Fast-Paced Review
Today's clinical
experiences seemed like a faster paced review of my prior 3 years. The late
afternoon appointment involved a middle-aged woman who has experienced a rash
of medical problems throughout her life requiring procedures and harsh
medications, including two middle ear surgeries and a quadruple bypass.
She walked into the
room with pep in her step, proud of the fact she had found some time to take
care of her hearing problem. She remarked there was a change in the air, that
this may be the last nuisance to pop up, at least for a little while. The
audiogram showed a moderate, reverse sloping sensorineural hearing loss in the
right ear. Odd, but fixable. The left ear was a different story. There were
air-bone gaps present across the board except at, you guessed it, 2kHz. My old
friend, Carhart's notch. I glanced at the tymp results to make sure Type A was
the right call. After confirming, I spoke with my preceptor, who agreed to
recommend a referral to a neurotologist in Arkansas.
Audiologists are not
charged with the responsibility of making medical diagnoses, but it seems as
though the poor woman may have another surgery on the horizon. If it turns out
to be otosclerosis, it's certainly not as frightening as open-heart surgery,
but is still yet another obstacle for her. I admired her approach, immediately
asking for the best physician recommendation and thinking in terms of
solutions. If the patient had any pity for herself, it certainly wasn't
apparent. She was excitedly talking about trout fishing before leaving the
patient room. Witnessing her mentality made staying close to two hours late
finishing reports a breeze. And who knows? Maybe she will come see us again for
the right ear down the road.