Tympanic Membrane and Thyroid Gland Study

Introduction

The tympanic membrane (TM) and the thyroid gland (TG) are some of the few potential targets for physical examination during a patient’s health assessment. TM, also known as the eardrum, is one of the most important parts of the human ear. It is a thin layer of tissue that separates the center ear from the outer ear. The size of the eardrum varies between 0.8 to 1 cm, with less than 0.1 mm thickness (Wang et al., 2015). The thyroid gland, on the other hand, is an endocrine gland that secretes the T3 and T4 hormones into the blood (Hegerova, Griebeler, Reynolds, Henry, & Gharib, 2015). Without them, the cells of the body would not be able to work normally. These two organs are subjected to a variety of conditions that need to be inspected during a visit. The purpose of this paper is to provide two health assessment histories of patients diagnosed with abnormalities of the tympanic membrane or the thyroid gland, outline potential findings and methods of examination, and complete two SOAP notes with each of the patient’s findings.

Possible Findings for Tympanic Membrane

There are several factors that might produce a disease affecting the tympanic membrane. Some of these factors include infection, trauma, perforation, or Eustachian tube obstruction (Wang et al., 2015). The symptoms of a tympanic membrane infection or perforation include a sore throat, nasal obstructions, migraines, fever, and rhinorrhea (Wang et al., 2015). One of the most common diagnoses involving the tympanic membrane is otitis. This disease causes inflammation of the middle ear due to an infection. It causes pain, redness, swellings, and is often accompanies by pus leaking out of the ear. Otitis media is frequent in young children and adults suffering from the common cold, influenza, or allergies.

Tympanic film perforations, on the other hand, are caused by traumas and objects being inserted into the ear canal. The majority of injuries to the TM happen during ear cleaning procedures with either sticks, pins, or other thin objects that have the potential of reaching the membrane. Small injuries to the eardrum are usually regenerated without any medical assistance. Larger injuries, however, take a while to recuperate and are frequently followed by cases of rhinorrhea.

Thyroid Gland Diseases and Examination

Thyroid gland capacity is determined by several fundamentals, which include iodine, calcitonin, and the T3 and T4 thyroid hormones. These hormones are created by the thyroid organ. Triiodothyronine (T3) and thyroxine (T4) are hormones of aminoacidic nature, both of which contain iodine particles. Thyroid hormones are tied to globulin, albumin, and parvalbumin, as they bind the proteins in cells of the thyroid organ, before being discharged into circulation (Hegerova et al., 2015). Some of the diseases of the thyroid gland are caused by hormonal misbalances as the result of thyroid cancer, hyperthyroidism, goiter, Graves’ disease, and others. During physical assessments, anterior and posterior examinations of the thyroid gland are used.

The anterior examination is performed using the following steps (Forbes & Watt, 2015):

• The patient needs to assume a neutral position while either sitting or standing, holding the chin slightly upwards.
•  The sources of light are placed in two separate directions in order to induce cross-lighting necessary for spotting physical alterations.
• The patient is instructed to extend the neck forward and swallow some water, which would further expose the gland and show its movements while stretching the tissues at the same time.

Posterior examination means that the gland will be inspected from behind, using hands to touch and feel its form. This method is useful for spotting deformations and size changes. The process goes as follows (Forbes & Watt, 2015):

• The patient is inspected while sitting or standing.
• The nurse takes position behind the patient and accesses the gland with both hands.
• The hands are moved into the position on the neck in order to be able to touch and feel the thyroid glands.
• The patient is instructed to swallow some water, enabling the nurse to feel the upward movement of the thyroid gland.

These simple steps enable a fast and straightforward thyroid gland examination.

Palpable abnormalities, enlargements, or asymmetries discovered during this exam may indicate problems with the gland.

Assessment Histories

Case 1

The patient is a five-year-old child who has been complaining about acute pain in the right ear for the past three days. The symptoms of the disease started a week after the child contracted influenza. Some of the symptoms of the earlier disease included nasal congestion, cough, and sneezing. The child reports having closed her nasal canals with fingers in order to prevent mucus from being ejected. The symptoms of influenza went down two days ago. The child’s mother reports that she needs to talk louder for the girl to hear her. The child says she gets dizzy whenever she is shaking her head or playing with her elder brother.

Case 2

A woman aged 34 reported to the hospital, complaining about increased perceptions of body temperature, sweating, and a general change of disposition towards nervousness. She says that these symptoms appeared roughly two months ago, during which she lost approximately 10 to 15 pounds. However, she did not suspect any health problems due to being on a diet. She was happy with the sudden weight loss. However, the sudden heat and mood swings have gotten her worried, which prompted a visit. She denies any other issues with her health, such as pains, palpitations, shortness of breath, fatigue, and other symptoms.

SOAP Notes

Case 1

• Subjective: 5-year-old girl complaining about ear pain for 3 days. Has a history of two cases of otitis in the past three years. Contracted influenza a week prior. No sick contacts stay at home. No suspected cranium injuries or mechanical damage of the tympanic membrane. The temperature of 39 for the two past days. Positive findings for fever, fatigue, and dizziness. No loss of weight, palpitations, or changes in appetite.
• Objective: All physical signs normal. Ear canals are clean. The left tympanic membrane is in normal shape, no inflammations, the color is pearly grey. Has a light reflex towards the light. The right tympanic membrane is inflated and bulging. Little to no reflex towards the light. Bony landmarks are invisible. No pain was observed during palpitation of the mastoid bone. No purulent drainage was found.
• Assessment: Symptoms indicate acute otitis media, especially considering that the patient suffered from it before, providing a positive history for the past 2 years.
• Plan: Amoxicillin treatment for 10 days, 90 mg per kilogram of mass per day. Tylenol 160 mg every 6 hours while fever and pain persist. Benzocaine 20% 4 drops every 2 hours until symptoms subside.
• Additional tests: Tympanometry, acoustic reflectometry. Normal readings include exhibited agility of the tympanic membrane. The membrane should absorb most of the sounds emitted by the instrument during reflectometry.

Case 2

• Subjective: The patient lost 10 to 15 lbs. of weight in the past two months. Mood changes, perceived heat, sweating. Denies any other symptoms like disorientation, fatigue, pain, palpitation, or shortness of breath. Assumes the loss of weight happened because of her diet.
• Objective: The patient’s age is 34. During the physical exam, a goiter was spotted around the thyroid gland. Exophthalmos was noted during palpitation assessment. Heartbeat rate is regular, 90 bpm. The patient is not in distress, though fidgeting in her seat.
• Assessment: Symptoms indicate hyperthyroidism or, potentially, Graves’ disease.
• Plan: The first step would be to obtain the thyroid-stimulating hormone assay, which would motivate any further treatments. Monitoring hormones would be necessary during the first 1-3 months. Antithyroid drugs would be prescribed as necessary. Radioactive iodine treatment is likely. If nothing else works, proceed with thyroid lobectomy.
• Additional Tests: Thyroid-stimulating hormone assay. THE normal TSH range should be between 0.4 and 5 mIU per liter. Low levels of TSH may indicate Graves’ disease. High levels indicate towards underactive thyroid. Radioiodine uptake test. Helps determine how much iodine the thyroid absorbs during 24 hours (English, Casey, Bell, Bergin, & Murphy, 2016). Helpful for determining the cause of hyperthyroidism.

Conclusion

The tympanic membrane and thyroid gland are very important parts of the human body. They are susceptible to numerous dysfunctions and diseases, which can be spotted during physical assessments or through various tests. The treatments should be decided upon based on the results of the overall assessment and diagnosis.

References

English, C., Casey, R., Bell, M., Bergin, D., & Murphy, J. (2016). The sonographic features of the thyroid gland after treatment with radioiodine therapy in patients with Graves’ disease. Ultrasound in Medicine & Biology, 42(1), 60-67.

Forbes, H., & Watt, H. (Eds.). (2015). Jarvis’s physical examination and health assessment (2nd ed.). Sidney, Australia: Elsevier.

Hegerova, L., Griebeler, M. L., Reynolds, J. P., Henry, M. R., & Gharib, H. (2015). Metastasis to the thyroid gland: Report of a large series from the Mayo Clinic. American journal of clinical oncology, 38(4), 338-342.

Wang, A. Y., Shen, Y., Liew, L. J., Wang, J. T., von Unge, M., Atlas, M. D., & Dilley, R. J. (2015). Searching for a rat model of chronic tympanic membrane perforation: Healing delayed by mitomycin C/dexamethasone but not paper implantation or iterative myringotomy. International journal of pediatric otorhinolaryngology, 79(8), 1240-1247.