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Dizziness and hearing difficulty

Dizziness and hearing difficulty

Chief Complaint
“Dizziness and hearing difficulty.”

History of Present Illness
A 64-year-old man presents to his PCP complaining of intermittent episodes of dizziness occurring over the past year. The dizziness, described as a spinning sensation, comes every 1 to 2 weeks and generally lasts for 6 to 12 hours. These episodes often are accompanied by nausea and vomiting. He has more recently noticed hearing fluctuations, especially in his left ear. The hearing loss is worse just before and during attacks and then improves. He also now describes a sense of aural fullness and tinnitus, described as a low-frequency blowing or roaring sound in the ear, associated with the episodes. He attributes these symptoms to noise exposure with his work. He has taken over-the-counter meclizine to help with the dizziness, with some relief of the symptoms.

Review of Systems
The patient’s ROS is positive for vertigo, tinnitus, hearing loss, nausea, and vomiting. He has occasional headaches that respond to treatment with acetaminophen. His ROS is negative for fever, chills, weight loss, or fatigue.

Relevant History
The patient has had no major illnesses, injuries, surgeries, or hospitalizations. He is a lifelong nonsmoker and drinks one to two glasses of wine per week. He is employed as a high school music teacher and plays in a band part-time on weekends. The patient is married and has three grown children who are all in good health. His family history is significant for hypertension in both parents. There is no family history of cancer, early heart disease, or diabetes.

No known medical allergies; no known drug allergies.

Meclizine 25 mg PO TID OTC, PRN.
Acetaminophen, 500 mg PRN.

Physical Examination
Vitals: T 37°C (98.6°F), P 76, R 14, BP 132/82, HT 177.8 cm (70 in.), WT 81.65 kg (180 lbs), BMI 25.8.
General: Well-developed and nourished 64-year-old male patient in no acute distress.
Psychiatric: Appears mildly anxious.

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