Dr Cyril John
Local General Practitioner
The Hail Land Medical Clinic
20 July 2019
Dear Dr John,
Re: Mr Alan Marco, aged 38
I am requesting an urgent visiting consultation and appropriate management for Mr Marco, who has provisionally
diagnosed with localized right external ear infection along with uncontrolled hyperglycemia.
Mr Marco presented to the Holiday Resort for a-two-week holiday and was participating in scuba diving and
swimming in daily basis. During the stay, he has been suffering from severe right ear pain which has not responded
to paracetamol, for the last five days. In addition to that sugar levels are currently unstable.
On assessment today, the ear pain still persists with warm to touch and shows tenderness when palpating. External
ear seems to be red but has no discharges. Despite the redness, the ear canal is swollen. Also, the tympanic
membrane looks pale in color. The pain was assessed four out of ten on a scale and ibuprofen was prescribed. In
spite of that, refraining from inserting cotton balls into the affected ear and swimming activities was advised. Blood
sugar levels have been monitored regularly.
Mr Marco has been treated for type 1 diabetes, for which he routinely takes insulin. He has been smoking ten
cigarettes per day.
Based on the aforementioned circumstances, immediate examination for a formal diagnosis of Mr Marcos’s health
condition would be extremely beneficial. Also, effective pain management and review of insulin therapy will be
If any information is required, please do not hesitate to contact me.