January 11, 2010

My first patient, Joseph, found me from the phone book.  He saw the Nurse Practitioner at his primary physician’s office.  During the examination the NP saw his right ear canal to be completely occluded with wax; consequently he recommended having the ear irrigated.  Unfortunately, the NP did not make a direct recommendation so Joseph found me in the Yellow Pages.  This will be a good opportunity to market my services to that office!  Joseph was indeed completely occluded in the right ear and had a moderate cerumen buildup in the left ear.  I irrigated his right ear about 10 times before the block of wax had egressed to the point where I could remove it with a curved buck curette.  After the large block of wax removed, there was some residual wax located near the eardrum, so one more irrigation was all that was needed to remove it.  The left ear was irrigated just once, and the canal was clear.  As is customary, a hearing test was performed after the wax was completely removed.  He had a high frequency sloping sensorineural hearing loss typical of presbycusis (age related hearing loss).  He reported being able to hear much better after the wax was removed, and did not feel his measured hearing loss affected his quality of life.  He felt that he was in pretty god shape for a 91 year old man.  I agreed with him.  I recommended to have him come back in 6 months so I could look in his ear and see if there was buildup occurring again.  The second patient was another Joseph (it must have been the day for Josephs).  He had been approved for two hearing aids from Medicaid after a long application process (about 5 months to be exact), and came in to be fit.  I had given him a loaner BTE for his left ear and he had an old ITE for the right ear (but it was insufficient for his loss); after today he had a brand new set of non-programmable digital BTE hearing aids from Personal Medical.  After an initial hiccup with the telecoil inadvertently being activated in the right ear, it was determined that both were operating quite well and he was very pleased with having both ears working together again.  I left for Dr. Hersh’s office