C10023967 / invoice 10000

Reason: Ear Recheck MYAppointment Notes: Special payment terms exist, Overdue reminders  ------- Sms reply: YHistory: Here today for ear recheck following Neptra application >1 month agoNoticed discharge coming from his facial folds this week - far more than usual and since then has been more difficult to medicate/examineOtherwise well in himselfExamination: Very headshy today, tried to bite when looking at earsLeft ear markedly erythematous, mild discharge (light brown)Right ear not overly inflamed, minimal dischargeModerate discharge in facial folds - light brown/green tingeLaboratory: Ear cytology:L ear ++++ yeast, no bacteria R ear ++ yeast, no bacteriaPreviously ear cytology was cocci for bothSwab of nasal fold ++++ mixed population of variably sized cocci, rodsAssessment: Bilateral malassezia OE, L>R Marked nasal fold bacterial pyodermaPlan: Given great difficulty in medicating ears, to try:- itraconazole 100mg PO SID for 2 weeks- clean ears and apply elocon 0.5ml both earsWipe nasal folds BID with chlorhex diluted with water 1:1Recheck in 2 weeks - if there is a response to itraconazole can continue for further 2 weeks if not fully resolvedIf no response within 2 weeks unlikely to be effective so maintain original reccommendation for GA and flush    Vital Signs    Weight: 18.2;