Hearing Loss — Free SCA Practice Case

Character Overview: You are Ewan, a 24-year-old music student who plays guitar in a band and works part-time gigging. You are articulate and a little anxious — your hearing is central to your studies and your future, so any threat to it frightens you. You are not panicking, but you want answers and reassurance. You had a cold a few weeks ago that you did not think much of at the time.

Opening Sentence: "Hi Doctor. Over the last month or so my right ear has gone quite muffled — like it's blocked, or underwater. It's making lectures hard to follow and it's freaking me out a bit because my whole course is music."

History if Asked (Data Gathering Phase)

• ●The hearing loss: "It's my right ear. It's come on gradually over about a month — got steadily more muffled. The left ear's fine."
• ●Preceding illness (only volunteered if asked): "Now you mention it, I had a stinking cold a few weeks back — blocked nose, sore throat, the lot. That cleared up, but the ear thing started around then and hasn't gone."
• ●Fullness and tinnitus: "There's a fullness, like pressure, and sometimes a faint ringing in that ear. No actual pain though."
• ●Loud music: "I've been gigging and rehearsing loud for about a year. I use earplugs sometimes but not always. That's what's worrying me — have I damaged it?"
• ●Impact: "I'm struggling in lectures and when I'm playing I can't balance the sound properly. If this is permanent, it could wreck my career before it starts."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores his perspective.

• ●Ideas: Ewan is convinced the loud music has permanently damaged his hearing; he has not connected the recent cold with the blocked-ear sensation. "In my head I've done this to myself with the loud gigs — I assume it's noise damage and it's permanent."
• ●Concerns: His overriding fear is that this is permanent and will end his music career. "The thing that scares me most is that it won't come back and I'll have to give up music. That's my whole life."
• ●Expectations: He wants to know what is wrong, whether it will recover, and whether he needs to stop playing loud music. "I want to know what it is, whether it'll get better, and whether I need to stop gigging for a bit."

If Asked — Medical History and Medications

The patient confirms these details only when directly asked.

• ●Ear history: "No previous ear problems, no grommets as a kid, nothing like that."
• ●Wax or water: "I don't think it's wax — I've not been poking about in there. No swimming recently."
• ●Medications: "Nothing. No regular tablets."
• ●Family history: "No, no one in my family has hearing problems or needed hearing aids young."
• ●Allergies: "None."

Social History and Lifestyle Impact

Ewan is a full-time music student living in university halls and gigging part-time.

• ●Music and noise: "Rehearsals a few times a week, gigs at weekends. Loud. I've got earplugs but I forget them half the time."
• ●Living: "I'm in halls. Non-smoker. I drink a bit at weekends, nothing major."
• ●Impact: "It's affecting my studies and my confidence playing. I keep testing my ear by clicking my fingers next to it."

If Asked — Associated Symptoms and Red-Flag Screen

The patient answers these only when directly asked.

• ●If asked about whether it came on suddenly or gradually: "Gradual — it built up over weeks, definitely not overnight." (Key: this is not sudden sensorineural hearing loss.)
• ●If asked about one or both ears: "Just the right. The left's completely normal."
• ●If asked about ear pain: "No pain, no."
• ●If asked about discharge from the ear: "No discharge, nothing coming out."
• ●If asked about vertigo or dizziness: "No, no spinning or dizziness."
• ●If asked about tinnitus: "A faint ringing in the right ear sometimes, comes and goes."
• ●If asked about fullness/popping: "Yes — it feels full and sometimes pops a little when I yawn or swallow."
• ●If asked about facial weakness or numbness (red flag): "No, my face feels totally normal — no drooping or numbness."
• ●If asked about headache or neurological symptoms: "No headaches, nothing like that."
• ●If asked about recent air travel or altitude change: "No flights recently."
• ●If asked about head injury: "No, no bangs to the head."

Responses to Management (The Negotiation Phase)

• ●If the Doctor explains this is likely Eustachian tube dysfunction after the cold, not noise damage: "So it might be from the cold, not the loud music? And it could actually get better?" (The tested point is explaining the likely post-viral Eustachian tube dysfunction and its usually self-limiting course, while still taking noise exposure seriously.)
• ●If the Doctor says they need to examine the ear in person: "You can't just tell from looking at me on the video? Why do I need to come in?" (The tested point is recognising that the ear cannot be assessed remotely and that in-person otoscopy and tuning-fork tests are needed.)
• ●If the Doctor recommends audiology / hearing test: "Do I need a proper hearing test? How long does that take to come through?"
• ●If the Doctor advises ear protection: "So can I keep gigging if I wear proper earplugs, or do I have to stop completely?"
• ●If the Doctor safety-nets about sudden worsening: "What would mean I need to be seen urgently?"