C10005842 / invoice 10000

Reason: Patient recheck
Presented by: Pear
History:
- See previous
- R ear is much improved but still not 100% acc. to O
O's assessment:
- Dubious

Examination:
Demeanour: BAR
EARS:
- L ear NAD
- R ear faint odour
- Erythema at cranial aspect of canal entrance
- Unable to examine otoscopically
- Swab taken with difficulty reveals +++ black discharge

Lab:
- No cocci
- Masses of non-nucleated squames

Assessment:
- Not happy with progress here
- Residual inflammation despite topical + oral medication
- Lots on discharge without infection
- Unilateral

Treatment:
- Continue pred 10mg SID 7d then drop to 10mg EOD

Plan:
- Flush with C&S under GA Monday

Reason: Patient recheck
History: Ongoing R OE
- Only partial response
- Good compliance
- Still headshaking
O's assessment:
- Not as good as they thought
- GIT signs resolved rapidly and spontaneously

Examination:
EARS:
- Marked erythema pinna folds
- Mild odour
- Cannot examine otoscopically

Lab: 1+ cocci (cf. 3+ cocci last week); 3+ keratinocytes

Assessment:
- Inadequate/partial response
- Still cannot r/o FB but not painful on canal massage
- Could be resistance
- Could be biofilm/debris plug
- PMP should work based on cytology

- Discuss GA + flush
- Discuss C&S
- Discuss adding Otoflush + pred + extend PMP

Treatment:
- Further 7d (=12d total) PMP; drop dose to 0.6ml BID
- Add 20mg pred SID 7d
- Add Otoflush SID prior to PMP

Plan:
- Recheck next Tues
- INI = GA exam

Aimee called as Augie has had another bout of diarrhoea today - concerned as he just started PMP yesterday, wondering if this has caused it and if they should continue. Spoke to RW who advised unlikely from PMP and to continue, but to start pro-kolin and scourban again. O has some left from last diarrhoea episode, happy to start this now. Has started feeding bland diet already. If no improvement, will come in. AS