68 year old male with L ear pain and facial paraesthesia.
This patient is a 68 year old male whose chief complaint is "My left cheek has a 'pins and needles' sensation and I have L ear pain, decreased hearing and bleeding from my ear" Approximately 3 days ago, the patient noticed some vesicles on his chin, which coalesced then scabbed. He also noted a 'pins and needles' sensation on his left cheek, in the V3 distribution, and then extending to his ear and into the external auditory canal. Late this evening he describes a worsening of the sensation in his Left ear as well as hearing loss and bleeding. He denies fever, chills, vertigo, lightheadedness, tinnitus, eye pain, or discharge. He had chickenpox as a child. Physical exam: Vitals: No fever, Pulse, respirations and blood pressure are wnl Skin: There is a diffuse papular rash extending from the left chin onto his cheek and along the mandible, into the ear. There is a 2 cm in diameter crusted area on his left chin. There is a single vesicle on the left side...