All | Archetype [runtimeNameConstraintForConceptName=null, archetypeConceptBinding=null, archetypeConceptDescription=Findings observed during the physical examination of the tympanic membrane
., archetypeConceptComment=null, otherContributors=Silje Ljosland Bakke, Bergen Hospital Trust, Norway Ian McNicoll, freshEHR Clinical Informatics, United Kingdom John Tore Valand, Haukeland Universitetssjukehus, Norway Heather Leslie, Atomica Informatics, Australia Stephen Chu, NEHTA, Australia Harvey Coates, UWA, Australia Marissa Cookson, Dept of Health, Australia Kimberley Crebbin, NT Hearing Services, Australia Graeme Crossland, Northern Territory, Australia Kathy Currie, Northern Territory Health, Australia Jacques de Haan, Alice Springs Hospital, Australia Jade Frederiksen, Hearing Health Program, DoH, Australia Sam Heard, Ocean Informatics, Australia (Editor) Paul Hickey, Hearing Health Program, Australia Oliver Hosking, Remote Health NT, Australia Amanda Leach, Menzies School of Health Research, Australia Anthony Leech, Hearing Health, Australia Kerrie Lee, Ngaanyatjarra Health Service, Australia Heather Leslie, Ocean Informatics, Australia (Editor) Ian McNicoll, Ocean Informatics, United Kingdom Hemi Patel, Royal Darwin Hospital, Australia Mark Ramjan, NT Department of Health, Australia Fiona Wake, RAHC, Australia Christine Wigger, Menzies School of Health Research, Australia, originalLanguage=en, translators=, subjectOfData=unconstrained, archetypeTranslationTree=null, topLevelToAshis={items=[ResourceSimplifiedHierarchyItem [path=/items[at0001], code=at0001, itemType=ELEMENT, level=1, text=Ear examined, description=Identification of the ear under examination., comment=This data element may be redundant if the ear examined has been specified in the archetype in which this archetype is nested., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0009::Left [The left ear was examined.]
- at0010::Right [The right ear was examined.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0002], code=at0002, itemType=ELEMENT, level=1, text=No abnormality detected, description=Statement that no abnormality was detected (NAD) on physical examination of the tympanic membrane., comment=Record as True if no abnormality was detected on examination. Specific statements about the examination can be included in the 'Clinical Interpretation' data element., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=Allowed values: {true}, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0003], code=at0003, itemType=ELEMENT, level=1, text=Clinical description, description=Narrative description of the overall findings observed during the physical examination of the tympanic membrane., comment=Use this data element to provide additional, narrative description of any data elements related to the tympanic membrane examination as a whole, that are not represented by structured values. For example: increased vascularity of the tympanic membrane., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0011], code=at0011, itemType=ELEMENT, level=1, text=View, description=Description about the examiner's view of the tympanic membrane., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0012::Adequate [The tympanic membrane was clearly visualised and the duration of time was sufficient; the clinical opinion of the state of the tympanic membrane is based on adequate information.]
- at0013::Compromised [The tympanic membrane was not clearly visualised and/or the duration of view was limited; the clinical opinion of the state of the tympanic membrane is based on limited information.]
- at0014::Total occlusion [The tympanic membrane was not visualised; a clinical opinion of the state of the tympanic membrane could not be formed.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0015], code=at0015, itemType=ELEMENT, level=1, text=Reason for occlusion, description=Narrative description of the reason for occlusion of view of the tympanic membrane., comment=For example, soft wax or foreign body., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0016], code=at0016, itemType=ELEMENT, level=1, text=Ventilation tube present?, description=Is a ventilation tube observed in the tympanic membrane?, comment=There is value in identifying the presence or absence of ventilation tubes in all examinations if ventilation tubes have previously been inserted. Please note: there is little value in recording the absence of ventilation tubes if they have never been inserted, unless it is not known if there has been previous insertion of ventilation tubes., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0017::Present [A ventilation tube is observed in the tympanic membrane or ear canal.]
- at0018::Absent [A ventilation tube is not observed in the tympanic membrane or ear canal.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0019], code=at0019, itemType=ELEMENT, level=1, text=Ventilation tube position, description=Observed position of the ventilation tube (or grommet) in the tympanic membrane or the auditory canal., comment=This data element is redundant if ventilation tubes have been recorded as absent., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0020::In situ [The ventilation tube is located in situ in the tympanic membrane.]
- at0021::Partially extruded [The ventilation tube is partially extruded from it's original position in the tympanic membrane.]
- at0022::Extruded - remains in canal [The ventilation tube has been extruded from the tympanic membrane but is visualised within the external auditory canal.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0023], code=at0023, itemType=ELEMENT, level=1, text=Membrane intact?, description=Is the tympanic membrane intact?, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0024::Intact [The tympanic membrane appears intact.]
- at0026::Indeterminate [It is not possible to determine if the tympanic membrane is intact or perforated.]
- at0025::Perforated [A perforation is observed in the tympanic membrane.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0027], code=at0027, itemType=ELEMENT, level=1, text=Appearance, description=Category describing the appearance of the tympanic membrane., comment=In most situations, this data element would only be recorded if the tympanic membrane is intact., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0028::Translucent [The tympanic membrane appears translucent and healthy.]
- at0029::Opaque [The tympanic membrane appears dull and opaque.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0030], code=at0030, itemType=ELEMENT, level=1, text=Colour, description=Description of the overall colour of the tympanic membrane., comment=For example: red, bluish, or yellow. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0031], code=at0031, itemType=ELEMENT, level=1, text=Light reflex, description=Is a normal light reflex observed?, comment=In most situations, this data element would only be recorded if the tympanic membrane is intact. A 'normal' light reflex may be described as : a complete, bright triangular area of reflected light seen in the anteroinferior portion of the tympanic membrane., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0032::Normal [A normal light reflex is observed.]
- at0033::Abnormal [A normal light reflex is not observed.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0034], code=at0034, itemType=ELEMENT, level=1, text=Surface features, description=Features observed on the surface of the tympanic membrane., comment=This data element allows multiple occurrences to enable multiple selections, if required. In most situations, this data element would only be recorded if the tympanic membrane is intact., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0035], code=at0035, itemType=ELEMENT, level=1, text=Location of tympanosclerosis, description=Description of the location of any tympanosclerosis observed on the tympanic membrane., comment=May be coded with an external terminology, if desired, and be expressed as multiple occurrences for multiple sites., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0036], code=at0036, itemType=ELEMENT, level=1, text=Position of tympanic membrane, description=Description of the position of the tympanic membrane., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0037::Neutral [The tympanic membrane is in a normal, neutral position - neither bulging or retracted.]
- at0038::Retracted [The tympanic membrane appears to be retracted.]
- at0039::Bulging [The tympanic membrane appears to be bulging.]
- at0040::Indeterminate [The position of the tympanic membrane is is not able to be determined.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0041], code=at0041, itemType=ELEMENT, level=1, text=Retraction description, description=Narrative description of the retraction of the tympanic membrane., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0042], code=at0042, itemType=SLOT, level=1, text=Retraction grade, description=Description of retraction using formal classification., comment=For example: Sade Classification or Tos Classification, typically used by ENT specialists., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.sade.v1 and specialisations or openEHR-EHR-CLUSTER.tos.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0043], code=at0043, itemType=ELEMENT, level=1, text=Fluid level presence, description=Observation of a fluid level behind the tympanic membrane., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0044::Present [A fluid level is observed behind the tympanic membrane.]
- at0045::Absent [A fluid level is not observed behind the tympanic membrane.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0046], code=at0046, itemType=ELEMENT, level=1, text=Fluid level description, description=Narrative description of the fluid level and other related features observed behind the tympanic membrane., comment=For example, presence of bubbles., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0047], code=at0047, itemType=ELEMENT, level=1, text=Mobility, description=Description of mobility of the tympanic membrane., comment=Occurrences has been set to 0..* to enable multiple methods of observing mobility to be recorded. For example: 'Mobility (Pneumatic Otoscopy'; or 'Mobility (Valsalva) with Mobile or Indeterminate as only appropriate value set., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0048::Immobile [Minimal or no movement of the tympanic membrane is observed when positive pressure is applied.]
- at0049::Hypomobile [Less than 1mm inward (medial) movement of the tympanic membrane is observed when positive pressure is applied. The movement may be sluggish.]
- at0050::Mobile [Crisp, inward (medial) movement (approx 1mm) when positive pressure is applied.]
- at0051::Hypermobile [Exaggerated movement of the tympanic membrane is observed when positive pressure is applied.]
- at0052::Indeterminate [It is not possible to determine the amount of movement of the tympanic membrane.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053], code=at0053, itemType=CLUSTER, level=1, text=Perforation details, description=Details about a perforation in the tympanic membrane., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=1..*, cardinalityText= (Cardinality: 1..*, unordered), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0054], code=at0054, itemType=ELEMENT, level=2, text=Perforation description, description=Narrative description of the perforation of the tympanic membrane., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0055], code=at0055, itemType=ELEMENT, level=2, text=Estimation of size, description=Estimation of the size of the tympanic membrane perforation, based on anatomical landmarks., comment=Many clinicians record perforations between the well defined 'pinhole' and 'subtotal' perforations using a variety of terms with inconsistent usage and definitions, such as small, medium and large. 'Intermediate' has been proposed as a means to minimise inter-clinician variability for documenting the size of all perforations falling between the 'pinhole' and 'subtotal' definitions. If more detail is required, then measurement of the perforation should be recorded., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0056::Pinhole [The perforation is the size of a pinhole.]
- at0057::Intermediate [The perforation is larger than a pinhole but smaller than a subtotal perforation.]
- at0058::Subtotal [The perforation is subtotal: the pars tensa is absent but the perforation does not include the annulus.]
- at0059::Total [The tympanic membrane is essentially absent.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0060], code=at0060, itemType=ELEMENT, level=2, text=Intermediate estimation, description=Further detail about the size of an intermediate perforation., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0061::<40% [The intermediate perforation is less than 40% of the area of the tympanic membrane.]
- at0062::>40% [The intermediate perforation is greater than 40% of the area of the tympanic membrane.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0063], code=at0063, itemType=SLOT, level=2, text=Dimensions, description=Direct measurement of the size of the tympanic membrane perforation, usually using a photograph as the source for direct measurement., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.dimensions.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0064], code=at0064, itemType=ELEMENT, level=2, text=Pars flaccida vs pars tensa?, description=Description of the region of the tympanic membrane perforation., comment=To document explicitly whether the perforation is located in the Pars flaccida and may be potentially unsafe. If 'Total' or 'Subtotal' is selected in 'Estimation of Size' data element then this data element becomes redundant., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0065::Pars flaccida [The perforation is located in the pars flaccida.]
- at0066::Pars tensa [The perforation is located in the pars tensa.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0067], code=at0067, itemType=ELEMENT, level=2, text=Marginal vs central?, description=Location of the tympanic membrane perforation., comment=To document explicitly whether the perforation is located marginally, and therefore might be clinically unsafe. If 'Total' is selected in 'Estimation of Size' data element then this data element becomes redundant., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0068::Marginal [The perforation involves the annulus of the tympanic membrane.]
- at0069::Central [The perforation is not involving the annulus and is bounded on all sides by the remnant of the tympanic membrane.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0070], code=at0070, itemType=ELEMENT, level=2, text=Anterior?, description=Is an anterior perforation present?, comment=To document the presence of perforation in the anterior portions of the pars tensa, which can be more difficult to manage than perforations elsewhere. If 'Total' or 'Subtotal' is selected in 'Estimation of Size' data element then this data element becomes redundant., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0071::Present [An anterior perforation is present in the pars tensa.]
- at0072::Absent [An anterior perforation is not present in the pars tensa.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0073], code=at0073, itemType=ELEMENT, level=2, text=Edge, description=Narrative description of the edge of the perforation., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0004], code=at0004, itemType=SLOT, level=1, text=Examination findings, description=Structured details about the physical examination findings., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: All not explicitly excluded archetypes, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0005], code=at0005, itemType=SLOT, level=1, text=Multimedia representation, description=Digital image, video or diagram representing the physical examination findings., comment=Both pre- and post-cleaning images to be recorded as part of the examination findings., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.multimedia.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0006], code=at0006, itemType=ELEMENT, level=1, text=Clinical interpretation, description=Single word, phrase or brief description that represents the clinical meaning and significance of the physical examination findings., comment=Coding with a terminology is preferred, if possible. For example, normal examination or chronic otitis media., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0007], code=at0007, itemType=ELEMENT, level=1, text=Comment, description=Additional narrative about the physical examination findings, not captured in other fields., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0008], code=at0008, itemType=SLOT, level=1, text=Examination not done, description=Details to explicitly record that this examination was not performed., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.exclusion_exam.v1 and specialisations, extendedValues=null]], description=[], context=[], activities=[], identities=[], capabilities=[], provider=[], protocol=[], content=[], source=[], credentials=[], events=[], data=[], contacts=[], ism_transition=[], details=[], relationships=[], state=[], target=[], other_participations=[]}, topLevelItems={items=ResourceSimplifiedHierarchyItem [path=ROOT_/, code=at0000, itemType=CLUSTER, level=0, text=null, description=null, comment=null, uncommonOntologyItems=null, occurencesFormal=1..1, occurencesText=Mandatory, cardinalityFormal=1..*, cardinalityText= (Cardinality: 1..*, unordered), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=null, extendedValues=null]}, addHierarchyItemsTo=items, currentHierarchyItemsForAdding=[ResourceSimplifiedHierarchyItem [path=/items[at0001], code=at0001, itemType=ELEMENT, level=1, text=Ear examined, description=Identification of the ear under examination., comment=This data element may be redundant if the ear examined has been specified in the archetype in which this archetype is nested., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0009::Left [The left ear was examined.]
- at0010::Right [The right ear was examined.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0002], code=at0002, itemType=ELEMENT, level=1, text=No abnormality detected, description=Statement that no abnormality was detected (NAD) on physical examination of the tympanic membrane., comment=Record as True if no abnormality was detected on examination. Specific statements about the examination can be included in the 'Clinical Interpretation' data element., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_BOOLEAN, bindings=null, values=Allowed values: {true}, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0003], code=at0003, itemType=ELEMENT, level=1, text=Clinical description, description=Narrative description of the overall findings observed during the physical examination of the tympanic membrane., comment=Use this data element to provide additional, narrative description of any data elements related to the tympanic membrane examination as a whole, that are not represented by structured values. For example: increased vascularity of the tympanic membrane., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0011], code=at0011, itemType=ELEMENT, level=1, text=View, description=Description about the examiner's view of the tympanic membrane., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0012::Adequate [The tympanic membrane was clearly visualised and the duration of time was sufficient; the clinical opinion of the state of the tympanic membrane is based on adequate information.]
- at0013::Compromised [The tympanic membrane was not clearly visualised and/or the duration of view was limited; the clinical opinion of the state of the tympanic membrane is based on limited information.]
- at0014::Total occlusion [The tympanic membrane was not visualised; a clinical opinion of the state of the tympanic membrane could not be formed.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0015], code=at0015, itemType=ELEMENT, level=1, text=Reason for occlusion, description=Narrative description of the reason for occlusion of view of the tympanic membrane., comment=For example, soft wax or foreign body., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0016], code=at0016, itemType=ELEMENT, level=1, text=Ventilation tube present?, description=Is a ventilation tube observed in the tympanic membrane?, comment=There is value in identifying the presence or absence of ventilation tubes in all examinations if ventilation tubes have previously been inserted. Please note: there is little value in recording the absence of ventilation tubes if they have never been inserted, unless it is not known if there has been previous insertion of ventilation tubes., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0017::Present [A ventilation tube is observed in the tympanic membrane or ear canal.]
- at0018::Absent [A ventilation tube is not observed in the tympanic membrane or ear canal.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0019], code=at0019, itemType=ELEMENT, level=1, text=Ventilation tube position, description=Observed position of the ventilation tube (or grommet) in the tympanic membrane or the auditory canal., comment=This data element is redundant if ventilation tubes have been recorded as absent., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0020::In situ [The ventilation tube is located in situ in the tympanic membrane.]
- at0021::Partially extruded [The ventilation tube is partially extruded from it's original position in the tympanic membrane.]
- at0022::Extruded - remains in canal [The ventilation tube has been extruded from the tympanic membrane but is visualised within the external auditory canal.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0023], code=at0023, itemType=ELEMENT, level=1, text=Membrane intact?, description=Is the tympanic membrane intact?, comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0024::Intact [The tympanic membrane appears intact.]
- at0026::Indeterminate [It is not possible to determine if the tympanic membrane is intact or perforated.]
- at0025::Perforated [A perforation is observed in the tympanic membrane.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0027], code=at0027, itemType=ELEMENT, level=1, text=Appearance, description=Category describing the appearance of the tympanic membrane., comment=In most situations, this data element would only be recorded if the tympanic membrane is intact., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0028::Translucent [The tympanic membrane appears translucent and healthy.]
- at0029::Opaque [The tympanic membrane appears dull and opaque.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0030], code=at0030, itemType=ELEMENT, level=1, text=Colour, description=Description of the overall colour of the tympanic membrane., comment=For example: red, bluish, or yellow. , uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0031], code=at0031, itemType=ELEMENT, level=1, text=Light reflex, description=Is a normal light reflex observed?, comment=In most situations, this data element would only be recorded if the tympanic membrane is intact. A 'normal' light reflex may be described as : a complete, bright triangular area of reflected light seen in the anteroinferior portion of the tympanic membrane., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0032::Normal [A normal light reflex is observed.]
- at0033::Abnormal [A normal light reflex is not observed.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0034], code=at0034, itemType=ELEMENT, level=1, text=Surface features, description=Features observed on the surface of the tympanic membrane., comment=This data element allows multiple occurrences to enable multiple selections, if required. In most situations, this data element would only be recorded if the tympanic membrane is intact., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0035], code=at0035, itemType=ELEMENT, level=1, text=Location of tympanosclerosis, description=Description of the location of any tympanosclerosis observed on the tympanic membrane., comment=May be coded with an external terminology, if desired, and be expressed as multiple occurrences for multiple sites., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0036], code=at0036, itemType=ELEMENT, level=1, text=Position of tympanic membrane, description=Description of the position of the tympanic membrane., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0037::Neutral [The tympanic membrane is in a normal, neutral position - neither bulging or retracted.]
- at0038::Retracted [The tympanic membrane appears to be retracted.]
- at0039::Bulging [The tympanic membrane appears to be bulging.]
- at0040::Indeterminate [The position of the tympanic membrane is is not able to be determined.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0041], code=at0041, itemType=ELEMENT, level=1, text=Retraction description, description=Narrative description of the retraction of the tympanic membrane., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0042], code=at0042, itemType=SLOT, level=1, text=Retraction grade, description=Description of retraction using formal classification., comment=For example: Sade Classification or Tos Classification, typically used by ENT specialists., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.sade.v1 and specialisations or openEHR-EHR-CLUSTER.tos.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0043], code=at0043, itemType=ELEMENT, level=1, text=Fluid level presence, description=Observation of a fluid level behind the tympanic membrane., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0044::Present [A fluid level is observed behind the tympanic membrane.]
- at0045::Absent [A fluid level is not observed behind the tympanic membrane.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0046], code=at0046, itemType=ELEMENT, level=1, text=Fluid level description, description=Narrative description of the fluid level and other related features observed behind the tympanic membrane., comment=For example, presence of bubbles., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0047], code=at0047, itemType=ELEMENT, level=1, text=Mobility, description=Description of mobility of the tympanic membrane., comment=Occurrences has been set to 0..* to enable multiple methods of observing mobility to be recorded. For example: 'Mobility (Pneumatic Otoscopy'; or 'Mobility (Valsalva) with Mobile or Indeterminate as only appropriate value set., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0048::Immobile [Minimal or no movement of the tympanic membrane is observed when positive pressure is applied.]
- at0049::Hypomobile [Less than 1mm inward (medial) movement of the tympanic membrane is observed when positive pressure is applied. The movement may be sluggish.]
- at0050::Mobile [Crisp, inward (medial) movement (approx 1mm) when positive pressure is applied.]
- at0051::Hypermobile [Exaggerated movement of the tympanic membrane is observed when positive pressure is applied.]
- at0052::Indeterminate [It is not possible to determine the amount of movement of the tympanic membrane.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053], code=at0053, itemType=CLUSTER, level=1, text=Perforation details, description=Details about a perforation in the tympanic membrane., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=1..*, cardinalityText= (Cardinality: 1..*, unordered), subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0054], code=at0054, itemType=ELEMENT, level=2, text=Perforation description, description=Narrative description of the perforation of the tympanic membrane., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0055], code=at0055, itemType=ELEMENT, level=2, text=Estimation of size, description=Estimation of the size of the tympanic membrane perforation, based on anatomical landmarks., comment=Many clinicians record perforations between the well defined 'pinhole' and 'subtotal' perforations using a variety of terms with inconsistent usage and definitions, such as small, medium and large. 'Intermediate' has been proposed as a means to minimise inter-clinician variability for documenting the size of all perforations falling between the 'pinhole' and 'subtotal' definitions. If more detail is required, then measurement of the perforation should be recorded., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0056::Pinhole [The perforation is the size of a pinhole.]
- at0057::Intermediate [The perforation is larger than a pinhole but smaller than a subtotal perforation.]
- at0058::Subtotal [The perforation is subtotal: the pars tensa is absent but the perforation does not include the annulus.]
- at0059::Total [The tympanic membrane is essentially absent.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0060], code=at0060, itemType=ELEMENT, level=2, text=Intermediate estimation, description=Further detail about the size of an intermediate perforation., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0061::<40% [The intermediate perforation is less than 40% of the area of the tympanic membrane.]
- at0062::>40% [The intermediate perforation is greater than 40% of the area of the tympanic membrane.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0063], code=at0063, itemType=SLOT, level=2, text=Dimensions, description=Direct measurement of the size of the tympanic membrane perforation, usually using a photograph as the source for direct measurement., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.dimensions.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0064], code=at0064, itemType=ELEMENT, level=2, text=Pars flaccida vs pars tensa?, description=Description of the region of the tympanic membrane perforation., comment=To document explicitly whether the perforation is located in the Pars flaccida and may be potentially unsafe. If 'Total' or 'Subtotal' is selected in 'Estimation of Size' data element then this data element becomes redundant., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0065::Pars flaccida [The perforation is located in the pars flaccida.]
- at0066::Pars tensa [The perforation is located in the pars tensa.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0067], code=at0067, itemType=ELEMENT, level=2, text=Marginal vs central?, description=Location of the tympanic membrane perforation., comment=To document explicitly whether the perforation is located marginally, and therefore might be clinically unsafe. If 'Total' is selected in 'Estimation of Size' data element then this data element becomes redundant., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0068::Marginal [The perforation involves the annulus of the tympanic membrane.]
- at0069::Central [The perforation is not involving the annulus and is bounded on all sides by the remnant of the tympanic membrane.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0070], code=at0070, itemType=ELEMENT, level=2, text=Anterior?, description=Is an anterior perforation present?, comment=To document the presence of perforation in the anterior portions of the pars tensa, which can be more difficult to manage than perforations elsewhere. If 'Total' or 'Subtotal' is selected in 'Estimation of Size' data element then this data element becomes redundant., uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_CODED_TEXT, bindings=null, values=- at0071::Present [An anterior perforation is present in the pars tensa.]
- at0072::Absent [An anterior perforation is not present in the pars tensa.]
, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0053]/items[at0073], code=at0073, itemType=ELEMENT, level=2, text=Edge, description=Narrative description of the edge of the perforation., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0004], code=at0004, itemType=SLOT, level=1, text=Examination findings, description=Structured details about the physical examination findings., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: All not explicitly excluded archetypes, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0005], code=at0005, itemType=SLOT, level=1, text=Multimedia representation, description=Digital image, video or diagram representing the physical examination findings., comment=Both pre- and post-cleaning images to be recorded as part of the examination findings., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.multimedia.v1 and specialisations, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0006], code=at0006, itemType=ELEMENT, level=1, text=Clinical interpretation, description=Single word, phrase or brief description that represents the clinical meaning and significance of the physical examination findings., comment=Coding with a terminology is preferred, if possible. For example, normal examination or chronic otitis media., uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0007], code=at0007, itemType=ELEMENT, level=1, text=Comment, description=Additional narrative about the physical examination findings, not captured in other fields., comment=null, uncommonOntologyItems=null, occurencesFormal=0..1, occurencesText=Optional, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=DV_TEXT, bindings=null, values=, extendedValues=null], ResourceSimplifiedHierarchyItem [path=/items[at0008], code=at0008, itemType=SLOT, level=1, text=Examination not done, description=Details to explicitly record that this examination was not performed., comment=null, uncommonOntologyItems=null, occurencesFormal=0..*, occurencesText=Optional, repeating, cardinalityFormal=null, cardinalityText=null, subCardinalityFormal=null, subCardinalityText=null, dataType=CLUSTER, bindings=null, values=Include: openEHR-EHR-CLUSTER.exclusion_exam.v1 and specialisations, extendedValues=null]], minIndents={}, termBindingRetrievalErrorMessage=null] |