Scenario 1: You are a first-year pediatric resident working in an after-hours clinic. Your first case of the day is a 4-year-old boy, Jeremiah, who began complaining about muffled hearing the week before. Jeremiah had never shown any sign of hearing loss prior to this time and previous well-child visits to the doctor were unremarkable. Upon examination, you note a small, soft object lodged in Jeremiah's left ear. After some manipulation, you are able to remove a small foam ball from Jeremiah's ear and restore his hearing. You explain that Jeremiah was experiencing conductive hearing loss in his left ear due to the foreign object blocking the auditory canal. Future hearing problems would not be an issue as long as the canal remains clear.
1) Explain to Jeremiah's mother, in detail, the step in the hearing process that was affected by the presence of the foam ball in Jeremiah's ear. Using proper anatomical terms, be sure to explain what wasn't working and why.

Scenario 2:
Your next case is Billy, a two-and-a-half-year-old boy. His parents ask for an antibiotic prescription right away. Billy’s mom is sure that he has an ear infection because every time he has had these symptoms, he was diagnosed with an ear infection. Billy’s parents tell you that he is complaining of right ear pain, but he has not had any ear discharge. His symptoms started yesterday afternoon, and this morning his temperature was about 99.5oF. Last week, Billy suffered from a mild cold that he caught at daycare. He recovered from this ailment and is otherwise healthy. On otoscopic examination, you see a bulging and right tympanic membrane. His left tympanic membrane is normal. As his mother suggested, Billy is most likely suffering from acute otitis media and you prescribe Amoxicillin (first-line antibiotics) to treat the condition. Due to Billy's repeated ear infections, you refer him to an ENT for further care.
2. Using correct anatomical terminology, explain to Billy's parents what is causing his pain and bulging tympanic membrane. Why did this condition develop?

3. Why is it important to treat acute otitis media? Describe the dangers of leaving the condition untreated.

4. The ENT recommends the insertion of ear tubes due to Billy's persistent ear infections. Why is this procedure recommended in Billy's case? Be sure to use proper anatomic terms in your explanation.

Scenario 3
Later that day, you meet with a 62-year-old man, Jose, whose wife insisted that he come to the clinic because he has had progressive hearing loss in both ears. After a thorough examination, you determine that Jose has sensineural hearing loss due to his age. You refer him to an audiologist and explain that the doctor will most likely prescribe hearing aids for this type of hearing loss.
5. Jose is resistant to this idea and asks how hearing aids work. Explain, in detail, to Jose which step in which his hearing is impaired (using proper anatomical terminology) and why a hearing aid will help him hear better.