Mar 12, 2026 11:58 To: +16042339777 Page: 41/46 From: Foremed Medical Clinic Fax: 16043985614

FRASER HEALTH AUTHORITY Emerg Note
Royal Columbian Hospital HOLAND,MARK THOMAS
RC0470727/25
| Blood Pressure | 152/82 | 03/03/2026 11:12 |
| Pulse Oximetry | 98 | 03/03/2026 11:12 |
Documentation

This 47-year-old male presents to the emergency department because he wants to see an
otolaryngologist today. He states that he has been having intermittent ear symptoms that started in
January, 2026. He states that he has aiso been seen 5 days ago at St. Paul's Hospital for the same.
At that time, he was referred to the ENT clinic but he has not heard back from them. He states that
he believes the cause of his symptoms are secondary to 2 large refrigerators behind his desk at work.
They are very noisy despite being assessed by the occupational therapist as within safe hearing
range. He is concerned that he has not been getting REM sleep. Today he denies any headache,
visual symptoms, tinnitus or discharge from his ears. He states that he did an audiology test in
Surrey and the report was normal. He denies any new drugs, head trauma, persistent earbud usage
(he uses noise-cancelling headphones all day), neurological deficits.

On a previous visit January 30, 2026 to the emergency department at the Royal Columbian Hospital,
his case was discussed with the otolaryngologist on-call, Dr. Zahabi. At that time, Dr. Zahabi feit that
the cause of the problems was not of ENT origin but that the noisy environment may have triggered
his migraines. He appears to have done his own independent sleep study since then and is concerned
that he is consistently moving throughout the night.

On examination, he looks well. Vital signs noted as above.
Bilateral tympanic membranes appear normal. There was no sign of infection. Normal ear canals.
Cranial nerve examination normal. Weber and Rinne tests normal.

Impression/ Plan:
Otalgia.

I have encouraged the patient to follow up with the otolaryngology clinic that he has been referred to
just a few days ago at St, Paul's Hospital. I have also encouraged him to follow up with his family
doctor to address his sleep concerns. if he develops fever, discharge, persistent headaches or is

unwell he is welcome to come back to the emergency department for reassessment. Patient is aware
and agrees.

Discharge Plan

This record contains confidential information which must be protested. Any unauthorized use or disclosure is stri¢tly prohibited.

Meditech Report !D: 0303-00213 2083

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