C09975596 / invoice 10000

Appointment Reason: Recheck Ear, Appointment Notes: ear, tilting, shaking head, doesnt seem to be resolvinghistory - in for ear flush/pluck 3 weeks ago, recheck 2 weeks ago - started on apoquel as invue all clear. end of last week (7d post starting apoquel) seemed worse, head tilt + shaking head a lot. left ear most affectedover the weekend did seem to improve, O thinks a lot better today. but worried still residual issue. very head shy - examined ears in treatment room. left ear TM visible, looks whole, but has cloudy white linear oppacity running down the middle - scar tissue? canal clear, very littel wax present, almost no hairs present. no inflammation in canal. right ear large clump of wax present at base blocking view of TM - flushed with sterile saline to try and help break up. but canal clear, no inflammation. if head tilting then concerned re possibly inner ear involvement? advised nothing down ear now, can continue using apoquel as required - can have repeat script if requested. if head tilt returns then consider referal for CT for imaging of inner ear? no evidence of continued infection today.     Vital Signs