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But it seems like every time I do treat the [MEDICAL_CONDITION] [MEDICAL_CONDITION], it's fine. Goes. Yeah. I mean it seems to just come just right back again. Yeah. And this last time we used to a [OCCUPATION] used a stronger medication than like the [DRUG], but it's when we finished that maybe [DURATION] [DURATION] ago. But the last [DURATION] days, like I said, it seems like it's starting to come back just by his behavior. Yeah. So. Yeah. Does it involve both ears or does it. Generally it's both, but the right I feel like is worse than the other. Yeah. Okay. The weight seems to have been affected more. And has he developed any [MEDICAL_CONDITION]? The [DRUG]. That's good. Okay. And do you suspect. It sounds like you suspect maybe there is some [MEDICAL_CONDITION] [MEDICAL_CONDITION]. Does he seem to. Well, does he seem to. I mean parents instinct is pretty good. Does he seem to hear things okay? Yes and no. It's hard to say. I mean, I don't know if he's just gotten so good at knowing how to respond to what's going on in the house and like knowing what there is. I don't know. I feel like he can, but not to the full extent. Okay. You feel like that's. He can. It's maybe muffled or something. I don't know. Yeah, it's hard to say, I guess. I mean, we'll say his name sometimes and yeah, he responds, but not, you know, he's not looking right at us right away. How's his balance been? Any issues with walking, falling, anything like that? I don't think so, no. I mean for [DURATION] [DURATION]. I don't know. I mean, he stumbles here and there, but nothing. But nothing. Obvious where you'd say this is kind of weird. Yeah. Okay. I think this. This speech is the. That with this coupled with the screaming. The last [DURATION] [DURATION] has been strange. Does he tug at the ear a lot? Yeah, he's always tugging. And behind. He's always going like this. Behind both ears. And does he get drainage from his ears with the [MEDICAL_CONDITION] or are they always just kind of behind the eardrums? Kind of stuck in there? Yeah. He knows much drainage? No. Okay. And then in terms of his growth, has he been following his growth curve? Okay. Yeah. Good. Okay. And any daycare at all or is he just. Okay. And then in terms of like any cigarette smoke at home? No, nothing like that. Good. Okay. All right. And then any family history of [MEDICAL_CONDITION] [MEDICAL_CONDITION]? Like at an early age at least? Not. Not like grandpa and grandma or anything, but. No. No. Okay. All right. Okay. Anything else that you wanted to mention at all? I don't think so. All right, I'll get a look. Let me just pause this thing and get my hands washed here. [MEDICAL_PROCESS] [MEDICAL_PROCESS] is next. The child is alert and active, period. He is playing with his parents, period. That's under general. Under [MEDICAL_PROCESS] [MEDICAL_PROCESS] put. The tympanic membranes are dulled bilaterally. Under [MEDICAL_PROCESS] [MEDICAL_PROCESS] put. The tonsils are one to two plus in size and the remainder of the [MEDICAL_PROCESS] [MEDICAL_PROCESS] is normal. Next paragraph. Assessment. [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] is number one and number two is [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION]. Next paragraph. This is an [PERSON_AGE] [PERSON_AGE] old [GENDER_SEXUALITY] who has had 6 [MEDICAL_CONDITION] [MEDICAL_CONDITION] since [DATE_INTERVAL] [DATE_INTERVAL] [DATE_INTERVAL] [DATE_INTERVAL], comma, requiring [MEDICAL_PROCESS] [MEDICAL_PROCESS], period. He typically gets better temporarily with treatment, but then symptoms recur, period. He is not having any issues with balance and his parents or correction, but his parents wonder if there is some [MEDICAL_CONDITION] [MEDICAL_CONDITION], comma, as he initially was using six to seven words but now only uses one or possibly two period. On [MEDICAL_PROCESS] [MEDICAL_PROCESS], comma. The tympanic membranes are dull bilaterally, comma consistent with middle ear effusion, period. Next paragraph. Plan. I discussed potential management options with the parents including [MEDICAL_PROCESS] [MEDICAL_PROCESS] involving [MEDICAL_PROCESS] [MEDICAL_PROCESS] and [MEDICAL_PROCESS] [MEDICAL_PROCESS], period. I discussed the procedure itself, comma, risks and benefits, comma, reasonable expectations, comma, and answered the parents questions to their stated satisfaction. Period. The parents would like to move forward with the procedure, period. This will be scheduled as an outpatient under [MEDICAL_PROCESS] [MEDICAL_PROCESS] with a [DURATION] [DURATION] procedure time period. Number. Next. [MEDICAL_PROCESS] [MEDICAL_PROCESS] before date of [MEDICAL_PROCESS]. Number Next. Return to clinic [DURATION] [DURATION] [DURATION] [DURATION] after [MEDICAL_PROCESS] [MEDICAL_PROCESS]. End of patient. Thanks.",
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}