Case Scenario 1
Lets Begin
Personal Information
Name: Doris Jones Age: 54 Reason for the appointment: She has recently experienced a sensation of fullness in left ear and has been finding it difficult to hear. This issue has been troubling her for the past few months, although she had no previous concerns about her hearing or ears before this time.
Otoscopy Results
Case History
Based on her symptoms, case history, and the otoscopy results, what do you think she is experiencing?
Wax
Normal
Otitis Externa
Normal?
After leaving your clinic, the patient remained concerned and continued to experience symptoms of hearing difficulties and fullness in the left ear. Consequently, they visited their General Practitioner, who confirmed the presence of occluding wax in the left ear. Once the wax was removed, their symptoms resolved. The patient returned to you upset, stating that you should have identified the wax and provided assistance. They expressed that they would not return to your service.
How could I have handled this better?
How could I have handled this better?
Small amounts of ear wax are healthy, but you should still be able to see the eardrum and identify its normal features. In this case, the wax was fully occluding the ear, causing symptoms and making the eardrum invisible. They would have benefited from being referred for microsuction, which is an appropriate management strategy in this situation. Remember, you have a multidisciplinary team at your disposal. If you're unsure about what you're seeing or want a second opinion, request a remote review for advice from the TympaHealth clinical team.
Enter the code below to move to the next scenario. 34520
RESTART
How will you manage this situation?
You have determined that this client has earwax buildup. What will you do next?
Would you refer this person for microsuction, given that the wax appears suitable for removal and the client is symptomatic?
Would you refer them to the GP as you believe it is beyond your scope of practice due to the darkness of the wax?
Would you request a remote review, as you are uncertain whether to refer or not?
Would you refrain from taking action as you do not consider it to be sufficient wax to remove from the person's ear?
Wax Removal
This is an appropriate management plan Because the client is experiencing symptoms such as fullness and hearing difficulties, and because the occluding wax is preventing a health assessment of the eardrum, this justifies referring the patient for wax removal.
Well Done
You refer the patient for microsuction for wax removal. At their next appointment, the wax is successfully removed and the client is delighted. Afterwards, they recommend their friends and family to see you, as they were able to access your service easily and did not need to wait long.
Remote Review
This is an appropriate management plan. There is no harm is asking the TympaHealth Clinical Team for advise regarding wax management. Most often, we would suggest advising the patient to use olive oil (e.g. Earol®) for 7 days, and if wax is very hard, advise them to alternate for a week between olive oil and Sodium Bicarbonate drops (could apply through the aural speculum as this will act as a funnel). The sodium bicarbonate will allow the wax to break down in order for the olive oil to penetrate in easier.
How could I have handled this better?
Well Done
After receiving guidance from the TympaHealth clinical team, you felt confident to refer this patient for microsuction. At their next appointment, the procedure to remove the wax was successful, much to the client’s delight. Subsequently, they enthusiastically referred their friends and family to you, appreciating the easy access to your service and the minimal waiting time.
Unnecessary Referral
After leaving your clinic, the patient waited 4 weeks to receive treatment from their General Practitioner. During this time, they felt very miserable. At the GP consultation, the patient mentioned their visit to you, which left the GP bemused as to why they had not been booked for a further appointment for microsuction to remove the wax. The patient returned to you upset, stating that you should have identified the wax and provided assistance at the time. They expressed that they would not return to your service.
How could I have handled this better?
How could I have handled this better?
Keep in mind that wax can vary in colour; the darker it appears, the older it is. They would have benefited from microsuction, which is an appropriate management strategy in this situation. Remember, you have a multidisciplinary team at your disposal. If you're unsure about what you're seeing or want a second opinion, request a remote review for advice from the TympaHealth clinical team.
Inappropriate Management
After leaving your clinic, the patient did not know where to go and continued to suffer from fullness and hearing difficulties in the left ear. They suffered with these difficulties for months. During this time, they felt very miserable. At the GP consultation, the patient mentioned their visit to you, which left the GP bemused as to why they had not been booked for a further appointment for microsuction to remove the wax. The patient returned to you upset, stating that you should have removed the wax and provided assistance at the time. They expressed that they would not return to your service.
How could I have handled this better?
How could I have handled this better?
Bear in mind, if the client shows symptoms and more than 50% of the ear canal is filled with wax, it is necessary to remove it. Moreover, if wax obstructs your view and prevents a complete assessment of the eardrum's health, it is advisible to remove it. Both criteria were met for this patient, therefore a referral for wax removal via microsuction was the appropriate management plan.
How will you manage this situation?
You have determined that this client has Otitis Externa. What will you do next?
Would you refer this person for microsuction, because you think it is within the microsuction practitioner’s scope of practice to remove it?
Would you request a remote review, as you are uncertain whether to refer or not?
Would you refer them to the GP or prescribing pharmacist as you believe it is beyond your scope of practice as they have Otitis Externa.
Wax?
The microsuction practitioner reviewed the pre- and post-images taken with your Tympa device. The practitioner clarified that it was wax, not Otitis Externa. The patient returned to you upset, claiming that you lack the necessary skills to examine ears properly and need more training. They stated that they would not return to your service.
How could I have handled this better?
How could I have handled this better?
Remember, you have a multidisciplinary team at your disposal. If you're unsure about what you're seeing or want a second opinion, request a remote review for advice from the TympaHealth clinical team.
Remote Review
This is an appropriate management plan. There is no harm is asking the TympaHealth Clinical Team for advice. We would of confirmed in this case it was wax. Most often as a result, we would suggest advising the patient to use olive oil (e.g. Earol®) for 7 days, and if wax is very hard, advise them to alternate for a week between olive oil and Sodium Bicarbonate drops (could apply through the aural speculum as this will act as a funnel). The sodium bicarbonate will allow the wax to break down in order for the olive oil to penetrate in easier.
How could I have handled this better?
Well Done
After receiving guidance from the TympaHealth clinical team, you were aware that it was in fact, wax and not Otitis Externa. As a result you could proceed with the wax removal as it is within your scope of practice. You refer the patient to the microsuction practitioner for wax removal, which is successful, much to the client’s delight. Subsequently, they enthusiastically refer their friends and family to you, appreciating the easy access to your service and the minimal waiting times.
Unnecessary Referral
After leaving your clinic, the patient was under the impression that they had Otitis Externa in the left ear. Concerned, they visited their GP and showed the pre- and post-images taken with your Tympa device. The GP clarified that it was wax, not Otitis Externa. The patient returned to you upset, claiming that you lack the necessary skills to examine ears properly and need more training. They stated that they would not return to your service.
How could I have handled this better?
How could I have handled this better?
Remember, you have a multidisciplinary team at your disposal. If you're unsure about what you're seeing or want a second opinion, request a remote review for advice from the TympaHealth clinical team. In this case, we would have advised you that it was wax and therefore you could have booked the patient in with the microsuction practitioner.
V1 Case 1 Wax Scenario
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Transcript
Case Scenario 1
Lets Begin
Personal Information
Name: Doris Jones Age: 54 Reason for the appointment: She has recently experienced a sensation of fullness in left ear and has been finding it difficult to hear. This issue has been troubling her for the past few months, although she had no previous concerns about her hearing or ears before this time.
Otoscopy Results
Case History
Based on her symptoms, case history, and the otoscopy results, what do you think she is experiencing?
Wax
Normal
Otitis Externa
Normal?
After leaving your clinic, the patient remained concerned and continued to experience symptoms of hearing difficulties and fullness in the left ear. Consequently, they visited their General Practitioner, who confirmed the presence of occluding wax in the left ear. Once the wax was removed, their symptoms resolved. The patient returned to you upset, stating that you should have identified the wax and provided assistance. They expressed that they would not return to your service.
How could I have handled this better?
How could I have handled this better?
Small amounts of ear wax are healthy, but you should still be able to see the eardrum and identify its normal features. In this case, the wax was fully occluding the ear, causing symptoms and making the eardrum invisible. They would have benefited from being referred for microsuction, which is an appropriate management strategy in this situation. Remember, you have a multidisciplinary team at your disposal. If you're unsure about what you're seeing or want a second opinion, request a remote review for advice from the TympaHealth clinical team.
Enter the code below to move to the next scenario. 34520
RESTART
How will you manage this situation?
You have determined that this client has earwax buildup. What will you do next?
Would you refer this person for microsuction, given that the wax appears suitable for removal and the client is symptomatic?
Would you refer them to the GP as you believe it is beyond your scope of practice due to the darkness of the wax?
Would you request a remote review, as you are uncertain whether to refer or not?
Would you refrain from taking action as you do not consider it to be sufficient wax to remove from the person's ear?
Wax Removal
This is an appropriate management plan Because the client is experiencing symptoms such as fullness and hearing difficulties, and because the occluding wax is preventing a health assessment of the eardrum, this justifies referring the patient for wax removal.
Well Done
You refer the patient for microsuction for wax removal. At their next appointment, the wax is successfully removed and the client is delighted. Afterwards, they recommend their friends and family to see you, as they were able to access your service easily and did not need to wait long.
Remote Review
This is an appropriate management plan. There is no harm is asking the TympaHealth Clinical Team for advise regarding wax management. Most often, we would suggest advising the patient to use olive oil (e.g. Earol®) for 7 days, and if wax is very hard, advise them to alternate for a week between olive oil and Sodium Bicarbonate drops (could apply through the aural speculum as this will act as a funnel). The sodium bicarbonate will allow the wax to break down in order for the olive oil to penetrate in easier.
How could I have handled this better?
Well Done
After receiving guidance from the TympaHealth clinical team, you felt confident to refer this patient for microsuction. At their next appointment, the procedure to remove the wax was successful, much to the client’s delight. Subsequently, they enthusiastically referred their friends and family to you, appreciating the easy access to your service and the minimal waiting time.
Unnecessary Referral
After leaving your clinic, the patient waited 4 weeks to receive treatment from their General Practitioner. During this time, they felt very miserable. At the GP consultation, the patient mentioned their visit to you, which left the GP bemused as to why they had not been booked for a further appointment for microsuction to remove the wax. The patient returned to you upset, stating that you should have identified the wax and provided assistance at the time. They expressed that they would not return to your service.
How could I have handled this better?
How could I have handled this better?
Keep in mind that wax can vary in colour; the darker it appears, the older it is. They would have benefited from microsuction, which is an appropriate management strategy in this situation. Remember, you have a multidisciplinary team at your disposal. If you're unsure about what you're seeing or want a second opinion, request a remote review for advice from the TympaHealth clinical team.
Inappropriate Management
After leaving your clinic, the patient did not know where to go and continued to suffer from fullness and hearing difficulties in the left ear. They suffered with these difficulties for months. During this time, they felt very miserable. At the GP consultation, the patient mentioned their visit to you, which left the GP bemused as to why they had not been booked for a further appointment for microsuction to remove the wax. The patient returned to you upset, stating that you should have removed the wax and provided assistance at the time. They expressed that they would not return to your service.
How could I have handled this better?
How could I have handled this better?
Bear in mind, if the client shows symptoms and more than 50% of the ear canal is filled with wax, it is necessary to remove it. Moreover, if wax obstructs your view and prevents a complete assessment of the eardrum's health, it is advisible to remove it. Both criteria were met for this patient, therefore a referral for wax removal via microsuction was the appropriate management plan.
How will you manage this situation?
You have determined that this client has Otitis Externa. What will you do next?
Would you refer this person for microsuction, because you think it is within the microsuction practitioner’s scope of practice to remove it?
Would you request a remote review, as you are uncertain whether to refer or not?
Would you refer them to the GP or prescribing pharmacist as you believe it is beyond your scope of practice as they have Otitis Externa.
Wax?
The microsuction practitioner reviewed the pre- and post-images taken with your Tympa device. The practitioner clarified that it was wax, not Otitis Externa. The patient returned to you upset, claiming that you lack the necessary skills to examine ears properly and need more training. They stated that they would not return to your service.
How could I have handled this better?
How could I have handled this better?
Remember, you have a multidisciplinary team at your disposal. If you're unsure about what you're seeing or want a second opinion, request a remote review for advice from the TympaHealth clinical team.
Remote Review
This is an appropriate management plan. There is no harm is asking the TympaHealth Clinical Team for advice. We would of confirmed in this case it was wax. Most often as a result, we would suggest advising the patient to use olive oil (e.g. Earol®) for 7 days, and if wax is very hard, advise them to alternate for a week between olive oil and Sodium Bicarbonate drops (could apply through the aural speculum as this will act as a funnel). The sodium bicarbonate will allow the wax to break down in order for the olive oil to penetrate in easier.
How could I have handled this better?
Well Done
After receiving guidance from the TympaHealth clinical team, you were aware that it was in fact, wax and not Otitis Externa. As a result you could proceed with the wax removal as it is within your scope of practice. You refer the patient to the microsuction practitioner for wax removal, which is successful, much to the client’s delight. Subsequently, they enthusiastically refer their friends and family to you, appreciating the easy access to your service and the minimal waiting times.
Unnecessary Referral
After leaving your clinic, the patient was under the impression that they had Otitis Externa in the left ear. Concerned, they visited their GP and showed the pre- and post-images taken with your Tympa device. The GP clarified that it was wax, not Otitis Externa. The patient returned to you upset, claiming that you lack the necessary skills to examine ears properly and need more training. They stated that they would not return to your service.
How could I have handled this better?
How could I have handled this better?
Remember, you have a multidisciplinary team at your disposal. If you're unsure about what you're seeing or want a second opinion, request a remote review for advice from the TympaHealth clinical team. In this case, we would have advised you that it was wax and therefore you could have booked the patient in with the microsuction practitioner.