Tympanic Membrane and the Thyroid Gland

Tympanic Membrane and the Thyroid Gland

Tympanic Membrane and the Thyroid Gland

The thyroid gland has a butterfly shape and it is situated around the neck. It produces hormones that are responsible for metabolism control. These hormones are triiodothyronine (T3) and thyroxine (T4) and they are responsible for control of heart rate, breathing, body weight, peripheral and central nervous system, cholesterol level, menstrual cycle, body temperature, digestive function, brain development, and bone maintenance. Its correct functioning depends on having a good supply of iodine from food supply.

Dimensionally, it is around two inches in length and positioned in front of throat, typical known as Adam’s apple (Jarvis, 2016). It has two sides known as lobes and they are situated on each sides of the windpipe. The two are connected by thyroid tissue strip termed as isthmus. Interestingly, not all people possess isthmus, instead they have two separately located thyroid lobes (Mtsamples.com, n.d.).

CLICK HERE TO ORDER Tympanic Membrane and the Thyroid Gland

Thyroid gland Pictures

Source: http://www.endocrineweb.com/conditions/thyroid-nodules/thyroid-gland-controls-bodys-metabolism-how-it-works-symptoms-hyperthyroi

The tympanic membrane is a thin layered tissue that has a cone shape and it separates the middle ear from outer ear. It is also known as eardrum. Its main function is transmission of the vibrations of sound collected from the air to the middle ear.

Ear picture showing Tympanic membrane

Source: http://study.com/academy/lesson/tympanic-membrane-definition-function.html

Tympanic is derived from a Latin word known as Tympanum, which means drum. The analogy of its function has direct correlation from the way ancient types of drums produces sound (Mansour et al, 2015). The in depth analysis of the drum insinuates that it has sturdy substance, which is thin, for instance the hide of animal, plastics, or polyester that are tightly stretched athwart the hollow casing. When the drum is hit by the stick, vibrations begin at a given frequency. The vibrations generated push the molecules of the surrounding air resulting to compression waves. The same instance happens in the tympanic membrane.

Tympanic Membrane Patient

Patient ID: Mr. H, 25 yr. old

Physical and History done by: Clinician

Physical and History done on: June 20, 2016

Source: History given by patient and approved on its reliability

Main Complaint: Decreased hearing to right ear with pain and bloody discharge

Present Illness History

The 25 year old male patient sought help after he accidentally fell while he was waterskiing. He felt an acute pain immediately when he fell while waterskiing with the right side of his face hitting the water going at a fast speed, and his hearing decreased immediately.

Past Medical History

No medical history to show

SOAP Note

Subjective

The 25 year old male present for physical examination, complaints of pain 8/10 to his right ear with decreased hearing. The pain is throbbing above his ear and right side of face. The patient states that the pain becomes worst when he puts pressure on his right ear. He states that the pain to his right ear was immediate when he fell on the right side of his face. Patient states that he has never had any pain to his right ear or face prior to the fall. Patient states he has been losing his balance when he gets up quickly from a sitting position.

Objective

Vital signs BP 130/80, HR 98, Resp 20, T 100.5, weight 160 lbs. Ht 5’9. Both of patients ears was assessed with an otoscope, right ear was noted with a small amount of bloody discharge in the ear canal and a perforated tympanic membrane. The patients hearing was tested using a pure tone audiometer. A pure tone audiometer gives a precise quantitative measure of hearing by assessing the person’s ability to hear sounds of varying frequency (Jarvis, 2016). The patient was noted to have minimal hearing loss in his right ear and no hearing loss in his left ear. The patient was asked to walk across the room putting one foot in front of the other and lost his balance.

Assessment

Perforated right tympanic membrane with complaints of pain, bloody discharge, and decrease in hearing of right ear; possible middle ear infection (otitis media).

Plan

The ear must be kept dry, antibiotics is advised in case of contaminants that may have entered the ear from the water. Tympanic membrane perforations usually heal spontaneously. Follow up with ENT for further workup, make need further hearing test with an audiologist if a decrease in hearing continues.

Discussions and Findings

There is no doubt that the traumatic perforations in Mr. H resulted from the impact of the right side of his face hitting the water at a very high speed. Possible cause of the perforation could be the impact of his ear/head or it may result from an object penetrating into the canal of the ear (Unmc.edu, 2016). Apart from waterskiing, other common causes of a perforated tympanic membrane are fireworks and Q-tips pushed too far in the ear canal. An audiogram is utilized to check on any disruptions on the ossicles. In case of ossicles disruption, surgical intervention is always recommended to realign the ossicles’ discontinuity. Drainage and infections are additional problems, in most cases traumatic perforations do heal spontaneously, normally within a month. Apart from perforations, research findings reveal several other defects related to eardrum that include entail cholesteatoma, chronic otitis media, and tympanosclerosis (Mansour et al, 2015). Trauma caused to the eardrum, can significantly lead to the defects discussed above. Therefore, quick response is required to treat the perforation.

Thyroid Gland Patient

Patient ID: Mrs. L, 40 year old Woman

Physical and History done by: Clinician

Physical and History done on: Feb, 2008

Source: History given by patient and approved on its reliability

Main Complaint: Hypothyroidism/increased fatigue

Present Illness History

This treatment plan represents a return visit to the clinic for the patients named above. Nursing notes states that she is 45 years of age and her last visit was six months ago. She states that her health status has not changed much. She also states feeling fatigue throughout the day.

SOAP Note

Subjective

45 year old woman presents for physical examination complaints of feeling fatigue throughout the day. The patient reported that she does have temperature intolerance and is cold most of the time, she does have weaknesses of the muscles, no nausea, no palpitations, no tremors, occasional constipation, and no diarrhea. The patient’s weight has been stable the last 6 months, but does complaint of insomnia but states that when she sleeps with her CPAP machine she gets a good night rest.

Objective

Vital Signs: BP 135/65, HR 85, Temp 96.9, Weight 85.7 kg. Thorax had clear lungs with no defects, regular rhythm and rate in cardiovascular. The patient’s thyroid was assessed anteriorly by facing the patient tilting her head back to stretch the skin against the thyroid, giving her a glass of water inspecting her neck as she swallows the water looking for diffuse enlargement or a nodular lump (Jarvis, 2016). The patient’s thyroid was then assessed posteriorly with her sitting up straight bending her head slightly forward and to the right relaxing the neck muscles on the right side with the healthcare provider using their left hand to push the trachea slightly to the right and curving the right fingers between the trachea and the stern mastoid muscle, retracting it slightly, while the patient takes a sip of water. The thyroid moves up under the palpating fingers with the trachea and larynx as the patient swallows (Jarvis, 2016). Reversing the procedure to palpate the left side posterior. Lab results for the following: Free T4 1.35, and TSH at 6.121, and the patient is currently taking Lithium for Bipolar disorder.

Assessment

No diffused enlargement or nodular lump noted.

Plan

Increase current dose of levothyroxine, currently taking 112mcg by mouth daily, due to TSH level at 6.121 normal range is 0.3-5. TSH levels are consistent with someone that has an underactive thyroid that will cause hypothyroidism, a high TSH level means hypothyroidism. Consult with psychologist that ordered the patient Lithium, this medication can trigger hypothyroidism, but normally in patients that are going to have thyroid problems anyway (Mtsamples.com, n.d.). Have patient come back in 4 weeks for repeat Free T4 and TSH.

Discussions and Findings

It is true that thyroid gland is responsible for various metabolic processes in the body.

Testing for hypothyroidism is simple, use of blood test is recommended, however certain patients presents complex treatment scenario like this patient where the cause of hypothyroidism is from a medication needed for a mental disorder.

Conclusion

Human hearing is very important part of human organs. Tympanic membrane being the converter of sounds from the air and that it is at the threshold of the inner ear, it plays a very important role in hearing. Every effort is vital that is aimed at keeping it effective for use. It therefore does transmissions of all the collected sounds from the air to the middle and inner ear. The patient in question had water causing disturbance in his ear during waterskiing, a condition that can be corrected with proper medical attention.

The thyroid gland is also a very vital organ in the body. It is the central organ that secures various hormones that are used in metabolism. The patient under question experiences low release of thyroid hormone, a condition that started due to the use of lithium that the patient was taking for her Bipolar disorder.

References

Jarvis, Carolyn. (2016). Physical Examination and Health Assessment, 7th Edition. [VitalSource Bookshelf Online]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9781455728107/

Joanne, A. (n.d.). Tympanic Membrane: Definition & Function. Retrieved from study.com’s website http://study.com/academy/lesson/tympanic-membrane-definition-function.html

Mansour, S., Magnan, J., Haidar, H., & Nicolas, K. (2015). Tympanic membrane retraction pocket: Overview and advances in diagnosis and management.

Michael, K., W., Jonathan, M., K., Debra, J., A., & Rose L., A. (2000). External and Middle Ear Trauma Resulting From Ear Impression. Retrieved from website http://www.audiology.org/sites/default/files/journal/JAAA_11_07_01.pdf

Mtsamples.com (n.d.). Sample Type / Medical Specialty: SOAP / Chart / Progress. Retrieved from website http://www.mtsamples.com/site/pages/sample.asp?Type=91-soap&Sample=2287-Acquired%20Hypothyroidism%20Followup

Unmc.edu (2016). Unit Five: Tympanic Membrane Perforations. Retrieved from website http://app1.unmc.edu/medicine/heywood/otology/unit5-tympanic-membrane-perforations.cfm