Complete patient context
Review years of patient history in seconds with AI-generated Patient Recaps.
Prior notes, labs, imaging, medications & intake forms pulled directly from your EHR
Structured chronological summary of the patient’s clinical journey
Reduces chart review time by up to 90%
Provider-Personalized Notes
Generate documentation that matches your preferred style and structure.
Detailed HPI capturing laterality, pain intensity, and other symptom-specific detail
Custom templates for scenarios such as infections, tinnitus, and balance disorders
Dynamic physical exam documentation, such otoscopy, nasal endoscopy etc.
Supports 90–120 min complex neurology consults
Trigger-Based Documentation
Macros insert the right text the instant a trigger is detected.
Triggers on actions, phrases, or clinical events, including custom conditions
Smart macros adapt automatically to what's actually said in the conversation
Covers procedures with medical necessity language built in
Every Score Captured
Automatically capture questionnaires, clinical scores, and technical evaluations.
Captures SNOT-22, NOSE, VHI-10, EAT-10, DHI, and other specialty questionnaires
Automatically embeds patient intake forms into documentation
Reduces chart review time by up to 90%
MDM-Backed Coding
Generate accurate, evidence-backed billing and coding.
ICD-10-CM, CPT & E/M coding with MDM rationale
Captures modifiers and add-on codes automatically
Reduce undercoding with evidence-based coding
When we looked for AI scribe vendors we went through a tedious process to find the right fit and we've found that in Marvix AI. Their software is customizable, integratable with EMR, specialist-friendly and is incredibly user friendly. They're responsive and willing to meet you where you are in today's ever changing AI landscape.
AM
Amanda McFayden
Director of Clinical Operations, DENT Neurologic Institute
Absolutely transformative! Marvix AI has literally changed my life by giving me back my most precious resource—time. I no longer spend weekends and evenings painstakingly finishing notes or writing long letters. With Marvix AI, I have my own personal scribe that seems to know me better than I know myself.
MC
Dr. Madeline Chadehumbe
CMO, Neurabilities
Marvix AI is amazing. It cuts the physician's cognitive effort by 50%. It captures details necessary for billing and documentation. I highly recommend it to all providers.
MQ
Dr. Mohammad Qasaymeh
Director of Pediatrics, DENT Neurologic Institute
Marvix AI has changed my work-life balance significantly! It's the single best advancement in charting — EVER!
TP
Tammy Pesaresi, AGPCNP-C
DENT Neurologic Institute
Pre-Visit Summaries
Complete Patient Context
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Review patient history with AI-summarized Patient Recaps
Prior notes, assessments, imaging, and audiograms pulled directly from your EHR
Structured chronological summary of the patient's clinical journey
Reduces chart review time by up to 90%
Custom Clinical Notes
Provider-Personalized Note
Generate documentation that matches your preferred style.
Detailed HPI capturing laterality, pain intensity, and other symptom-specific detail.
Custom templates for scenarios such as infections, tinnitus, and balance disorders
Dynamic physical exam documentation, such otoscopy, nasal endoscopy etc.
Converting layman language of the transcript into clinical phrasing.
Macros for Procedures
Trigger-Based Documentation
Macros insert the right text the instant a trigger is detected.
Triggers on actions, phrases, or clinical events, including custom conditions
Smart macros adapt automatically to what's actually said in the conversation
Covers procedures with medical necessity language built in
Questionnaires & Scores
Every Score Captured
Automatically capture questionnaires, clinical scores, and technical evaluations.
Captures SNOT-22, NOSE, VHI-10, EAT-10, DHI, and other specialty questionnaires
Automatically embeds patient intake forms into documentation
Generates structured summaries of technical test results
MDM-Backed Coding
Generate accurate, evidence-backed billing and coding.
ICD-10-CM, CPT & E/M coding with MDM rationale
Captures modifiers and add-on codes automatically
Reduce undercoding with evidence-based coding
1
Before the Visit
Walk In Prepared
Marvix AI pulls years of patient history from your EHR nd builds an AI Patient Recap before you enter the room.
AI Summarized Patient Recaps
Retrieves prior notes, assessments, imaging, and audiograms
Captures completed intake questionnaires like SNOT-22 and DHI before the visit
Appointment schedule synced from your EHR
Active problems and HCC recapture
Care-gap and MIPS/HEDIS alerts
Coverage and eligibility check
2
During the Visit
Complete Consult Intelligence
Ambient capture of the full neurological encounter, merged into one structured note as you speak.
Ambient note generation as you consult
Macros insert procedure descriptions and medical necessity language as you speak
Captures technical HPIs with precise symptom detail like laterality and pain intensity
Custom templates for every ENT scenario
Captures dynamic physical exam findings scenario by scenario
Documents differential diagnoses as they're discussed
Real-time documentation nudges and missing-detail alerts
3
After the Visit
Insurance-Ready Documentation
Clinical notes, coding and patient documents are generated and pushed back to your EHR in one click.
Complete clinical notes in your style
ICD-10, CPT and E/M coding with MDM rationale and modifiers
Medical-necessity language for payers
One-click push into EHR sections, including diagnosis codes and order sets
Carries forward histories and assessments from past visits
AVS, referral letters and patient instructions
Marvix AI works alongside your existing EHR—pulling the right patient data before every visit and pushing structured documentation back into the correct sections automatically.
No manual copy-paste
No new workflows to learn
Supports FHIR, HL7, and API integrations
FROM YOUR EHR
Automatically Available
Appointments & Schedule
Prior Notes
Labs & Imaging
Medications
Intake Forms
Scanned Documents
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BACK TO YOUR EHR
Automatically Synced
Clinical Notes
ICD-10 & E/M Coding
Referral Letters
After Visit Summary (AVS)
Patient Instructions
Section-Mapped Documentation
Two-Way Sync
Real-Time Updates
No Integration Fee*
HIPAA Compliant
No middleware required
Connects with your EHR
Don't see your EHR? We can build a custom integration for your practice. Talk to us
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Don't see your EHR? We can build a custom integration for your practice. Talk to us.
Every Marvix AI note ties documentation to the codes it supports — so the level you bill is the level you can defend. If a claim is questioned, the proof is already in the note.
E/M level justified
MDM complexity, total time, and counseling are captured directly in the note as you document the visit.
ICD-10 to the right specificity
Symptom laterality, chronicity, and severity are coded to the specificity payers require.
CPT & procedure codes captured
In-office procedures like cerumen removal and nasal endoscopy are pulled from the encounter and coded automatically.
Audit-ready trail
Every code links back to the exact line in the note that supports it, so the proof is ready if a claim is reviewed.
HCC recapture & modifiers
Chronic conditions are recaptured for accurate HCC risk scores, with modifiers applied to reflect the true complexity of the visit.
$262B
in claims denied annually falls into the gap between what's written and what payers require. (CAQH)
Coding
Audit-ready
E/M 99214
Established patient · moderate complexity
SUPPORTED BY
Detailed interval history documenting nasal congestion and prior treatment response
Anatomic detail from the nasal endoscopy findings
Moderate-complexity medical decision-making
ICD-10
J32.9 · Chronic sinusitis, unspecified
CPT
99214 · Established patient E/M · 31231 · Diagnostic nasal endoscopy
Modifiers
-25 · Separate E/M service on the same day as the endoscopy
Pick a documentation type to preview what Marvix AI generates.
Chief Complaint
Intermittent nasal congestion and mouth breathing, with occasional throat discomfort.
History of Present Illness
Eric Benassi is a 12-year-old male who presents with his mother for evaluation of intermittent nasal congestion that has been occurring for approximately six months. His mother reports that he frequently breathes through his mouth, particularly at night, and occasionally wakes with a dry mouth. The congestion is generally worse during the evening and during periods of seasonal change.
He also reports occasional throat discomfort in the mornings. The discomfort is mild and usually improves after drinking water. He denies persistent sore throat, difficulty swallowing, painful swallowing, or changes in his voice.
His mother has noticed occasional noisy breathing during sleep but has not observed prolonged pauses in breathing, gasping, or choking episodes. Eric does not regularly wake during the night and generally feels rested in the morning. There has been no significant change in school performance or daytime activity.
He occasionally has a runny nose and sneezes, particularly when pollen levels are higher. Nasal drainage is usually clear. He denies recurrent nosebleeds, facial pain, purulent drainage, or significant reduction in smell.
He has had two uncomplicated upper respiratory infections during the past year, both managed at home without antibiotics. He has not required emergency evaluation for his ENT symptoms.
His mother has tried saline nasal spray intermittently, which provides temporary relief. He has not previously used a prescription nasal spray. He takes no regular medication for his nasal symptoms.
ENT Symptom Burden
Intermittent nasal congestion with predominantly nighttime mouth breathing and occasional morning throat dryness. Symptoms occur several days per week and are more noticeable during seasonal changes. No history of recurrent severe throat infections, significant swallowing difficulty, persistent ear symptoms, or recurrent bacterial sinus infections.
Current Medications
Allergies
Medical History
Surgical History
Family History
Exposure History
Smoke Exposure: No cigarette or vaping exposure in the home.
Environmental Triggers: Nasal symptoms appear somewhat worse during spring and periods of increased pollen exposure.
School Exposure: Attends middle school. No significant exposure to occupational or industrial irritants.
Home Environment: Lives with parents and one younger sibling. No pets.
Sleep: Sleeps approximately 9 hours per night. Occasional mouth breathing and noisy breathing reported. No witnessed apnea, gasping, or prolonged pauses in breathing.
Nasal Treatment Adherence: Saline spray used intermittently. No prior consistent daily medical nasal therapy.
Vitals
BP: 108/68 mmHg
Pulse: 78 beats per minute
Temp: 98.1°F
Height: 5 feet 1 inch
Weight: 102 lb
BMI: 19.2 kg/m²
Examination
General Appearance: Well-appearing 12-year-old male, alert and cooperative, in no acute distress.
Ears: External ears normal bilaterally. Ear canals patent without significant cerumen or discharge. Tympanic membranes intact with normal landmarks and no visible middle ear effusion or acute inflammation.
Nose: External nose without deformity. Nasal mucosa mildly edematous with a small amount of clear mucus. No purulent drainage or visible nasal mass.
Septum: Mild septal deviation without significant obstructive deformity.
Inferior Turbinates: Mild bilateral enlargement.
Anterior Rhinoscopy: Mild mucosal edema, clear secretions, and mild bilateral inferior turbinate enlargement. No visible polyps or obstructing lesion.
Oral Cavity: Mucosa healthy without lesions. Dentition appropriate for age.
Oropharynx: Tonsils 2+ bilaterally without erythema or exudate. No mucosal lesions. Mild posterior pharyngeal irritation.
Nasopharyngeal Assessment: No obvious obstructing mass on routine examination. Mild nasal congestion noted.
Neck: Supple without cervical lymphadenopathy or palpable masses.
Voice: Normal age-appropriate voice without hoarseness or significant hyponasality.
Neurologic: Alert and oriented. Facial movement symmetric. Grossly appropriate neurologic function for age.
Hearing: Responds appropriately to conversational voice bilaterally. No subjective hearing concern reported by patient or parent.
Assessment
Plan
1. Intermittent nasal congestion
Six-month history of intermittent nasal congestion with mild mucosal edema and clear nasal secretions on examination. Symptoms are more noticeable at night and during seasonal changes. There is no purulent drainage, significant facial pain, recurrent bacterial sinus infection, or visible obstructing nasal lesion.
2. Mouth breathing, predominantly at night
Nighttime mouth breathing appears associated with nasal congestion. Occasional noisy breathing is reported, without witnessed apnea, gasping, choking, or significant daytime sleepiness.
3. Seasonal nasal allergy symptoms
Intermittent sneezing and clear rhinorrhea with increased symptoms during seasonal pollen exposure. Family history is positive for seasonal allergies.
4. Mild bilateral inferior turbinate enlargement
Mild bilateral inferior turbinate enlargement is present on examination and may contribute to nasal obstruction. There is no significant structural obstruction requiring surgical intervention at this time.
5. Occasional morning throat dryness and irritation
Mild morning throat discomfort occurs in association with nighttime mouth breathing. There is no persistent sore throat, dysphagia, odynophagia, tonsillar exudate, or recurrent severe throat infection.
Follow Up
Follow up in approximately 8 to 12 weeks to reassess nasal breathing and nighttime symptoms after consistent conservative management. Earlier evaluation is recommended for persistent unilateral nasal obstruction, recurrent significant nosebleeds, worsening sleep-related breathing symptoms, difficulty swallowing, persistent voice changes, or other new ENT concerns.
SCROLL THE FULL NOTE
WHAT IT CAPTURES
Captures a broad ENT evaluation with nasal symptoms, allergy history, focused examination, and conservative treatment planning in one structured note.
Nasal congestion, mouth breathing, and throat discomfort documented with symptom frequency and triggers
Allergy, environmental, sleep, and treatment history captured for relevant clinical context
Focused ENT examination documents ears, nose, oropharynx, neck, airway, and hearing findings
Conservative treatment and follow-up plan structured around symptoms and examination findings
Your Workflow Stays Exactly the Same
We tailor Marvix AI to your specialty, notes workflows, and EHR.
Chief Complaint
Recurrent episodes of spinning dizziness, primarily triggered by turning in bed and changing head position.
History of Present Illness
Charlie Jones is a 54-year-old female who presents for evaluation of recurrent episodes of positional dizziness that began approximately six weeks ago. She describes the episodes as a sudden sensation that the room is spinning rather than generalized lightheadedness or a feeling of impending fainting.
The first episode occurred when she rolled onto her right side while getting into bed. She experienced approximately 20 to 30 seconds of intense spinning accompanied by nausea. The symptoms settled when she remained still. Since then, similar episodes have occurred when rolling onto the right side in bed, looking upward, or getting up after lying down. The episodes are brief and generally last less than one minute.
She reports approximately four to five episodes per week. The symptoms are most reliably triggered by turning her head to the right or changing position in bed. Between episodes, she feels generally normal but occasionally notices mild imbalance for several minutes after a more intense episode.
She denies persistent dizziness between episodes, fainting, chest pain, palpitations, or shortness of breath. She has not fallen and does not require assistance walking.
She reports mild nausea during the more severe episodes but no vomiting. She denies new hearing loss, unilateral tinnitus, ear pressure, ear drainage, or ear pain. She has occasional longstanding bilateral tinnitus that predates the dizziness and has not changed since the onset of her current symptoms.
She denies headache associated with the episodes and has no history of migraine. She denies double vision, facial weakness, facial numbness, slurred speech, difficulty swallowing, limb weakness, or new coordination problems.
She has not experienced a recent ear infection or significant head injury. She recalls having a similar but less severe episode of positional dizziness approximately eight years ago that resolved within several days without treatment.
She has not previously undergone vestibular testing. Her primary care physician recommended ENT evaluation after the episodes continued to recur. She has not taken a vestibular suppressant regularly. She used meclizine once during an especially severe episode, with partial improvement but significant drowsiness.
Vertigo Symptom Burden
Episodes occur approximately four to five times weekly and are consistently provoked by positional changes, particularly rolling onto the right side, looking upward, and moving from lying down. Individual episodes generally last less than one minute and are accompanied by transient nausea. No persistent vertigo or significant functional limitation is reported between episodes.
Current Medications
Allergies
Medical History
Surgical History
Exposure and Relevant History
Head Trauma: No recent head injury or concussion.
Ear History: No recurrent childhood or adult ear infections. No history of tympanic membrane perforation or chronic ear drainage.
Noise Exposure: No significant occupational noise exposure.
Prior Vertigo: One brief episode of positional dizziness approximately eight years ago that resolved spontaneously.
Fall Risk: No falls related to current episodes. Ambulates independently.
Sleep Position: Frequently sleeps on her right side, which reliably triggers symptoms when turning in bed.
Hydration: Reports adequate daily fluid intake. No consistent relationship between symptoms and missed meals or dehydration.
Vitals
BP: 126/76 mmHg
Pulse: 74 beats per minute
Temp: 98.0°F
Height: 5 feet 5 inches
Weight: 148 lb
BMI: 24.6 kg/m²
Examination
General Appearance: Well-appearing female in no acute distress. Alert and appropriately conversant.
External Ears: Normal auricular anatomy bilaterally without tenderness, swelling, or lesions.
Right Ear: External auditory canal patent. Tympanic membrane intact with normal landmarks. No middle ear effusion or acute inflammatory changes.
Left Ear: External auditory canal patent. Tympanic membrane intact with normal landmarks. No middle ear effusion or acute inflammatory changes.
Nose: Nasal mucosa without significant edema or purulent drainage. No visible nasal mass.
Oropharynx: Oral and pharyngeal mucosa healthy without lesions or acute inflammation.
Neck: Supple without cervical lymphadenopathy or palpable mass.
Neurologic: Alert and oriented. Facial movement symmetric. Speech clear. Upper and lower extremity strength grossly symmetric. No obvious focal neurologic deficit.
Eye Examination: Extraocular movements intact. No spontaneous resting nystagmus.
Gait: Ambulates independently with stable gait during routine examination.
Romberg: Mild subjective unsteadiness without significant loss of balance.
Dix-Hallpike Testing: Right-sided testing reproduces the patient's characteristic brief spinning sensation with a delayed onset of torsional upbeating nystagmus. Symptoms resolve after remaining still. Left-sided testing does not reproduce the patient's typical symptoms.
Head Impulse Testing: No obvious corrective saccade with routine bedside testing.
Procedure
A positional vestibular examination was performed using the Dix-Hallpike maneuver. Right-sided testing reproduced the patient's typical vertigo with characteristic transient positional nystagmus. The response fatigued with repeated positioning. Left-sided testing was negative.
Based on the positive right-sided Dix-Hallpike response, a right Epley canalith repositioning maneuver was performed. The patient tolerated the maneuver without complication and reported mild transient dizziness during repositioning.
Assessment
Plan
1. Benign paroxysmal positional vertigo, right
Six-week history of brief, recurrent spinning episodes consistently triggered by positional changes, particularly rolling onto the right side and looking upward. Right Dix-Hallpike testing reproduces the patient's typical symptoms with characteristic transient positional nystagmus. Findings are consistent with right-sided benign paroxysmal positional vertigo.
2. Episodic positional dizziness
Dizziness is brief, reproducible, and closely associated with specific head movements. There is no persistent spontaneous vertigo or concerning focal neurologic finding on today's examination.
3. Nausea associated with vertigo
Transient nausea occurs during more intense spinning episodes without recurrent vomiting.
4. Bilateral nonpulsatile tinnitus, longstanding
Longstanding bilateral tinnitus predates the current vertigo and has not changed with the onset of positional symptoms. She denies pulsatile tinnitus or associated new hearing loss.
Follow Up
Follow up in approximately 6 to 8 weeks if symptoms persist or sooner if recurrent episodes continue despite the repositioning maneuver. Earlier evaluation is recommended for sudden hearing loss, persistent severe vertigo, new neurologic symptoms, inability to walk, severe headache, or other significant change in symptom pattern.
WHAT IT CAPTURES
Evaluates recurrent dizziness through symptom pattern, positional triggers, associated symptoms, vestibular examination, and targeted management planning.
Vertigo episodes documented with duration, frequency, triggers, and associated nausea
Relevant ear, neurologic, medication, trauma, and prior vertigo history captured
Focused vestibular examination includes eye movements, gait, balance, and positional testing
Assessment and treatment plan structured around the patient's positional symptoms and examination findings
Your Workflow Stays Exactly the Same
We tailor Marvix AI to your specialty, notes workflows, and EHR.
Chief Complaint
Difficulty hearing conversations, particularly in noisy environments, with occasional ringing in both ears.
History of Present Illness
Ryan Moore is a 41-year-old male who presents for evaluation of gradually noticeable difficulty hearing over the past year. He first became aware of the problem when he began having difficulty following conversations in restaurants and group settings. He feels that people sometimes speak unclearly, although he can generally hear well when talking with someone in a quiet room.
His wife has also noticed that he occasionally asks her to repeat herself and sometimes increases the television volume. He reports that the difficulty is present in both ears without a clear difference between the right and left sides. He has not experienced a sudden change in hearing.
He reports intermittent high-pitched ringing in both ears several times per week. The tinnitus generally lasts a few minutes and resolves on its own. It is more noticeable in quiet surroundings. He denies pulsatile tinnitus or hearing a sound that corresponds with his heartbeat.
He denies ear pain, ear drainage, recurrent ear infections, persistent ear pressure, or a sensation of fluid in the ears. He occasionally notices that his ears feel blocked during upper respiratory infections, but this resolves as the illness improves.
He has no history of significant childhood ear disease, tympanic membrane perforation, or previous ear surgery. He reports occasional exposure to loud music at concerts and previously used power tools recreationally without consistent hearing protection. His current occupation is primarily office-based.
He denies dizziness, spinning sensation, imbalance, facial weakness, or other neurologic symptoms. He has not previously used hearing aids and has never had a formal hearing evaluation as an adult.
He has not tried any specific treatment for his hearing concerns. He occasionally uses over-the-counter ear drops when his ears feel blocked, although he has not noticed a consistent benefit.
Hearing Symptom Burden
Difficulty understanding speech is most noticeable in restaurants, meetings, and other environments with background noise. He reports intermittent bilateral nonpulsatile tinnitus several times per week. There is no sudden hearing change, persistent ear pain, drainage, significant vertigo, or unilateral hearing complaint.
Current Medications
Allergies
Medical History
Surgical History
Exposure History
Noise Exposure: Occasional recreational exposure to loud music and power tools. Hearing protection was used inconsistently in the past.
Occupational Environment: Works in an office-based environment with no regular occupational noise exposure.
Ear Instrumentation: Occasionally uses over-the-counter ear drops but denies routine Q-tip use or insertion of objects into the ear canal.
Family History: Mother developed age-related hearing difficulty in her late 60s. No known family history of early-onset hearing loss.
Recent Illness: Occasional upper respiratory infections with temporary ear fullness that resolves after the illness.
Vitals
BP: 124/78 mmHg
Pulse: 70 beats per minute
Temp: 98.2°F
Height: 5 feet 10 inches
Weight: 178 lb
BMI: 25.5 kg/m²
Examination
General Appearance: Well-appearing male in no acute distress. Alert and cooperative throughout the examination.
External Ears: Normal auricular anatomy bilaterally without deformity, lesions, swelling, or tenderness.
Right Ear Canal: Patent without significant cerumen, edema, erythema, or drainage.
Right Tympanic Membrane: Intact with normal landmarks and mobility. No visible middle ear effusion, perforation, or acute inflammatory changes.
Left Ear Canal: Patent without significant cerumen, edema, erythema, or drainage.
Left Tympanic Membrane: Intact with normal landmarks and mobility. No visible middle ear effusion, perforation, or acute inflammatory changes.
Tuning Fork Examination: Weber is midline. Rinne testing demonstrates air conduction greater than bone conduction bilaterally.
Nose: Nasal mucosa mildly edematous without purulent drainage or visible mass.
Oropharynx: Oral and pharyngeal mucosa healthy without lesions or acute inflammation.
Neck: Supple without cervical lymphadenopathy or palpable masses.
Neurologic: Alert and oriented. Facial movement symmetric. No obvious focal neurologic deficit.
Audiology Evaluation
Comprehensive audiologic evaluation was performed to assess the patient's subjective hearing difficulty and establish a baseline.
Pure-tone testing demonstrates hearing within normal limits through the speech frequencies with mild high-frequency threshold reduction bilaterally. Speech recognition thresholds are consistent with pure-tone findings. Word recognition is excellent bilaterally at appropriate presentation levels.
Tympanometry demonstrates Type A tympanograms bilaterally, consistent with normal middle ear pressure and tympanic membrane mobility. Acoustic reflexes are present at expected levels.
Assessment
Plan
1. Subjective bilateral hearing difficulty
Patient reports increasing difficulty understanding speech in noisy environments despite relatively good hearing in quiet settings. Audiologic evaluation demonstrates mild high-frequency hearing loss bilaterally with excellent word recognition and normal middle ear function.
2. Mild bilateral high-frequency hearing loss
Mild high-frequency threshold reduction is present bilaterally without significant asymmetry or evidence of conductive middle ear disease.
3. Bilateral intermittent nonpulsatile tinnitus
Intermittent high-pitched tinnitus occurs several times per week and is bilateral and nonpulsatile. There is no associated sudden hearing change, significant vertigo, or focal neurologic symptom.
4. History of recreational noise exposure
Previous exposure to loud music and power tools with inconsistent hearing protection may contribute to the high-frequency hearing changes.
5. Seasonal allergic rhinitis
Mild seasonal nasal symptoms without significant current nasal obstruction or evidence of acute infection.
Follow Up
Repeat hearing evaluation in approximately 12 months to monitor hearing thresholds. Earlier evaluation is recommended for sudden hearing change, new unilateral hearing loss, persistent unilateral tinnitus, pulsatile tinnitus, recurrent ear drainage, significant ear pain, or development of vertigo or imbalance.
WHAT IT CAPTURES
Evaluates hearing concerns through symptom history, noise exposure, focused ear examination, audiologic testing, and hearing management planning.
Hearing difficulty documented with communication challenges, duration, and relevant associated symptoms
Noise exposure, ear history, medications, allergies, and family history captured for clinical context
Focused otologic examination includes ear canals, tympanic membranes, tuning fork testing, and neurologic findings
Audiologic findings and hearing management recommendations structured around the patient's functional needs
Your Workflow Stays Exactly the Same
We tailor Marvix AI to your specialty, notes workflows, and EHR.
Chief Complaint
Follow-up for persistent nasal congestion and postnasal drainage after medical treatment.
History of Present Illness
Martin Romero is a 42-year-old male who returns for follow-up of nasal congestion, postnasal drainage, and intermittent facial pressure. He was last seen approximately eight weeks ago and was started on daily saline irrigation and intranasal corticosteroid therapy.
He reports that his nasal breathing has improved since the last visit, particularly during the daytime. He estimates approximately 50% overall improvement in congestion. He continues to notice some obstruction at night, especially when lying down. The obstruction remains bilateral without a consistent side predominance.
Postnasal drainage has also decreased. He previously experienced drainage most days, while he now notices it several times per week. The mucus is generally clear or white. He has not had thick yellow or green drainage since the last visit.
Facial pressure has become less frequent and now occurs approximately once or twice per week. He denies significant facial pain, facial swelling, severe headache, or dental pain.
His sense of smell has improved but has not completely returned to his previous baseline. He denies complete loss of smell.
He has been using saline irrigation once daily and fluticasone nasal spray consistently since the last visit. He reports better results since using both treatments regularly. He has not required antibiotics or oral steroids since his previous appointment.
He continues to experience intermittent sneezing and clear rhinorrhea during periods of seasonal allergy symptoms. He uses cetirizine as needed with good control.
He denies recurrent nosebleeds, recurrent acute sinus infections, vision changes, or new ear symptoms. He has not developed any new respiratory or systemic symptoms.
Sinonasal Symptom Burden
Overall sinonasal symptoms have improved by approximately 50% with consistent medical therapy. Nasal congestion remains most noticeable at night. Postnasal drainage and facial pressure have decreased in frequency. No antibiotic-treated sinus infection or significant acute flare has occurred since the previous visit.
Current Medications
Allergies
Medical History
Surgical History
Exposure History
Smoke Exposure: Never smoker. No regular secondhand smoke exposure.
Environmental Triggers: Seasonal pollen exposure continues to trigger intermittent sneezing and clear rhinorrhea.
Occupational Environment: Office-based work without significant exposure to dust, fumes, or chemical irritants.
Home Environment: Lives with a cat. No clear relationship between the pet and his symptoms.
Nasal Treatment Adherence: Using saline irrigation once daily and fluticasone consistently since the previous visit.
Vitals
BP: 124/78 mmHg
Pulse: 72 beats per minute
Temp: 98.1°F
Height: 5 feet 9 inches
Weight: 170 lb
BMI: 25.1 kg/m²
Examination
General Appearance: Well-appearing male in no acute distress.
Periorbital: Extraocular movements intact without visible edema or erythema.
External Nose: No visible deformity or swelling.
Nasal Mucosa: Mild residual bilateral mucosal edema with small amounts of clear mucus. No purulent drainage.
Septum: Mild rightward septal deviation.
Inferior Turbinates: Mild bilateral inferior turbinate enlargement, improved from previous examination.
Anterior Rhinoscopy: Mild mucosal edema and turbinate enlargement without polyps, mass, significant crusting, or purulent drainage.
Oropharynx: Healthy mucosa without lesions or exudate. Mild posterior pharyngeal cobblestoning.
Sinus Examination: No significant facial tenderness or visible swelling.
Neck: Supple without cervical lymphadenopathy or palpable masses.
Airway: Breathing comfortably on room air without respiratory distress.
Procedure
Diagnostic nasal endoscopy was performed following topical anesthetic and decongestant application.
The right nasal cavity demonstrated mild residual inferior turbinate enlargement and mucosal edema. The middle meatus was patent with a small amount of clear mucus and no purulent drainage or nasal polyps. The sphenoethmoid recess was clear without suspicious lesion.
The left nasal cavity demonstrated mild mucosal edema and inferior turbinate enlargement. The middle meatus was patent without polyps, mass, or purulent secretions. No obstructing lesion was identified.
Compared with the previous examination, there is less mucosal edema and no evidence of active purulent sinonasal infection.
Assessment
Plan
1. Chronic nasal congestion
Patient reports approximately 50% improvement in nasal obstruction with consistent saline irrigation and intranasal corticosteroid therapy. Examination and endoscopy show mild residual mucosal edema without purulence or obstructing lesion.
2. Postnasal drainage
Drainage has decreased from most days to several times per week and is currently clear or white. No evidence of active bacterial infection on examination.
3. Intermittent facial pressure
Facial pressure has decreased to approximately once or twice weekly without significant pain, swelling, or acute infectious symptoms.
4. Mild reduction in sense of smell
Smell has partially improved with reduction in nasal inflammation. No nasal polyps or obstructing lesion are seen on endoscopy.
5. Seasonal allergic rhinitis
Seasonal sneezing and clear rhinorrhea remain controlled with intermittent cetirizine.
6. Mild bilateral inferior turbinate hypertrophy
Mild residual turbinate enlargement is present but has improved with medical therapy.
7. Mild deviated nasal septum
Mild rightward deviation remains present without significant obstructive findings on today's examination.
Follow Up
Follow up in approximately three months to reassess nasal obstruction, drainage, facial pressure, and sense of smell. Continue current medical therapy until the next evaluation. Earlier follow-up is recommended for recurrent antibiotic-treated infections, significant worsening of facial pain or pressure, purulent drainage, facial swelling, visual symptoms, or substantial decline in smell.
WHAT IT CAPTURES
Reviews response to prior sinus treatment through current symptoms, treatment adherence, focused ENT examination, and ongoing management planning.
Changes in nasal congestion, drainage, facial pressure, and sense of smell documented since the previous visit
Current treatment use and response assessed alongside allergy and environmental history
Focused nasal examination and endoscopy used to evaluate residual inflammation and obstruction
Continued medical management and follow-up structured around symptom improvement and clinical findings
Your Workflow Stays Exactly the Same
We tailor Marvix AI to your specialty, notes workflows, and EHR.
Chief Complaint
Persistent ringing in both ears, more noticeable in the left ear, for approximately eight months.
History of Present Illness
Joel Sebastian is a 49-year-old male who presents for evaluation of bilateral ringing in the ears that has been present for approximately eight months. He describes the sound as a high-pitched tone that is more noticeable in the left ear. The tinnitus is present daily but fluctuates in intensity.
He first noticed the ringing after attending a loud indoor concert. He did not experience an immediate loss of hearing or significant ear pain at the time. The tinnitus initially occurred intermittently but became more frequent over the following several weeks and has remained present most days since then.
The sound is most noticeable at night when his surroundings are quiet. During the day, he is usually able to ignore it while working or having conversations. He reports occasional difficulty falling asleep when the tinnitus is particularly prominent but generally remains asleep once he falls asleep.
He denies a pulsating or heartbeat-synchronous quality. The sound does not change with his heartbeat or physical activity. He also denies clicking, buzzing associated with jaw movement, or a sensation of an external sound source.
He reports occasional mild ear fullness on the left but no persistent pressure. He denies ear pain, drainage, recurrent ear infections, or a history of tympanic membrane perforation. He has not experienced sudden hearing loss.
He feels that his hearing is generally adequate for everyday conversations. He occasionally has difficulty following conversations in restaurants or other noisy environments but has not noticed a clear difference between his ears.
He denies spinning vertigo, recurrent imbalance, fainting, facial weakness, facial numbness, new headaches, visual changes, or other neurologic symptoms.
He has a history of recreational noise exposure from concerts and occasional use of power tools. He previously attended several concerts each year without consistently using hearing protection. He now uses earplugs at concerts and around loud equipment.
He drinks two cups of coffee most days and reports that the tinnitus occasionally seems more noticeable after a poor night's sleep or during periods of increased stress. He has not identified a consistent food or medication trigger.
He has not previously undergone an ENT evaluation for tinnitus. He has not used hearing aids or other tinnitus-specific devices. He has occasionally used background music at night, which makes the tinnitus less noticeable.
Tinnitus Symptom Burden
Daily bilateral high-pitched nonpulsatile tinnitus, greater on the left, with fluctuating intensity. Symptoms are most noticeable in quiet environments and occasionally interfere with sleep onset. No sudden hearing loss, significant vertigo, pulsatile tinnitus, otorrhea, or focal neurologic symptoms.
Current Medications
Allergies
Medical History
Surgical History
Exposure History
Noise Exposure: Recurrent recreational exposure to loud concerts and intermittent power-tool use. Hearing protection was inconsistent in the past and is now used more regularly.
Occupational Environment: Works in an office environment without significant ongoing occupational noise exposure.
Ear Instrumentation: Denies routine Q-tip use or insertion of objects into the ear canals.
Caffeine: Drinks approximately two cups of coffee daily. No consistent relationship between caffeine intake and tinnitus intensity.
Sleep: Tinnitus is more noticeable at bedtime and occasionally delays sleep onset.
Stress: Reports that tinnitus is more noticeable during periods of increased work-related stress.
Vitals
BP: 130/80 mmHg
Pulse: 70 beats per minute
Temp: 98.2°F
Height: 5 feet 10 inches
Weight: 181 lb
BMI: 26.0 kg/m²
Examination
General Appearance: Well-appearing male in no acute distress.
External Ears: Normal auricular anatomy bilaterally without lesions, swelling, or tenderness.
Right Ear Canal: Patent without significant cerumen, edema, erythema, or discharge.
Right Tympanic Membrane: Intact with normal landmarks and no visible middle ear effusion, retraction, perforation, or acute inflammation.
Left Ear Canal: Patent without significant cerumen, edema, erythema, or discharge.
Left Tympanic Membrane: Intact with normal landmarks and no visible middle ear effusion, retraction, perforation, or acute inflammation.
Tuning Fork Examination: Weber is midline. Rinne testing demonstrates air conduction greater than bone conduction bilaterally.
Nose: Mild nasal mucosal edema without purulent drainage or visible mass.
Oropharynx: Healthy mucosa without lesions or acute inflammation.
Temporomandibular Joint: No significant tenderness or reproducible clicking with routine examination.
Neck: Supple without cervical lymphadenopathy or palpable masses.
Neurologic: Alert and oriented. Facial movement symmetric. No obvious focal neurologic deficit.
Eye Examination: Extraocular movements intact. No spontaneous nystagmus.
Audiology Evaluation
Comprehensive audiologic evaluation demonstrates hearing within normal limits through the speech frequencies with mild high-frequency sensorineural hearing loss bilaterally. There is no clinically significant asymmetry.
Speech recognition thresholds are consistent with pure-tone findings. Word recognition is excellent bilaterally.
Tympanometry demonstrates Type A tympanograms bilaterally, consistent with normal middle ear pressure and tympanic membrane mobility.
Assessment
Plan
1. Bilateral nonpulsatile tinnitus
Daily bilateral high-pitched tinnitus, greater on the left, without pulsatile quality, sudden hearing loss, significant vertigo, or neurologic symptoms. Audiologic evaluation demonstrates mild bilateral high-frequency hearing changes without significant asymmetry.
2. Mild bilateral high-frequency sensorineural hearing loss
Mild high-frequency hearing loss is present bilaterally with excellent word recognition and normal middle ear function. The pattern is compatible with cumulative noise exposure and age-related hearing change.
3. History of recreational noise exposure
Previous exposure to loud concerts and power tools occurred with inconsistent hearing protection.
4. Intermittent left aural fullness
Occasional mild left ear fullness occurs without persistent pressure, otalgia, drainage, or evidence of middle ear effusion. Tympanometry is normal.
5. Seasonal allergic rhinitis
Mild seasonal nasal symptoms are controlled with intermittent cetirizine. No significant sinonasal findings are present today.
Follow Up
Repeat audiologic evaluation in approximately 12 months, or sooner if hearing or tinnitus changes. Return earlier for sudden hearing loss, new unilateral or markedly worsening tinnitus, pulsatile tinnitus, persistent vertigo, facial weakness or numbness, or other new neurologic symptoms.
WHAT IT CAPTURES
Evaluates persistent tinnitus through symptom characteristics, relevant ear and noise exposure history, focused otologic examination, and hearing assessment.
Tinnitus documented with duration, laterality, sound characteristics, frequency, and factors that affect symptom awareness
Relevant hearing, ear, medication, noise exposure, sleep, and stress history captured
Focused otologic examination includes ear canals, tympanic membranes, tuning fork testing, and neurologic findings
Audiologic findings and tinnitus management plan structured around the patient's clinical presentation
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Chief Complaint
Follow-up for dizziness and imbalance after starting vestibular rehabilitation.
History of Present Illness
Dominic Steve is a 62-year-old male who returns for follow-up of dizziness and imbalance after beginning vestibular therapy approximately five weeks ago. He reports gradual improvement in his symptoms since starting therapy.
At his previous visit, he described brief episodes of dizziness with head movement along with a persistent sense of imbalance when walking in visually busy environments. He was referred for vestibular rehabilitation and was given a home exercise program.
He has attended four vestibular therapy sessions and reports completing his prescribed home exercises on most days. He initially experienced mild dizziness while performing the exercises, particularly with rapid head movements, but this has become less noticeable as he has continued therapy.
He currently experiences brief dizziness approximately two to three times per week compared with daily symptoms previously. Episodes are generally triggered by turning his head quickly, looking up, or getting out of bed. The episodes last less than one minute and resolve without intervention.
His baseline imbalance has also improved. He is now able to walk through grocery stores and other visually busy environments with less difficulty. He continues to feel mildly unsteady when walking on uneven ground or when turning quickly.
He denies falls since the previous visit. He occasionally uses a handrail on stairs but does not require a cane or walker.
He denies new hearing loss, ear drainage, ear pain, persistent tinnitus, or aural fullness. He has not developed headaches, double vision, facial weakness, numbness, slurred speech, difficulty swallowing, or limb weakness.
He reports no episodes of prolonged spinning vertigo since beginning therapy. He has not needed meclizine since the previous visit.
Vestibular Symptom Burden
Dizziness has decreased from daily episodes to approximately two to three brief episodes per week. Baseline imbalance has improved, particularly in visually busy environments. Mild instability remains with rapid head movement and uneven surfaces. No falls or new neurologic symptoms have occurred.
Current Medications
Allergies
Medical History
Surgical History
Relevant Therapy History
Vestibular Therapy: Four sessions completed over approximately five weeks.
Home Exercise Program: Performing prescribed vestibular exercises on most days.
Exercise Response: Mild dizziness initially during exercises, now significantly reduced.
Fall History: No falls since beginning therapy.
Assistive Devices: No cane or walker required.
Functional Status: Improved tolerance of grocery stores and visually busy environments. Mild difficulty remains with uneven ground and rapid head turns.
Vitals
BP: 128/76 mmHg
Pulse: 72 beats per minute
Temp: 98.1°F
Height: 5 feet 10 inches
Weight: 184 lb
BMI: 26.4 kg/m²
Examination
General Appearance: Well-appearing male in no acute distress.
External Ears: Normal auricular anatomy bilaterally without tenderness, swelling, or lesions.
Right Ear: Canal patent. Tympanic membrane intact with normal landmarks and no middle ear effusion or acute inflammatory changes.
Left Ear: Canal patent. Tympanic membrane intact with normal landmarks and no middle ear effusion or acute inflammatory changes.
Eye Examination: Extraocular movements intact. No spontaneous resting nystagmus.
Neurologic: Alert and oriented. Facial movement symmetric. Speech clear. No obvious focal neurologic deficit.
Gait: Ambulates independently with generally stable gait. Mild unsteadiness noted with rapid turning.
Romberg: Mild sway without loss of balance.
Head Movement: Mild subjective dizziness with rapid horizontal head movement. Symptoms resolve shortly after movement stops.
Vestibular Examination: No spontaneous nystagmus or persistent positional nystagmus observed during today's examination.
Procedure
A focused vestibular reassessment was performed, including observation of spontaneous eye movements, gait, balance, and response to controlled head movement.
No spontaneous nystagmus was observed. Rapid horizontal head movement produced mild transient subjective dizziness without significant loss of balance. The patient recovered quickly after stopping the movement.
Findings are improved compared with the patient's reported symptoms at the previous visit.
Assessment
Plan
1. Dizziness and imbalance, improving with vestibular rehabilitation
Patient reports meaningful improvement after five weeks of vestibular rehabilitation, with reduction in dizziness frequency from daily episodes to approximately two to three brief episodes per week. Examination demonstrates mild residual symptoms with rapid head movement without spontaneous nystagmus or focal neurologic findings.
2. Vestibular hypofunction, suspected
Persistent mild dizziness with rapid head movement and imbalance in visually complex environments, with improvement following vestibular rehabilitation, remains suggestive of a peripheral vestibular compensation process.
3. Gait and balance impairment, improving
Patient remains independently ambulatory and has had no falls since starting therapy. Mild instability persists with uneven surfaces and rapid turns.
4. Fall risk related to residual imbalance
Current fall risk is reduced compared with the previous visit but remains present during rapid positional changes and uneven walking surfaces.
Follow Up
Continue vestibular therapy and home exercises, with ENT follow-up in approximately 8 to 10 weeks to assess further improvement. Vestibular testing can be considered if symptoms plateau or recur. Earlier evaluation is recommended for persistent severe vertigo, new hearing loss, significant worsening of imbalance, falls, severe headache, double vision, facial weakness, numbness, speech changes, or other new neurologic symptoms.
WHAT IT CAPTURES
Reviews progress with vestibular rehabilitation through symptom changes, therapy adherence, functional improvement, focused vestibular examination, and continued rehabilitation planning.
Dizziness and imbalance tracked through frequency, triggers, severity, and functional changes since starting therapy
Vestibular therapy attendance, home exercise adherence, and response to exercises documented
Focused examination assesses eye movements, gait, balance, and response to head movement
Continued therapy and fall-prevention plan structured around residual symptoms and functional progress
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Chief Complaint
Follow-up after recent bilateral hearing aid fitting with difficulty adjusting to some sounds and occasional discomfort in the left ear.
History of Present Illness
Alex Blacc is a 67-year-old male who returns for follow-up approximately four weeks after being fitted with bilateral hearing aids for age-related hearing difficulty. He reports wearing the devices most days and estimates an average use of approximately eight hours per day.
He feels that the hearing aids have improved his ability to follow conversations, particularly when speaking with family members and during one-on-one conversations. He also notices improved awareness of environmental sounds that he previously missed.
He continues to have difficulty understanding speech in restaurants and other environments with substantial background noise. He reports that voices can occasionally sound too sharp or mechanical in crowded settings. This is more noticeable with the left hearing aid.
He reports intermittent pressure and mild tenderness behind the left ear after wearing the device for several consecutive hours. He does not experience pain immediately after insertion and has not noticed redness, drainage, or skin breakdown. The right hearing aid is comfortable.
He occasionally removes the hearing aids during the afternoon because of sound fatigue, particularly when exposed to multiple simultaneous conversations. He has been cleaning the devices regularly and reports no difficulty inserting or removing them.
He has not noticed feedback from the right device. The left device occasionally produces a brief whistling sound when he is using the telephone or when the device is touched.
He denies new sudden hearing changes, ear drainage, significant ear pain, dizziness, or new tinnitus. His baseline bilateral tinnitus has not noticeably changed since the hearing aids were fitted.
He reports that television volume has decreased since beginning hearing aid use and that his family has noticed that he asks for fewer repetitions during conversation.
Hearing Aid Use and Benefit
Current Medications
Allergies
Medical History
Surgical History
Relevant Hearing Aid History
Fitting: Bilateral hearing aids fitted four weeks ago.
Daily Use: Approximately eight hours per day on most days.
Maintenance: Cleans devices regularly and changes wax filters as instructed.
Right Device: Comfortable with good benefit and no significant feedback.
Left Device: Mild pressure after prolonged use with occasional brief feedback.
Communication Environments: Best benefit in quiet and one-on-one settings. Continued difficulty in restaurants and group conversations.
Patient Goals: Improve speech understanding in background noise and wear devices comfortably throughout the day.
Vitals
BP: 130/78 mmHg
Pulse: 70 beats per minute
Temp: 98.0°F
Height: 5 feet 9 inches
Weight: 176 lb
BMI: 26.0 kg/m²
Examination
General Appearance: Well-appearing male in no acute distress.
External Ears: Normal auricular anatomy bilaterally without swelling, lesions, or tenderness.
Right Ear Canal: Patent and clear without significant cerumen, edema, or discharge.
Right Tympanic Membrane: Intact with normal landmarks and no visible middle ear effusion or acute inflammation.
Left Ear Canal: Patent without significant cerumen or discharge.
Left Tympanic Membrane: Intact with normal landmarks and no visible middle ear effusion or acute inflammation.
Left Postauricular Skin: Mild pressure-related erythema without skin breakdown, ulceration, or drainage.
Neurologic: Alert and oriented. Facial movement symmetric. No obvious focal neurologic deficit.
Hearing Aid Examination
Both hearing aids inspected and found to be functioning appropriately. Microphones and receivers are clear. Wax filters and domes inspected.
The right device is appropriately seated without evidence of excessive pressure.
The left device shows appropriate function but produces intermittent feedback under certain positioning conditions. Fit and acoustic coupling were reviewed.
Audiologic/Device Verification
Hearing aid output was evaluated against the patient's prescribed amplification targets. Overall amplification was appropriately matched to the patient's hearing thresholds.
Speech mapping demonstrated appropriate output across the primary speech frequencies. Gain was adjusted slightly in the left device to improve comfort while maintaining appropriate speech audibility.
Noise-reduction and directional microphone settings were reviewed for use in complex listening environments.
Assessment
Plan
1. Bilateral sensorineural hearing loss with hearing aid use
Patient reports meaningful benefit from bilateral amplification, particularly for one-on-one conversations and television listening. Continued difficulty occurs in restaurants and group settings, which is consistent with the greater listening demands of background noise.
2. Hearing aid adjustment and programming needs
Both devices are functioning appropriately. The left device produces occasional feedback and the patient reports that some sounds are overly sharp in noisy environments.
3. Left hearing aid discomfort
Mild pressure and tenderness occur after several hours of continuous use. Examination shows mild localized pressure-related erythema without skin breakdown or infection.
4. Difficulty hearing in background noise
Patient continues to experience reduced speech understanding in restaurants and group conversations despite overall benefit from amplification.
5. Bilateral nonpulsatile tinnitus
Baseline bilateral tinnitus remains stable without significant worsening since hearing aid fitting.
Follow Up
Follow up in approximately 6 to 8 weeks for hearing aid performance and programming review. Repeat audiologic evaluation is recommended according to routine hearing-monitoring intervals or sooner if a noticeable change in hearing occurs. Earlier evaluation is recommended for sudden hearing loss, persistent ear pain, drainage, significant skin irritation, new vertigo, or a substantial change in tinnitus.
WHAT IT CAPTURES
Reviews hearing aid use through device comfort, daily use, real-world hearing benefit, programming needs, and ongoing hearing management.
Hearing aid use, wearing time, comfort, and maintenance documented
Real-world benefit and remaining difficulty in challenging listening environments assessed
Device function, fit, feedback, and programming reviewed during follow-up
Hearing aid adjustments and continued use structured around the patient's comfort and communication needs
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Chief Complaint
Intermittent nasal congestion and mouth breathing, with occasional throat discomfort.
History of Present Illness
Eric Benassi is a 12-year-old male who presents with his mother for evaluation of intermittent nasal congestion that has been occurring for approximately six months. His mother reports that he frequently breathes through his mouth, particularly at night, and occasionally wakes with a dry mouth. The congestion is generally worse during the evening and during periods of seasonal change.
He also reports occasional throat discomfort in the mornings. The discomfort is mild and usually improves after drinking water. He denies persistent sore throat, difficulty swallowing, painful swallowing, or changes in his voice.
His mother has noticed occasional noisy breathing during sleep but has not observed prolonged pauses in breathing, gasping, or choking episodes. Eric does not regularly wake during the night and generally feels rested in the morning. There has been no significant change in school performance or daytime activity.
He occasionally has a runny nose and sneezes, particularly when pollen levels are higher. Nasal drainage is usually clear. He denies recurrent nosebleeds, facial pain, purulent drainage, or significant reduction in smell.
He has had two uncomplicated upper respiratory infections during the past year, both managed at home without antibiotics. He has not required emergency evaluation for his ENT symptoms.
His mother has tried saline nasal spray intermittently, which provides temporary relief. He has not previously used a prescription nasal spray. He takes no regular medication for his nasal symptoms.
ENT Symptom Burden
Intermittent nasal congestion with predominantly nighttime mouth breathing and occasional morning throat dryness. Symptoms occur several days per week and are more noticeable during seasonal changes. No history of recurrent severe throat infections, significant swallowing difficulty, persistent ear symptoms, or recurrent bacterial sinus infections.
Current Medications
Allergies
Medical History
Surgical History
Family History
Exposure History
Smoke Exposure: No cigarette or vaping exposure in the home.
Environmental Triggers: Nasal symptoms appear somewhat worse during spring and periods of increased pollen exposure.
School Exposure: Attends middle school. No significant exposure to occupational or industrial irritants.
Home Environment: Lives with parents and one younger sibling. No pets.
Sleep: Sleeps approximately 9 hours per night. Occasional mouth breathing and noisy breathing reported. No witnessed apnea, gasping, or prolonged pauses in breathing.
Nasal Treatment Adherence: Saline spray used intermittently. No prior consistent daily medical nasal therapy.
Vitals
Examination
Assessment
Plan
1. Intermittent nasal congestion
Six-month history of intermittent nasal congestion with mild mucosal edema and clear nasal secretions on examination. Symptoms are more noticeable at night and during seasonal changes. There is no purulent drainage, significant facial pain, recurrent bacterial sinus infection, or visible obstructing nasal lesion.
2. Mouth breathing, predominantly at night
Nighttime mouth breathing appears associated with nasal congestion. Occasional noisy breathing is reported, without witnessed apnea, gasping, choking, or significant daytime sleepiness.
3. Seasonal nasal allergy symptoms
Intermittent sneezing and clear rhinorrhea with increased symptoms during seasonal pollen exposure. Family history is positive for seasonal allergies.
4. Mild bilateral inferior turbinate enlargement
Mild bilateral inferior turbinate enlargement is present on examination and may contribute to nasal obstruction. There is no significant structural obstruction requiring surgical intervention at this time.
Chief Complaint
Recurrent episodes of spinning dizziness, primarily triggered by turning in bed and changing head position.
History of Present Illness
Charlie Jones is a 54-year-old female who presents for evaluation of recurrent episodes of positional dizziness that began approximately six weeks ago. She describes the episodes as a sudden sensation that the room is spinning rather than generalized lightheadedness or a feeling of impending fainting.
The first episode occurred when she rolled onto her right side while getting into bed. She experienced approximately 20 to 30 seconds of intense spinning accompanied by nausea. The symptoms settled when she remained still. Since then, similar episodes have occurred when rolling onto the right side in bed, looking upward, or getting up after lying down. The episodes are brief and generally last less than one minute.
She reports approximately four to five episodes per week. The symptoms are most reliably triggered by turning her head to the right or changing position in bed. Between episodes, she feels generally normal but occasionally notices mild imbalance for several minutes after a more intense episode.
She denies persistent dizziness between episodes, fainting, chest pain, palpitations, or shortness of breath. She has not fallen and does not require assistance walking.
She reports mild nausea during the more severe episodes but no vomiting. She denies new hearing loss, unilateral tinnitus, ear pressure, ear drainage, or ear pain. She has occasional longstanding bilateral tinnitus that predates the dizziness and has not changed since the onset of her current symptoms.
She denies headache associated with the episodes and has no history of migraine. She denies double vision, facial weakness, facial numbness, slurred speech, difficulty swallowing, limb weakness, or new coordination problems.
She has not experienced a recent ear infection or significant head injury. She recalls having a similar but less severe episode of positional dizziness approximately eight years ago that resolved within several days without treatment.
She has not previously undergone vestibular testing. Her primary care physician recommended ENT evaluation after the episodes continued to recur. She has not taken a vestibular suppressant regularly. She used meclizine once during an especially severe episode, with partial improvement but significant drowsiness.
Vertigo Symptom Burden
Episodes occur approximately four to five times weekly and are consistently provoked by positional changes, particularly rolling onto the right side, looking upward, and moving from lying down. Individual episodes generally last less than one minute and are accompanied by transient nausea. No persistent vertigo or significant functional limitation is reported between episodes.
Current Medications
Allergies
Medical History
Surgical History
Exposure and Relevant History
Head Trauma: No recent head injury or concussion.
Ear History: No recurrent childhood or adult ear infections. No history of tympanic membrane perforation or chronic ear drainage.
Noise Exposure: No significant occupational noise exposure.
Prior Vertigo: One brief episode of positional dizziness approximately eight years ago that resolved spontaneously.
Fall Risk: No falls related to current episodes. Ambulates independently.
Sleep Position: Frequently sleeps on her right side, which reliably triggers symptoms when turning in bed.
Hydration: Reports adequate daily fluid intake. No consistent relationship between symptoms and missed meals or dehydration.
Vitals
BP: 126/76 mmHg
Pulse: 74 beats per minute
Temp: 98.0°F
Height: 5 feet 5 inches
Weight: 148 lb
BMI: 24.6 kg/m²
Examination
General Appearance: Well-appearing female in no acute distress. Alert and appropriately conversant.
External Ears: Normal auricular anatomy bilaterally without tenderness, swelling, or lesions.
Right Ear: External auditory canal patent. Tympanic membrane intact with normal landmarks. No middle ear effusion or acute inflammatory changes.
Left Ear: External auditory canal patent. Tympanic membrane intact with normal landmarks. No middle ear effusion or acute inflammatory changes.
Nose: Nasal mucosa without significant edema or purulent drainage. No visible nasal mass.
Oropharynx: Oral and pharyngeal mucosa healthy without lesions or acute inflammation.
Neck: Supple without cervical lymphadenopathy or palpable mass.
Neurologic: Alert and oriented. Facial movement symmetric. Speech clear. Upper and lower extremity strength grossly symmetric. No obvious focal neurologic deficit.
Eye Examination: Extraocular movements intact. No spontaneous resting nystagmus.
Gait: Ambulates independently with stable gait during routine examination.
Romberg: Mild subjective unsteadiness without significant loss of balance.
Dix-Hallpike Testing: Right-sided testing reproduces the patient's characteristic brief spinning sensation with a delayed onset of torsional upbeating nystagmus. Symptoms resolve after remaining still. Left-sided testing does not reproduce the patient's typical symptoms.
Head Impulse Testing: No obvious corrective saccade with routine bedside testing.
Procedure
A positional vestibular examination was performed using the Dix-Hallpike maneuver. Right-sided testing reproduced the patient's typical vertigo with characteristic transient positional nystagmus. The response fatigued with repeated positioning. Left-sided testing was negative.
Based on the positive right-sided Dix-Hallpike response, a right Epley canalith repositioning maneuver was performed. The patient tolerated the maneuver without complication and reported mild transient dizziness during repositioning.
Assessment
Plan
1. Benign paroxysmal positional vertigo, right
Six-week history of brief, recurrent spinning episodes consistently triggered by positional changes, particularly rolling onto the right side and looking upward. Right Dix-Hallpike testing reproduces the patient's typical symptoms with characteristic transient positional nystagmus. Findings are consistent with right-sided benign paroxysmal positional vertigo.
2. Episodic positional dizziness
Dizziness is brief, reproducible, and closely associated with specific head movements. There is no persistent spontaneous vertigo or concerning focal neurologic finding on today's examination.
3. Nausea associated with vertigo
Transient nausea occurs during more intense spinning episodes without recurrent vomiting.
4. Bilateral nonpulsatile tinnitus, longstanding
Longstanding bilateral tinnitus predates the current vertigo and has not changed with the onset of positional symptoms. She denies pulsatile tinnitus or associated new hearing loss.
Follow Up
Follow up in approximately 6 to 8 weeks if symptoms persist or sooner if recurrent episodes continue despite the repositioning maneuver. Earlier evaluation is recommended for sudden hearing loss, persistent severe vertigo, new neurologic symptoms, inability to walk, severe headache, or other significant change in symptom pattern.
Chief Complaint
Difficulty hearing conversations, particularly in noisy environments, with occasional ringing in both ears.
History of Present Illness
Ryan Moore is a 41-year-old male who presents for evaluation of gradually noticeable difficulty hearing over the past year. He first became aware of the problem when he began having difficulty following conversations in restaurants and group settings. He feels that people sometimes speak unclearly, although he can generally hear well when talking with someone in a quiet room.
His wife has also noticed that he occasionally asks her to repeat herself and sometimes increases the television volume. He reports that the difficulty is present in both ears without a clear difference between the right and left sides. He has not experienced a sudden change in hearing.
He reports intermittent high-pitched ringing in both ears several times per week. The tinnitus generally lasts a few minutes and resolves on its own. It is more noticeable in quiet surroundings. He denies pulsatile tinnitus or hearing a sound that corresponds with his heartbeat.
He denies ear pain, ear drainage, recurrent ear infections, persistent ear pressure, or a sensation of fluid in the ears. He occasionally notices that his ears feel blocked during upper respiratory infections, but this resolves as the illness improves.
He has no history of significant childhood ear disease, tympanic membrane perforation, or previous ear surgery. He reports occasional exposure to loud music at concerts and previously used power tools recreationally without consistent hearing protection. His current occupation is primarily office-based.
He denies dizziness, spinning sensation, imbalance, facial weakness, or other neurologic symptoms. He has not previously used hearing aids and has never had a formal hearing evaluation as an adult.
He has not tried any specific treatment for his hearing concerns. He occasionally uses over-the-counter ear drops when his ears feel blocked, although he has not noticed a consistent benefit.
Hearing Symptom Burden
Difficulty understanding speech is most noticeable in restaurants, meetings, and other environments with background noise. He reports intermittent bilateral nonpulsatile tinnitus several times per week. There is no sudden hearing change, persistent ear pain, drainage, significant vertigo, or unilateral hearing complaint.
Current Medications
Allergies
Medical History
Surgical History
Exposure History
Noise Exposure: Occasional recreational exposure to loud music and power tools. Hearing protection was used inconsistently in the past.
Occupational Environment: Works in an office-based environment with no regular occupational noise exposure.
Ear Instrumentation: Occasionally uses over-the-counter ear drops but denies routine Q-tip use or insertion of objects into the ear canal.
Family History: Mother developed age-related hearing difficulty in her late 60s. No known family history of early-onset hearing loss.
Recent Illness: Occasional upper respiratory infections with temporary ear fullness that resolves after the illness.
Vitals
BP: 124/78 mmHg
Pulse: 70 beats per minute
Temp: 98.2°F
Height: 5 feet 10 inches
Weight: 178 lb
BMI: 25.5 kg/m²
Examination
General Appearance: Well-appearing male in no acute distress. Alert and cooperative throughout the examination.
External Ears: Normal auricular anatomy bilaterally without deformity, lesions, swelling, or tenderness.
Right Ear Canal: Patent without significant cerumen, edema, erythema, or drainage.
Right Tympanic Membrane: Intact with normal landmarks and mobility. No visible middle ear effusion, perforation, or acute inflammatory changes.
Left Ear Canal: Patent without significant cerumen, edema, erythema, or drainage.
Left Tympanic Membrane: Intact with normal landmarks and mobility. No visible middle ear effusion, perforation, or acute inflammatory changes.
Tuning Fork Examination: Weber is midline. Rinne testing demonstrates air conduction greater than bone conduction bilaterally.
Nose: Nasal mucosa mildly edematous without purulent drainage or visible mass.
Oropharynx: Oral and pharyngeal mucosa healthy without lesions or acute inflammation.
Neck: Supple without cervical lymphadenopathy or palpable masses.
Neurologic: Alert and oriented. Facial movement symmetric. No obvious focal neurologic deficit.
Audiology Evaluation
Comprehensive audiologic evaluation was performed to assess the patient's subjective hearing difficulty and establish a baseline.
Pure-tone testing demonstrates hearing within normal limits through the speech frequencies with mild high-frequency threshold reduction bilaterally. Speech recognition thresholds are consistent with pure-tone findings. Word recognition is excellent bilaterally at appropriate presentation levels.
Tympanometry demonstrates Type A tympanograms bilaterally, consistent with normal middle ear pressure and tympanic membrane mobility. Acoustic reflexes are present at expected levels.
Assessment
Plan
1. Subjective bilateral hearing difficulty
Patient reports increasing difficulty understanding speech in noisy environments despite relatively good hearing in quiet settings. Audiologic evaluation demonstrates mild high-frequency hearing loss bilaterally with excellent word recognition and normal middle ear function.
2. Mild bilateral high-frequency hearing loss
Mild high-frequency threshold reduction is present bilaterally without significant asymmetry or evidence of conductive middle ear disease.
3. Bilateral intermittent nonpulsatile tinnitus
Intermittent high-pitched tinnitus occurs several times per week and is bilateral and nonpulsatile. There is no associated sudden hearing change, significant vertigo, or focal neurologic symptom.
4. History of recreational noise exposure
Previous exposure to loud music and power tools with inconsistent hearing protection may contribute to the high-frequency hearing changes.
5. Seasonal allergic rhinitis
Mild seasonal nasal symptoms without significant current nasal obstruction or evidence of acute infection.
Follow Up
Repeat hearing evaluation in approximately 12 months to monitor hearing thresholds. Earlier evaluation is recommended for sudden hearing change, new unilateral hearing loss, persistent unilateral tinnitus, pulsatile tinnitus, recurrent ear drainage, significant ear pain, or development of vertigo or imbalance.
Chief Complaint
Follow-up for persistent nasal congestion and postnasal drainage after medical treatment.
History of Present Illness
Martin Romero is a 42-year-old male who returns for follow-up of nasal congestion, postnasal drainage, and intermittent facial pressure. He was last seen approximately eight weeks ago and was started on daily saline irrigation and intranasal corticosteroid therapy.
He reports that his nasal breathing has improved since the last visit, particularly during the daytime. He estimates approximately 50% overall improvement in congestion. He continues to notice some obstruction at night, especially when lying down. The obstruction remains bilateral without a consistent side predominance.
Postnasal drainage has also decreased. He previously experienced drainage most days, while he now notices it several times per week. The mucus is generally clear or white. He has not had thick yellow or green drainage since the last visit.
Facial pressure has become less frequent and now occurs approximately once or twice per week. He denies significant facial pain, facial swelling, severe headache, or dental pain.
His sense of smell has improved but has not completely returned to his previous baseline. He denies complete loss of smell.
He has been using saline irrigation once daily and fluticasone nasal spray consistently since the last visit. He reports better results since using both treatments regularly. He has not required antibiotics or oral steroids since his previous appointment.
He continues to experience intermittent sneezing and clear rhinorrhea during periods of seasonal allergy symptoms. He uses cetirizine as needed with good control.
He denies recurrent nosebleeds, recurrent acute sinus infections, vision changes, or new ear symptoms. He has not developed any new respiratory or systemic symptoms.
Sinonasal Symptom Burden
Overall sinonasal symptoms have improved by approximately 50% with consistent medical therapy. Nasal congestion remains most noticeable at night. Postnasal drainage and facial pressure have decreased in frequency. No antibiotic-treated sinus infection or significant acute flare has occurred since the previous visit.
Current Medications
Allergies
Medical History
Surgical History
Exposure History
Smoke Exposure: Never smoker. No regular secondhand smoke exposure.
Environmental Triggers: Seasonal pollen exposure continues to trigger intermittent sneezing and clear rhinorrhea.
Occupational Environment: Office-based work without significant exposure to dust, fumes, or chemical irritants.
Home Environment: Lives with a cat. No clear relationship between the pet and his symptoms.
Nasal Treatment Adherence: Using saline irrigation once daily and fluticasone consistently since the previous visit.
Vitals
BP: 124/78 mmHg
Pulse: 72 beats per minute
Temp: 98.1°F
Height: 5 feet 9 inches
Weight: 170 lb
BMI: 25.1 kg/m²
Examination
General Appearance: Well-appearing male in no acute distress.
Periorbital: Extraocular movements intact without visible edema or erythema.
External Nose: No visible deformity or swelling.
Nasal Mucosa: Mild residual bilateral mucosal edema with small amounts of clear mucus. No purulent drainage.
Septum: Mild rightward septal deviation.
Inferior Turbinates: Mild bilateral inferior turbinate enlargement, improved from previous examination.
Anterior Rhinoscopy: Mild mucosal edema and turbinate enlargement without polyps, mass, significant crusting, or purulent drainage.
Oropharynx: Healthy mucosa without lesions or exudate. Mild posterior pharyngeal cobblestoning.
Sinus Examination: No significant facial tenderness or visible swelling.
Neck: Supple without cervical lymphadenopathy or palpable masses.
Airway: Breathing comfortably on room air without respiratory distress.
Procedure
Diagnostic nasal endoscopy was performed following topical anesthetic and decongestant application.
The right nasal cavity demonstrated mild residual inferior turbinate enlargement and mucosal edema. The middle meatus was patent with a small amount of clear mucus and no purulent drainage or nasal polyps. The sphenoethmoid recess was clear without suspicious lesion.
The left nasal cavity demonstrated mild mucosal edema and inferior turbinate enlargement. The middle meatus was patent without polyps, mass, or purulent secretions. No obstructing lesion was identified.
Compared with the previous examination, there is less mucosal edema and no evidence of active purulent sinonasal infection.
Assessment
Plan
1. Chronic nasal congestion
Patient reports approximately 50% improvement in nasal obstruction with consistent saline irrigation and intranasal corticosteroid therapy. Examination and endoscopy show mild residual mucosal edema without purulence or obstructing lesion.
2. Postnasal drainage
Drainage has decreased from most days to several times per week and is currently clear or white. No evidence of active bacterial infection on examination.
3. Intermittent facial pressure
Facial pressure has decreased to approximately once or twice weekly without significant pain, swelling, or acute infectious symptoms.
4. Mild reduction in sense of smell
Smell has partially improved with reduction in nasal inflammation. No nasal polyps or obstructing lesion are seen on endoscopy.
5. Seasonal allergic rhinitis
Seasonal sneezing and clear rhinorrhea remain controlled with intermittent cetirizine.
6. Mild bilateral inferior turbinate hypertrophy
Mild residual turbinate enlargement is present but has improved with medical therapy.
7. Mild deviated nasal septum
Mild rightward deviation remains present without significant obstructive findings on today's examination.
Follow Up
Follow up in approximately three months to reassess nasal obstruction, drainage, facial pressure, and sense of smell. Continue current medical therapy until the next evaluation. Earlier follow-up is recommended for recurrent antibiotic-treated infections, significant worsening of facial pain or pressure, purulent drainage, facial swelling, visual symptoms, or substantial decline in smell.
Chief Complaint
Persistent ringing in both ears, more noticeable in the left ear, for approximately eight months.
History of Present Illness
Joel Sebastian is a 49-year-old male who presents for evaluation of bilateral ringing in the ears that has been present for approximately eight months. He describes the sound as a high-pitched tone that is more noticeable in the left ear. The tinnitus is present daily but fluctuates in intensity.
He first noticed the ringing after attending a loud indoor concert. He did not experience an immediate loss of hearing or significant ear pain at the time. The tinnitus initially occurred intermittently but became more frequent over the following several weeks and has remained present most days since then.
The sound is most noticeable at night when his surroundings are quiet. During the day, he is usually able to ignore it while working or having conversations. He reports occasional difficulty falling asleep when the tinnitus is particularly prominent but generally remains asleep once he falls asleep.
He denies a pulsating or heartbeat-synchronous quality. The sound does not change with his heartbeat or physical activity. He also denies clicking, buzzing associated with jaw movement, or a sensation of an external sound source.
He reports occasional mild ear fullness on the left but no persistent pressure. He denies ear pain, drainage, recurrent ear infections, or a history of tympanic membrane perforation. He has not experienced sudden hearing loss.
He feels that his hearing is generally adequate for everyday conversations. He occasionally has difficulty following conversations in restaurants or other noisy environments but has not noticed a clear difference between his ears.
He denies spinning vertigo, recurrent imbalance, fainting, facial weakness, facial numbness, new headaches, visual changes, or other neurologic symptoms.
He has a history of recreational noise exposure from concerts and occasional use of power tools. He previously attended several concerts each year without consistently using hearing protection. He now uses earplugs at concerts and around loud equipment.
He drinks two cups of coffee most days and reports that the tinnitus occasionally seems more noticeable after a poor night's sleep or during periods of increased stress. He has not identified a consistent food or medication trigger.
He has not previously undergone an ENT evaluation for tinnitus. He has not used hearing aids or other tinnitus-specific devices. He has occasionally used background music at night, which makes the tinnitus less noticeable.
Tinnitus Symptom Burden
Daily bilateral high-pitched nonpulsatile tinnitus, greater on the left, with fluctuating intensity. Symptoms are most noticeable in quiet environments and occasionally interfere with sleep onset. No sudden hearing loss, significant vertigo, pulsatile tinnitus, otorrhea, or focal neurologic symptoms.
Current Medications
Allergies
Medical History
Surgical History
Exposure History
Noise Exposure: Recurrent recreational exposure to loud concerts and intermittent power-tool use. Hearing protection was inconsistent in the past and is now used more regularly.
Occupational Environment: Works in an office environment without significant ongoing occupational noise exposure.
Ear Instrumentation: Denies routine Q-tip use or insertion of objects into the ear canals.
Caffeine: Drinks approximately two cups of coffee daily. No consistent relationship between caffeine intake and tinnitus intensity.
Sleep: Tinnitus is more noticeable at bedtime and occasionally delays sleep onset.
Stress: Reports that tinnitus is more noticeable during periods of increased work-related stress.
Vitals
BP: 130/80 mmHg
Pulse: 70 beats per minute
Temp: 98.2°F
Height: 5 feet 10 inches
Weight: 181 lb
BMI: 26.0 kg/m²
Examination
General Appearance: Well-appearing male in no acute distress.
External Ears: Normal auricular anatomy bilaterally without lesions, swelling, or tenderness.
Right Ear Canal: Patent without significant cerumen, edema, erythema, or discharge.
Right Tympanic Membrane: Intact with normal landmarks and no visible middle ear effusion, retraction, perforation, or acute inflammation.
Left Ear Canal: Patent without significant cerumen, edema, erythema, or discharge.
Left Tympanic Membrane: Intact with normal landmarks and no visible middle ear effusion, retraction, perforation, or acute inflammation.
Tuning Fork Examination: Weber is midline. Rinne testing demonstrates air conduction greater than bone conduction bilaterally.
Nose: Mild nasal mucosal edema without purulent drainage or visible mass.
Oropharynx: Healthy mucosa without lesions or acute inflammation.
Temporomandibular Joint: No significant tenderness or reproducible clicking with routine examination.
Neck: Supple without cervical lymphadenopathy or palpable masses.
Neurologic: Alert and oriented. Facial movement symmetric. No obvious focal neurologic deficit.
Eye Examination: Extraocular movements intact. No spontaneous nystagmus.
Audiology Evaluation
Comprehensive audiologic evaluation demonstrates hearing within normal limits through the speech frequencies with mild high-frequency sensorineural hearing loss bilaterally. There is no clinically significant asymmetry.
Speech recognition thresholds are consistent with pure-tone findings. Word recognition is excellent bilaterally.
Tympanometry demonstrates Type A tympanograms bilaterally, consistent with normal middle ear pressure and tympanic membrane mobility.
Assessment
Plan
1. Bilateral nonpulsatile tinnitus
Daily bilateral high-pitched tinnitus, greater on the left, without pulsatile quality, sudden hearing loss, significant vertigo, or neurologic symptoms. Audiologic evaluation demonstrates mild bilateral high-frequency hearing changes without significant asymmetry.
2. Mild bilateral high-frequency sensorineural hearing loss
Mild high-frequency hearing loss is present bilaterally with excellent word recognition and normal middle ear function. The pattern is compatible with cumulative noise exposure and age-related hearing change.
3. History of recreational noise exposure
Previous exposure to loud concerts and power tools occurred with inconsistent hearing protection.
4. Intermittent left aural fullness
Occasional mild left ear fullness occurs without persistent pressure, otalgia, drainage, or evidence of middle ear effusion. Tympanometry is normal.
5. Seasonal allergic rhinitis
Mild seasonal nasal symptoms are controlled with intermittent cetirizine. No significant sinonasal findings are present today.
Follow Up
Repeat audiologic evaluation in approximately 12 months, or sooner if hearing or tinnitus changes. Return earlier for sudden hearing loss, new unilateral or markedly worsening tinnitus, pulsatile tinnitus, persistent vertigo, facial weakness or numbness, or other new neurologic symptoms.
Chief Complaint
Follow-up for dizziness and imbalance after starting vestibular rehabilitation.
History of Present Illness
Dominic Steve is a 62-year-old male who returns for follow-up of dizziness and imbalance after beginning vestibular therapy approximately five weeks ago. He reports gradual improvement in his symptoms since starting therapy.
At his previous visit, he described brief episodes of dizziness with head movement along with a persistent sense of imbalance when walking in visually busy environments. He was referred for vestibular rehabilitation and was given a home exercise program.
He has attended four vestibular therapy sessions and reports completing his prescribed home exercises on most days. He initially experienced mild dizziness while performing the exercises, particularly with rapid head movements, but this has become less noticeable as he has continued therapy.
He currently experiences brief dizziness approximately two to three times per week compared with daily symptoms previously. Episodes are generally triggered by turning his head quickly, looking up, or getting out of bed. The episodes last less than one minute and resolve without intervention.
His baseline imbalance has also improved. He is now able to walk through grocery stores and other visually busy environments with less difficulty. He continues to feel mildly unsteady when walking on uneven ground or when turning quickly.
He denies falls since the previous visit. He occasionally uses a handrail on stairs but does not require a cane or walker.
He denies new hearing loss, ear drainage, ear pain, persistent tinnitus, or aural fullness. He has not developed headaches, double vision, facial weakness, numbness, slurred speech, difficulty swallowing, or limb weakness.
He reports no episodes of prolonged spinning vertigo since beginning therapy. He has not needed meclizine since the previous visit.
Vestibular Symptom Burden
Dizziness has decreased from daily episodes to approximately two to three brief episodes per week. Baseline imbalance has improved, particularly in visually busy environments. Mild instability remains with rapid head movement and uneven surfaces. No falls or new neurologic symptoms have occurred.
Current Medications
Allergies
Medical History
Surgical History
Relevant Therapy History
Vestibular Therapy: Four sessions completed over approximately five weeks.
Home Exercise Program: Performing prescribed vestibular exercises on most days.
Exercise Response: Mild dizziness initially during exercises, now significantly reduced.
Fall History: No falls since beginning therapy.
Assistive Devices: No cane or walker required.
Functional Status: Improved tolerance of grocery stores and visually busy environments. Mild difficulty remains with uneven ground and rapid head turns.
Vitals
BP: 128/76 mmHg
Pulse: 72 beats per minute
Temp: 98.1°F
Height: 5 feet 10 inches
Weight: 184 lb
BMI: 26.4 kg/m²
Examination
General Appearance: Well-appearing male in no acute distress.
External Ears: Normal auricular anatomy bilaterally without tenderness, swelling, or lesions.
Right Ear: Canal patent. Tympanic membrane intact with normal landmarks and no middle ear effusion or acute inflammatory changes.
Left Ear: Canal patent. Tympanic membrane intact with normal landmarks and no middle ear effusion or acute inflammatory changes.
Eye Examination: Extraocular movements intact. No spontaneous resting nystagmus.
Neurologic: Alert and oriented. Facial movement symmetric. Speech clear. No obvious focal neurologic deficit.
Gait: Ambulates independently with generally stable gait. Mild unsteadiness noted with rapid turning.
Romberg: Mild sway without loss of balance.
Head Movement: Mild subjective dizziness with rapid horizontal head movement. Symptoms resolve shortly after movement stops.
Vestibular Examination: No spontaneous nystagmus or persistent positional nystagmus observed during today's examination.
Procedure
A focused vestibular reassessment was performed, including observation of spontaneous eye movements, gait, balance, and response to controlled head movement.
No spontaneous nystagmus was observed. Rapid horizontal head movement produced mild transient subjective dizziness without significant loss of balance. The patient recovered quickly after stopping the movement.
Findings are improved compared with the patient's reported symptoms at the previous visit.
Assessment
Plan
1. Dizziness and imbalance, improving with vestibular rehabilitation
Patient reports meaningful improvement after five weeks of vestibular rehabilitation, with reduction in dizziness frequency from daily episodes to approximately two to three brief episodes per week. Examination demonstrates mild residual symptoms with rapid head movement without spontaneous nystagmus or focal neurologic findings.
2. Vestibular hypofunction, suspected
Persistent mild dizziness with rapid head movement and imbalance in visually complex environments, with improvement following vestibular rehabilitation, remains suggestive of a peripheral vestibular compensation process.
3. Gait and balance impairment, improving
Patient remains independently ambulatory and has had no falls since starting therapy. Mild instability persists with uneven surfaces and rapid turns.
4. Fall risk related to residual imbalance
Current fall risk is reduced compared with the previous visit but remains present during rapid positional changes and uneven walking surfaces.
Follow Up
Continue vestibular therapy and home exercises, with ENT follow-up in approximately 8 to 10 weeks to assess further improvement. Vestibular testing can be considered if symptoms plateau or recur. Earlier evaluation is recommended for persistent severe vertigo, new hearing loss, significant worsening of imbalance, falls, severe headache, double vision, facial weakness, numbness, speech changes, or other new neurologic symptoms.
Chief Complaint
Follow-up after recent bilateral hearing aid fitting with difficulty adjusting to some sounds and occasional discomfort in the left ear.
History of Present Illness
Alex Blacc is a 67-year-old male who returns for follow-up approximately four weeks after being fitted with bilateral hearing aids for age-related hearing difficulty. He reports wearing the devices most days and estimates an average use of approximately eight hours per day.
He feels that the hearing aids have improved his ability to follow conversations, particularly when speaking with family members and during one-on-one conversations. He also notices improved awareness of environmental sounds that he previously missed.
He continues to have difficulty understanding speech in restaurants and other environments with substantial background noise. He reports that voices can occasionally sound too sharp or mechanical in crowded settings. This is more noticeable with the left hearing aid.
He reports intermittent pressure and mild tenderness behind the left ear after wearing the device for several consecutive hours. He does not experience pain immediately after insertion and has not noticed redness, drainage, or skin breakdown. The right hearing aid is comfortable.
He occasionally removes the hearing aids during the afternoon because of sound fatigue, particularly when exposed to multiple simultaneous conversations. He has been cleaning the devices regularly and reports no difficulty inserting or removing them.
He has not noticed feedback from the right device. The left device occasionally produces a brief whistling sound when he is using the telephone or when the device is touched.
He denies new sudden hearing changes, ear drainage, significant ear pain, dizziness, or new tinnitus. His baseline bilateral tinnitus has not noticeably changed since the hearing aids were fitted.
He reports that television volume has decreased since beginning hearing aid use and that his family has noticed that he asks for fewer repetitions during conversation.
Hearing Aid Use and Benefit
Current Medications
Allergies
Medical History
Surgical History
Relevant Hearing Aid History
Fitting: Bilateral hearing aids fitted four weeks ago.
Daily Use: Approximately eight hours per day on most days.
Maintenance: Cleans devices regularly and changes wax filters as instructed.
Right Device: Comfortable with good benefit and no significant feedback.
Left Device: Mild pressure after prolonged use with occasional brief feedback.
Communication Environments: Best benefit in quiet and one-on-one settings. Continued difficulty in restaurants and group conversations.
Patient Goals: Improve speech understanding in background noise and wear devices comfortably throughout the day.
Vitals
BP: 130/78 mmHg
Pulse: 70 beats per minute
Temp: 98.0°F
Height: 5 feet 9 inches
Weight: 176 lb
BMI: 26.0 kg/m²
Examination
General Appearance: Well-appearing male in no acute distress.
External Ears: Normal auricular anatomy bilaterally without swelling, lesions, or tenderness.
Right Ear Canal: Patent and clear without significant cerumen, edema, or discharge.
Right Tympanic Membrane: Intact with normal landmarks and no visible middle ear effusion or acute inflammation.
Left Ear Canal: Patent without significant cerumen or discharge.
Left Tympanic Membrane: Intact with normal landmarks and no visible middle ear effusion or acute inflammation.
Left Postauricular Skin: Mild pressure-related erythema without skin breakdown, ulceration, or drainage.
Neurologic: Alert and oriented. Facial movement symmetric. No obvious focal neurologic deficit.
Hearing Aid Examination
Both hearing aids inspected and found to be functioning appropriately. Microphones and receivers are clear. Wax filters and domes inspected.
The right device is appropriately seated without evidence of excessive pressure.
The left device shows appropriate function but produces intermittent feedback under certain positioning conditions. Fit and acoustic coupling were reviewed.
Audiologic/Device Verification
Hearing aid output was evaluated against the patient's prescribed amplification targets. Overall amplification was appropriately matched to the patient's hearing thresholds.
Speech mapping demonstrated appropriate output across the primary speech frequencies. Gain was adjusted slightly in the left device to improve comfort while maintaining appropriate speech audibility.
Noise-reduction and directional microphone settings were reviewed for use in complex listening environments.
Assessment
Plan
1. Bilateral sensorineural hearing loss with hearing aid use
Patient reports meaningful benefit from bilateral amplification, particularly for one-on-one conversations and television listening. Continued difficulty occurs in restaurants and group settings, which is consistent with the greater listening demands of background noise.
2. Hearing aid adjustment and programming needs
Both devices are functioning appropriately. The left device produces occasional feedback and the patient reports that some sounds are overly sharp in noisy environments.
3. Left hearing aid discomfort
Mild pressure and tenderness occur after several hours of continuous use. Examination shows mild localized pressure-related erythema without skin breakdown or infection.
4. Difficulty hearing in background noise
Patient continues to experience reduced speech understanding in restaurants and group conversations despite overall benefit from amplification.
5. Bilateral nonpulsatile tinnitus
Baseline bilateral tinnitus remains stable without significant worsening since hearing aid fitting.
Follow Up
Follow up in approximately 6 to 8 weeks for hearing aid performance and programming review. Repeat audiologic evaluation is recommended according to routine hearing-monitoring intervals or sooner if a noticeable change in hearing occurs. Earlier evaluation is recommended for sudden hearing loss, persistent ear pain, drainage, significant skin irritation, new vertigo, or a substantial change in tinnitus.
NEW PATIENT
New Patient ENT Consultation
Establishes the patient's ENT history, current symptoms, and exam findings for the initial evaluation.
WHAT MARVIX AI CAPTURES
Captures
HPI, symptom detail, exam findings, prior treatments
Coding
New-patient E/M level with MDM rationale
Also generates
Diagnostic workup orders and referral letters
FOLLOW-UP
Established Patient Follow-up
Reviews symptom progression and treatment response to guide ongoing management.
WHAT MARVIX AI CAPTURES
Captures
Interval symptoms, treatment response, exam findings
Coding
Established-patient E/M level with MDM rationale
Also generates
Updated treatment plan and AVS
SINUSITIS
Chronic Sinusitis Follow-up
Tracks sinonasal symptom burden and treatment response for chronic rhinosinusitis.
WHAT MARVIX AI CAPTURES
Captures
SNOT-22 score, nasal endoscopy findings, treatment response
Coding
ICD-10 with chronicity and severity specified
Also generates
Treatment plan and follow-up imaging orders
VERTIGO
BPPV / Vertigo Workup
Documents dizziness symptoms, triggers, and exam findings to guide diagnosis and treatment.
WHAT MARVIX AI CAPTURES
Captures
DHI score, symptom triggers, positional testing findings
Coding
ICD-10 with laterality specified
Also generates
Treatment plan and referral for vestibular therapy
HEARING LOSS
Hearing Loss Evaluation
Documents hearing symptoms, audiometric findings, and treatment options.
WHAT MARVIX AI CAPTURES
Captures
Audiometry results, symptom onset, exam findings
Coding
ICD-10 with type and laterality specified
Also generates
Hearing aid or referral orders
VOICE
Voice / Dysphonia Consult
Documents voice symptoms, laryngoscopy findings, and treatment planning.
WHAT MARVIX AI CAPTURES
Captures
VHI-10 score, laryngoscopy findings, voice use history
Coding
ICD-10 with symptom detail
Also generates
Referral to voice therapy and treatment plan
OTITIS MEDIA
Otitis Media Visit
Documents ear symptoms, otoscopy findings, and treatment for ear infections.
WHAT MARVIX AI CAPTURES
Captures
Otoscopy findings, symptom duration, treatment history
Coding
ICD-10 with acute or chronic specificity
Also generates
Treatment plan and follow-up instructions
SLEEP APNEA
Obstructive Sleep Apnea Consult
Documents sleep symptoms, exam findings, and treatment planning for suspected or diagnosed OSA.
WHAT MARVIX AI CAPTURES
Captures
Symptom history, exam findings, sleep study results
Coding
ICD-10 with severity specified
Also generates
Sleep study or treatment referral orders
TELECONSULT
ENT Teleconsult Visit
Supports remote ENT management while maintaining documentation continuity across visits.
WHAT MARVIX AI CAPTURES
Captures
Interval symptom status, treatment response, medication changes
Coding
Telehealth-appropriate E/M level
Also generates
Treatment plan and AVS
PROCEDURE
In-Office Procedure
Documents botulinum toxin, nerve blocks, and EMG/NCS studies with consent and technique detail.
WHAT MARVIX AI CAPTURES
Captures
Indication, consent, sites, dosing and technique
Coding
Procedure CPT with units and modifiers
Also generates
Post-procedure instructions and AVS
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Marvix AI
ENT Documentation
General-purpose templates
Built for every ENT scenario, with dedicated templates for infections, tinnitus, balance disorders and more
Symptom & Exam Capture
Standardized note output
Technical HPI and dynamic physical exam documentation, scenario by scenario
Patient Histories
Standardized note output
Comprehensive histories: prior treatments, assessments, and symptom history carried forward
Procedure Documentation
Manual documentation
Macros insert procedure descriptions and medical necessity language automatically
Questionnaires & Scores
Manual documentation / limited support
Medical Billing & Coding
Limited support
ICD-10, CPT & E/M coding with MDM rationale
Team Collaboration
Limited support
Physicians, MAs, NPs & nurses collaborate in one note
AI Assistant
Not available
Chat with every consult using transcripts, notes & uploaded files
EHR Integration
Varies by platform
Deep two-way integration with major EHRs
Payer Compliance
Not addressed
Medical necessity language and audit-ready coding built in
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