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{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M76_F2.jpg"}},{"insert":"\n\nYou are introduced you 18-year-old Nadiya, a university student. \u201cHello doctor \u2013 I\u2019ve come about my hearing,\u201d she says. You prompt her for more details.\n\n\u201cWell, I\u2019ve had trouble hearing people properly. I have to ask them to repeat themselves. In fact \u2013 I\u0027ve started relying on my friends\u0027 notes, because I can\u0027t hear the lecturers sometimes.\u201d\n\nYou ask her if she has any other symptoms. She thinks carefully and then replies:\n\n\u201cWell, I suppose I\u2019ve become clumsier in the last couple of months. Might be nothing really \u2013 I\u0027ve been feeling anxious since I\u0027m living on my own for the first time. It\u2019s funny though \u2013 I used to do gymnastics when I was a kid, but now I always seem to be knocking into something!\u201d\n\nYou glance at her medical records. She\u0027s been the picture of health, aside from an episode of chickenpox as an infant. You ask her if she\u0027s been ill in the recent past.\n\n\u201cI\u2019ve been completely fine, doctor \u2013 not even a flu or a stomach bug,\u0022 she responds.\n\nYou ask about her family history, and find out that that it is completely unremarkable. Both parents are in excellent health. There is no history of hearing impairment.\n"}]}