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Earwax

Practice this case based on how you are assessed in your OSCEs, and use the relevant sections for general revision. 🤓

 

Doctor Instruction:


You are a doctor working in family medicine. Your next patient is called Chad Mander, a 21-year-old gentleman presenting with hearing difficulty. Please take a history and perform an appropriate examination.


 

Patient History:


Chad Mander, a 21-year-old male student


You are coming in today as your hearing has gradually worsened in the past few weeks. During lectures, you now struggle to hear what the professor is saying, and you have to sit in the front row to hear more clearly. If asked specifically, you think hearing loss only affects the right ear. You tried using cotton buds to clean your right ear, and symptoms remain the same, if not worse.


Your right ear feels uncomfortable and full as if something is inside the ear, and your right ear can sometimes get itchy.


There's no pain in the ears. No recent flu-like symptoms/ infection. No fever. You do not feel dizzy. There's no ringing noise in the ears. No ear discharge. You don't wear a hearing aid or have any grommets in place. You didn't put anything abnormal into your ears lately.


Idea, Concern, Expectation:

  • You want to know what is going on. You hope it is not an ear infection. You are concerned, as this is beginning to affect your ability to do well at the university. You hope to get a first for your English Literature degree this year. You hope to find out what is going on.


Past Medical History:

  • Depression, Anxiety.

  • No history of ENT surgery.


Drug History:

  • Sertraline

  • NKDA


Family History:

  • Nil


Social History:

  • You currently live with your parents to save money for uni. You do not smoke. You drink only occasionally - 1-2 pints per week with your mates. You are currently a first-year university student studying English Literature. You are independent at home.


 

Examination Findings:

  • Conductive hearing loss (right)

  • Impacted ear wax completely covering the tympanic membrane in the right ear on otoscopy


 

Differentials:

  1. Impacted earwax (right)

  2. Keratosis obturans

  3. Foreign body

  4. Eustachian tube dysfunction

  5. Otitis external


 

Investigations:

  • Clinical Diagnosis

  • Otoscopy

  • Consider an audiogram if the hearing impairment is persistent and impaction has been removed


 

Management:

  • Watch and wait - the ear naturally regulates and removes wax in the ear canal

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