Introduction
The thyroid gland, which regulates metabolic rate, and the eardrum, also called the tympanic membrane, are prominent anatomical structures. Having a solid grasp of anatomy, physiology, and evaluation techniques is crucial for healthcare practitioners to ensure accurate diagnosis and treatment. Here we shall examine the tympanic membrane and thyroid gland, their functions, the examination process, the tests to be performed, and the use of the SOAP format in two fictitious patient situations.
The tympanic membrane will be the next topic we cover. The semitransparent and thin tympanic membrane divides the middle ear from the external auditory canal. Important for the transmission of acoustic waves from the environment to the auditory cortex for processing (Ahmadi et al., 2020). Extensive documentation of the patient’s auditory complaints, such as hearing loss, ear discomfort, or discharge, is necessary for a practical evaluation of the tympanic membrane in a focused health assessment history.
Patient Assessment
Tympanic Membrane
First off, we have Sarah, a 35-year-old female patient who comes in complaining of left ear hearing loss and chronic ear discomfort. Sarah said that she has been dealing with an earache, fullness, and slight vertigo for the last seven days while she was being tested. She claims she has never had an ear infection or been hurt before. The nurse saw reddening and swelling of her left ear’s tympanic membrane and therefore diagnosed her with acute otitis media, an infection of the middle ear.
One can see the umbo and the malleus handle through the tympanic membrane when it’s functioning properly; it is transparent and pearly gray. Redness, inflammation, and bulging may result from fluid and pus collecting behind the eardrum in otitis media. To examine Sarah more closely, the nurse uses pneumatic otoscopy. Sarah will have air gently forced into her ear canal to monitor the movement of her tympanic membrane. When middle ear fluid accumulates, as in otitis media, the tympanic membrane’s mobility diminishes or vanishes completely.
According to Thompson et al. (2019), tympanometry may evaluate middle ear function and identify anomalies such as fluid buildup or eustachian tube dysfunction, which are symptoms of tympanic membrane disorders. A typical peak pressure point on a conventional tympanogram indicates that the pressure in the middle ear is within the usual range. On the other hand, otitis media may be diagnosed with a flat or type B tympanogram, which might indicate middle ear fluid.
The next structure to be mentioned is the front of the neck, the butterfly-shaped thyroid gland. This organ’s hormones play an essential role in controlling development, maturation, and metabolic rate. By palpating the thyroid gland from the front and the back, anomalies such as nodules or enlargement may be found during an evaluation.
Thyroid Gland
The second hypothetical patient is John, a 45-year-old male. His symptoms manifest as palpitations, hyperthyroidism, and hypothyroidism. John reports feeling nervous and fidgety, having an increased hunger, and perspiring profusely during the evaluation. According to Thompson et al. (2019), the nurse stands behind John and uses the anterior approach to palpate his thyroid gland. As a swallowing exercise, the nurse will delicately lay her fingers on the patient’s neck, just below the thyroid cartilage. When one swallows normally, one cannot see the thyroid gland. When a patient has an enlarged thyroid, the nurse may see that the gland is symmetrically enlarged.
The posterior method gives an additional vantage point for evaluating the thyroid gland, complementing the anterior procedure. Thompson et al. (2019) state that this technique has the potential to provide doctors with detailed information on the gland’s size, texture, and the existence or absence of anomalies such as nodules. This approach allows for a more comprehensive inspection by providing a new angle for palpation, which may reveal irregularities that aren’t noticeable while looking straight ahead.
The patient must gently tilt their head forward, then move it laterally away from the examiner’s hand to palpate the thyroid gland. We refer to this as the posterior technique. By circling the patient’s neck, the nurse may palpate each gland. This methodology improves diagnostic accuracy and aids in therapeutic decision-making by detecting asymmetries and nodules that would otherwise go unnoticed by the frontal approach (Wong et al., 2020). The patient may sit back and relax throughout the examination, as the posterior approach minimizes the risk of pain and stress. Medical practitioners may gain a clearer picture of the thyroid gland by combining the two methods. This opens the door to more accurate diagnosis and individualized treatment programs for those with thyroid issues.
The diagnosis of thyroid gland problems generally involves thyroid function tests (TFTs). These assays may assess thyroid hormone levels (TSH, thyroxine, and triiodothyronine). The hallmarks of hyperthyroidism are elevated T3 and T4 levels and decreased TSH levels. On the other hand, elevated TSH levels and decreased T3 and T4 levels are hallmarks of hypothyroidism.
SOAP Notes
First Patient: Sarah
- Subjective: The patient has been reporting mild dizziness, diminished hearing, and left ear pain for the last week.
- Objective: Examining the reddening and bulging of the left tympanic membrane was the goal of this test.
- Assessment: Acute otitis media was confirmed by the physical examination, which supported the NANDA diagnosis.
- Plan: Provide antibiotics (such as amoxicillin) and pain medications (such as acetaminophen) for a duration of 7-10 days. In two weeks, you will have an appointment to have your condition reevaluated.
Second Patient: John
- Subjective: The patient describes hyperthyroidism symptoms as heart palpitations, loss of appetite, and hypersensitivity to heat.
- Objective: By palpating the patient from the front and back, the doctor hoped to identify an enlarged thyroid gland.
- Assessment: The patient presents with clinical symptoms and a positive physical examination result, suggesting hyperthyroidism. This diagnosis is further supported by the NANDA test.
- Plan: Have thyroid function tests (TFTs) performed to measure TSH, T3, and T4 levels. You may want to consider having further imaging tests done (such as a thyroid ultrasound) if nodules are found. After that, refer them to an endocrinologist for further treatment.
Conclusion
Therefore, a complete assessment of the thyroid gland and tympanic membrane requires diagnostic testing, a complete physical examination, and a complete medical history. In order to provide patients with the best treatment possible when they come in with problems with the tympanic membrane or thyroid gland, healthcare providers should be knowledgeable about typical and abnormal findings, examination procedures, and diagnostic tests related to these structures.
References
Ahmadi, N., Ahmadi, F., Sadiqi, M., Ziemnicka, K., & Minczykowski, A. (2020). Thyroid gland dysfunction and its effect on the cardiovascular system: a comprehensive review of the literature. Endokrynologia Polska, 71(5), 466–478.
Thompson, L. D. R., Wei, C., Rooper, L. M., & Lau, S. K. (2019). Thyroid gland solitary fibrous tumor: Report of 3 cases and a comprehensive review of the literature. Head and Neck Pathology, 13(4), 597–605.
Wong, A., Wong, J. C., Pandey, P. U., & Wiseman, S. M. (2020). Novel techniques for intraoperative parathyroid gland identification: a comprehensive review. Expert Review of Endocrinology & Metabolism, 15(6), 439–457.
