoms – dead ear, other ear symptoms? Screen meningitis, CSF leak. Investigations done so far
  • “Thank you for bringing me up to date.”

Invitation 

  • Can I go over my examination findings with you now
  • “Is there anybody else you would like to be present?”

Knowledge

  • Use an audiogram if present.
  • Unfortunately it is not good news.
  • This tells us that the hearing in that ear is gone beyond repair- Pause

Depending on fracture type

  • Longitudinal fractures (80%)  – more likely conductive hearing loss – may resolve follow up in 6 weeks, If persists may have ossicular chain disruption (us incus dislocation) may benefit from tympanoplasty
  • Transverse Fractures (20%) – more likely sensorineural hearing loss  likely to persist. Nb if with vertigo, the brain will adapt + improve. Will need Hearing aids, If bilateral – consider cochlear implant

Answer questions

  • Can he join the NAVY? – According to my understanding no, but he will need to check the Ministry of Defense’s latest guidance. Cannot join any uniform jobs

Empathy

  • “I am sorry to have to give you this news today.”
  • “I can see this is a huge shock” Pause and wait

Strategy and Summary

  • We can offer you a hearing aid – CROS aid, BAHA
  • Technology great – Bluetooth
  • Refer to audiology
  • MUST protect the other ear. – Loud noises, alcohol (cause of fall), motorcycle
  • If any problems with the other ear – seek urgent medical attention. I’ll write to your GP that if there are any problems we would like to see you

Summary

  • Today we have talked about…. 
  • Do you have any further questions?
  • Once again my name is…
  • Secretary number
  • Book an appointment for 1-2 weeks, can come with a friend or relative.
  • Some literature on the diagnosis


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