MERRF Syndrome Home Care in Ghaziabad: Managing Myoclonus, Safe Mobility, and Seizure Support at Home

Patient Background

Rohan (a fictional name) was 38 years old and lived in Ghaziabad, Uttar Pradesh, with his wife and his elderly mother. He had worked for years as a graphic-printing supervisor, a job that demanded steady hands, long hours on his feet, and quick problem solving. His condition eventually made that work impossible, and by the time this case begins he was no longer employed outside the home.

Rohan’s muscle jerks and seizure episodes had begun in his late twenties. Over the following years, his specialist neurological team carried out the evaluations and investigations that supported a diagnosis of Myoclonic Epilepsy with Ragged-Red Fibers (MERRF) syndrome, a rare genetic mitochondrial disorder. He had been under regular neurological care ever since, with prescribed antiseizure treatment and supportive management.

What changed recently

Two things brought the family to seek home-based help. First, Rohan’s fatigue had grown noticeably worse. Longer walks had become difficult, stair climbing had slowed, and physical activity left him drained. Second, and more worrying for his family, his sudden muscle jerks became more visible when he was tired. His wife began noticing that the jerks clustered at the end of busy days, and she was increasingly afraid he would fall during one of them.

The family requested home-based rehabilitation and caregiver training. They were not looking for a cure. They wanted practical help: a safer home, a wife who knew exactly what to do during a seizure, and a way for Rohan to stay active without pushing himself into exhaustion.

Baseline function

Family situation and risk factors

• Primary caregiver: his wife, who managed the household and most of his day-to-day support.
• Other household member: his elderly mother, who needed consideration in her own right during home planning.
• Key medical risks: seizures, sudden myoclonic jerks during fatigue, exercise intolerance, balance difficulty, and mild difficulty hearing conversations in noisy settings, which is a feature sometimes seen in mitochondrial disorders.
• Key safety risks at home: bathrooms, the kitchen, stair use, and any task involving carrying objects while walking.

One more detail mattered. Because Rohan’s jerks were triggered by fatigue, his risk was highest during ordinary moments: the end of a shower, the last stretch of cooking, the walk back from the market. His home was not a hospital ward. It was a normal apartment with a normal kitchen, and that is exactly where the care had to be designed.

Understanding the Diagnosis

What MERRF syndrome is

MERRF stands for Myoclonic Epilepsy with Ragged-Red Fibers. Each part of the name describes something real:

• Myoclonus means sudden, brief, shock-like jerks of a muscle or group of muscles. They are involuntary, which means the person cannot stop them.
• Epilepsy means the condition can involve seizures, which happened in Rohan’s case and were managed with antiseizure medicine prescribed by his neurologist.
• Ragged-red fibers describes the appearance of muscle tissue under a microscope in many people with this condition. It reflects damaged energy-producing structures inside muscle cells.

MERRF is a mitochondrial disorder. Mitochondria are the tiny structures inside our cells that produce energy. In mitochondrial diseases, this energy production does not work properly. That is why conditions like MERRF often affect tissues that need a lot of energy, especially muscles and the nervous system, and why exercise intolerance and fatigue are so central to daily life.

Common features of MERRF

People with MERRF may experience some or all of the following, and the pattern varies widely from person to person:

• Myoclonus (sudden muscle jerks)
• Seizures
• Muscle weakness
• Coordination problems and unsteadiness
• Hearing difficulties
• Exercise intolerance and marked fatigue

How MERRF is generally confirmed

As general medical education, MERRF is usually suspected from a person’s clinical pattern and confirmed through specialist testing, which may include neurological examination, electroencephalography (EEG) for seizure activity, nerve and muscle studies, muscle biopsy, and genetic testing. The details of Rohan’s diagnostic workup were managed entirely by his specialist team and were not part of the home-care record. The home-care documentation simply recorded the established fact that he had a confirmed MERRF diagnosis and ongoing specialist management. This article does not reproduce or invent any of his hospital test results.

Initial home assessment

Before building the plan, the home-care team assessed Rohan at home. The assessment covered walking pattern, balance, muscle strength, coordination, transfer ability (moving between bed, chair, and toilet), stair safety, fatigue levels, the frequency and pattern of his muscle jerks, his ability to perform personal-care activities, household safety, and his wife’s concerns as caregiver.

The team also reviewed whether any specific activity seemed to increase his symptoms. This was a supportive functional assessment only. It did not replace neurological evaluation, and any medical questions were referred back to his specialist team.

Presenting concerns

Specialist Care Before and During Home Support

There was no recent hospital admission documented in this case. Rohan’s MERRF was not being managed through inpatient care at the time. His treatment ran through regular outpatient neurological appointments with his specialist team, which included prescribed antiseizure medication and supportive care.

The specific names and doses of his medicines were part of his specialist record and are not reproduced here. What the home plan documented was the medication routine around those prescriptions, because for families, the practical side of medication is where problems usually begin.

This division of responsibility shaped everything that followed. The neurologist owned the disease. The home-care team owned the environment, the skills, and the daily observation. Neither replaced the other.

Why Home Healthcare Was Needed

It is fair to ask why a 38-year-old man who could walk and care for himself needed professional home care. The answer lies in how MERRF behaves in real life rather than in a clinic.

1. The symptoms lived at home, not at the hospital

Rohan’s jerks clustered around fatigue. Fatigue built up through ordinary domestic activity: bathing, dressing, moving between rooms, cooking. A neurologist could see him for thirty minutes in an outpatient room, but the moments that mattered, the tired evening hours when a jerk could send him into a table corner or down a step, happened at home. Only structured home observation could capture that pattern and turn it into useful information for his specialist.

This is a broader clinical truth that home-care teams see constantly: patients who look stable in snapshots can still deteriorate between appointments, which is why daily observation catches changes that occasional visits cannot.

2. The fall risk was concentrated in specific rooms

A sudden jerk while walking is dangerous anywhere. A sudden jerk in a bathroom with wet floors, or while carrying a hot pan, is a different order of risk. Reducing that risk required physical changes to the home (grip bars, non-slip flooring, better lighting, cleared walkways) and behavioral rules around high-risk tasks. Neither happens without someone physically present, assessing, and following up.

3. The family had a skills gap, and it was a safety issue

Rohan’s wife loved him and was deeply committed. But love is not the same as training. She had never been taught seizure first aid, safe transfer assistance, or how to pace his day. She also carried the emotional weight of being the only safety net, which is itself a health risk for caregivers.

The family had earlier considered hiring untrained domestic help from a local bureau as a cheaper option. Many families in Ghaziabad face this exact choice, and the consequences of untrained help around a person with seizures are serious enough that we documented them separately in why cheap, untrained home help puts Ghaziabad families at risk. For a condition like MERRF, a helper who does not know that nothing must ever go into a person’s mouth during a seizure is not neutral support. That person is a hazard.

4. Fear was quietly shrinking his life

Rohan had stopped going outdoors. The fear of falling during a jerk had done more damage to his independence than the jerks themselves. Confidence like this does not return through advice. It returns through graded, repeated, supported practice in real settings: a corridor, then the building lobby, then the street outside. That rebuilding needs a therapist physically present, which is a core argument for rehabilitation delivered in the patient’s actual living environment rather than a clinic.

5. Ghaziabad’s geography made emergency readiness a clinical requirement

Because MERRF can involve seizures, the family needed a working emergency plan. In Ghaziabad, that plan carries extra weight. Congestion along the NH-24 (NH-9) corridor and around Mohan Nagar and Vijay Nagar can delay an ambulance significantly, a reality we discuss in why emergency readiness at home matters for families living with NH-24 traffic. When the nearest emergency care may take longer to reach than in a less congested city, the first response at home has to be correct. That reality shaped the seizure first-aid training, the placement of the written emergency plan, and the decision to keep any prescribed rescue medication accessible, exactly as his medical team had instructed.

6. Continuity was the missing piece

Rohan saw his specialists periodically. Between visits, nobody was systematically watching his function, his fatigue pattern, or his near-falls. Families in Ghaziabad often discover this gap the hard way, sometimes after a loved one has already declined despite having someone at home, a pattern we have described in why patients in Ghaziabad can decline even when families believe care is in place. Rohan’s family wanted to close that gap before a serious fall or seizure forced the issue.

Home Care Plan by AtHomeCare

The plan was built around the family’s stated goals: safe mobility, reduced fall risk, effective pacing, medication adherence, seizure safety awareness, and more confidence in daily activities. Each service below is described along with the clinical reasoning behind it.

Home nursing: observation and coordination

A trained nurse visited on a structured schedule and monitored medication adherence, seizure-related concerns, the myoclonus pattern, falls and near-falls, mobility changes, fatigue, daily function, and general health changes. Any significant neurological change was communicated directly to Rohan’s treating team.

The myoclonus symptom diary

The family kept a written diary of Rohan’s muscle jerks. It was a simple tool, but it did the work of turning scattered worry into data.

Seizure safety planning

Because MERRF can be associated with epilepsy, seizure safety was built into the home plan from day one. The family was trained to act calmly and correctly during a seizure, and to recognize when an episode crossed into emergency territory.

Any prescribed rescue medication, if one had been provided as part of his seizure plan, was kept in a known, accessible location, and both wife and mother knew where it was and when it was to be used. The written emergency plan was posted where the family could see it and stored on the wife’s phone.

For the family’s broader preparedness, the team also walked them through general how to recognize warning signs at home and respond quickly, and reinforced the response sequence through the same structured approach used in our home emergency training programs.

Physiotherapy: function over exhaustion

Physiotherapy focused on maintaining useful movement without excessive fatigue. Sessions included gentle strengthening, sit-to-stand practice, controlled walking, balance exercises, transfer training, gentle stretching, and posture exercises. The intensity was adjusted at every session according to Rohan’s energy level, and the stated aim was always to maintain function rather than push him toward exhaustion.

Walking training

Rohan practiced walking on safe indoor surfaces with the physiotherapist. The drills were practical rather than athletic: starting and stopping safely, turning, changing direction, walking around furniture and obstacles, controlled stepping, and holding an appropriate pace. There was one firm rule: when fatigue increased, the session stopped or shifted to a lower-demand activity. Progress was measured in control and confidence, not distance.

Balance and fall prevention

Sudden jerks and coordination difficulty made falls the single biggest physical threat in Rohan’s daily life. The response combined environmental changes with behavioral rules.

Behaviorally, Rohan was taught to ask for assistance during activities with a higher risk of falling. This was framed as strength, not weakness. A wider set of practical changes like these is described in our comprehensive guide to fall prevention at home, and the physical side of it, including supports and aids, can be arranged through home medical equipment rental. The family also kept a simple rule about tracking every stumble: any fall or near-fall was recorded in the diary, because patterns in near-misses predict real falls, and a fall that has already happened deserves proper observation as described in nursing observation after a fall at home.

Fatigue management and pacing

Fatigue was Rohan’s major functional limitation, so the plan treated energy like a budget that had to be spent deliberately. The family learned a simple pacing rhythm:

The team reinforced this with broader daily-movement planning of the kind described in structured daily movement and fall-prevention planning, adapted for a 38-year-old with a mitochondrial energy limit rather than an aging body.

Occupational therapy support

Occupational therapy made daily activities safer rather than impossible. Rohan practiced dressing, grooming, meal preparation, using household appliances safely, organizing his belongings, using his phone, and completing simple paperwork. When fatigue or muscle jerks made a task difficult, it was broken into smaller steps rather than abandoned.

Kitchen safety

Because sudden muscle movements could cause objects to fall, the kitchen carried its own rules. When Rohan was significantly fatigued or having frequent jerks, he avoided handling very hot utensils, sharp objects, and heavy containers. Frequently used items were kept at accessible heights so he did not need to stretch or climb. His wife assisted with higher-risk cooking activities when necessary.

Bathroom safety

The bathroom was reviewed carefully, since it combines water, hard surfaces, and privacy, meaning a fall there may not be witnessed immediately. Safety measures included non-slip flooring or appropriate anti-slip measures, adequate lighting, stable support near the shower where clinically appropriate, easy access to toiletries, and a household rule against rushed movements. Rohan was also encouraged to sit for certain grooming activities whenever standing became tiring.

Medication routine

Rohan followed the medication schedule prescribed by his neurologist, supported by a structured home routine: a medication chart on the wall, phone reminders, a pill organizer where appropriate, and caregiver confirmation when needed. New side effects and any change in seizure frequency were reported to his healthcare team. The discipline behind this routine reflects the approach described in medication monitoring and management at home.

Nutrition and hydration

Rohan was encouraged to maintain regular meals and adequate fluids, unless his medical team advised any restriction. The family’s weekly plan included protein-containing foods, vegetables, fruits, whole grains, and healthy fats. The home team was explicit with the family on one point: no specific diet was presented as a cure for MERRF, and anyone promising one should be treated with caution. Good nutrition supports general health and energy, a principle we expand on in nutrition and hydration support for people receiving care at home.

Sleep and rest

Good sleep was built into the routine because poor sleep can make fatigue harder to manage and, for some people, can interfere with seizure control. The family encouraged a consistent bedtime, a quiet sleeping environment, reduced late-night screen use, planned daytime rest, and avoiding heavy physical activity late in the day. Persistent sleep problems were to be discussed with his medical team rather than handled at home.

Communication and hearing support

Mitochondrial disorders can sometimes involve hearing difficulties, and Rohan reported mild trouble following conversations in noisy environments. The family made small, high-impact adjustments: reducing background noise during conversations, facing him while speaking, using written information when it helped, and encouraging an appropriate hearing evaluation. Any significant change in hearing was to be referred to the relevant healthcare professional.

Rebuilding community mobility

Rohan’s withdrawal from outdoor life was treated as a clinical problem with a clinical solution: a graded ladder, climbed one rung at a time, with rest planned into every level.

1. Indoor walking, mastered first
2. Walking in the immediate home surroundings
3. Short supervised outdoor walks
4. Familiar community locations
5. Gradually increasing activity as tolerated

A walking aid could be considered if recommended after functional assessment; it was not imposed, and any decision would be trialed and reviewed. The psychology here mattered as much as the mechanics, because fear of falling is one of the most treatable causes of lost independence, as we describe in how fear delays mobility recovery after illness. The same graded logic we apply in helping patients walk again after illness applied directly to Rohan’s street-level confidence.

Caregiver training for Rohan’s wife

Rohan’s wife learned how to provide safe assistance without unnecessarily restricting his independence. Her training covered:

• Recognizing changes in seizure patterns
• Maintaining and updating the seizure safety plan
• Assisting with higher-risk activities correctly
• Monitoring fatigue before it became a trigger
• Tracking falls and near-falls in the diary
• Encouraging medication adherence without nagging
• Keeping the home environment continuously safe

Just as important, she was encouraged to take regular breaks from caregiving. Caregiver exhaustion is a slow medical risk for the caregiver and an eventual safety risk for the patient, which is why we address it directly in managing caregiver stress and protecting your own wellbeing.

Escalation boundaries, stated honestly

The plan was explicit about its limits. Home care managed observation, rehabilitation, and safety. Emergencies went to hospital emergency services, full stop. For patients whose conditions do require hospital-level support delivered at home, such as after critical illness, structured home ICU setups exist as a separate service; Rohan’s needs were rehabilitation and safety, not critical care, and pretending otherwise would have been poor medicine.

Four-Week Plan and Recovery Timeline

The support program ran as a four-week plan. Each week had a theme, and each theme built on the one before it. The timeline below records what was planned, what the team did, and what was actually observed, keeping a clear line between the two.

• D1
  Day 1: Assessment and Baseline

  Clinical actions: The home-care team completed the full functional assessment at home: walking, balance, strength, coordination, transfers, stairs, fatigue, jerk pattern, personal-care ability, household safety, and caregiver concerns.

  Setup completed: The myoclonus diary was started, the seizure safety plan was reviewed with the family, the medication chart was established, and fall hazards were flagged for correction.

  Family response: Relief. For the first time, the problems they had been describing vaguely had names, priorities, and dates.

• W1
  Week 1: Safety and Baseline

  Focus: Assess walking and balance, review seizure safety, identify fall hazards, start the symptom diary, establish the medication routine.

  Nursing intervention: Early diary entries already supported what the family had noticed: jerks clustered around tired periods. The home safety corrections began, led by rug removal and lighting improvements.

  Family observation: The wife reported that knowing exactly what to do during a seizure reduced her background anxiety, even before any physical change occurred.

• W2
  Week 2: Mobility

  Focus: Begin gentle strengthening, practice transfers, improve balance, introduce controlled walking, establish pacing strategies.

  Therapy intervention: Physiotherapy sessions stayed short and energy-aware. Sit-to-stand and transfer practice were prioritized because transfers combine the highest risk with the highest daily frequency. The Activity, Rest, Activity rhythm was formalized into Rohan’s daily schedule.

  Patient response: Rohan engaged well with structured sessions; fatigue remained the limiting factor, and sessions were adjusted downward when needed, as designed.

• W3
  Week 3: Daily Activities

  Focus: Practice dressing and grooming strategies, improve kitchen safety, increase safe household participation, continue fatigue management.

  Intervention: Occupational therapy broke larger tasks into steps. Kitchen rules took effect: no hot utensils, sharp objects, or heavy containers during fatigued or jerk-frequent periods; items moved to accessible heights.

  Family observation: Rohan began joining more routine household activities while respecting the high-risk-task boundaries, exactly the balance the plan aimed for.

• W4
  Week 4: Independence

  Focus: Review mobility progress, reassess fall risks, practice supervised outdoor walking, update the caregiver plan, prepare long-term rehabilitation goals.

  Intervention: The week’s plan included supervised outdoor walking practice on familiar routes, and the fall-risk review confirmed the earlier home modifications were holding.

  Documented outcome at four weeks: Rohan demonstrated better confidence during indoor walking and transfers. His muscle jerks continued, particularly during fatigue, but he and his family had become noticeably better at identifying when additional rest was needed. Family confidence with seizure safety had improved clearly.

• W4+
  After Week 4: Ongoing Support

  Continuation: Rohan continued neurological follow-up and medication management with his specialist team, unchanged. Home support continued to focus on maintaining mobility gains, updating the pacing plan as needed, and keeping the seizure safety plan current.

  Direction: Long-term goals shifted from “get safer” to “stay safer and stay included,” with regular reassessment as his condition evolved.

Clinical Evidence

Table 1: Baseline home assessment (documented domains)

Table 2: Four-week plan (as documented)

Table 3: Four-week documented observations

Note that the documented outcome is honest and modest. The jerks did not disappear. The plan never promised they would. What changed was the family’s ability to predict, prevent, and respond, and Rohan’s confidence in moving through his own home.

Medical Authority

Dr. Ekta Fageriya, MBBS

RMC Registration No. 44780

Specialization: Geriatric Medicine Clinical Experience: 7 Years

This case study has been clinically reviewed for accuracy, safe rehabilitation principles, and clear communication for patients and caregivers.

Supporting Clinical Documents

This case was documented through home-care records rather than hospital paperwork. The documents supporting this article were:

• Home nursing visit notes, covering adherence checks, observed mobility, fatigue reports, and any seizure-related concerns across the four weeks.
• The myoclonus symptom diary, maintained by the family and reviewed at nursing visits.
• The home safety assessment checklist, recording fall hazards identified and corrections completed.
• Physiotherapy session notes, documenting exercise content, intensity adjustments, and fatigue-limited session changes.
• The caregiver training record, listing the seizure safety and transfer-assistance competencies covered with Rohan’s wife.
• The written seizure emergency plan, kept accessible at home and reflected in the family’s training.

No discharge summary, ECG, radiology report, or blood report is reproduced here, because there was no recent hospital admission in this case and all hospital-held records stayed confidentially with the treating team. Patient confidentiality is respected throughout; the case itself is fictional, and no real patient information has been disclosed.

Recovery Outcome

Mobility

After four weeks, Rohan walked indoors with visibly better confidence, and his transfers between bed, chair, and toilet were smoother and more controlled. His home was physically safer, and he had internalized the habit of asking for help during genuinely higher-risk moments.

Fatigue and myoclonus

The jerks continued. This is stated plainly because it is the truth of MERRF: rehabilitation does not remove the condition. What changed was management. The family could now predict the tired periods when jerks were likely, schedule rest before those periods, and step back from high-risk tasks during frequent-jerk windows. Fatigue stopped being an ambush and became a forecast.

Daily life and participation

Rohan participated in more routine household activities than before the program, while avoiding higher-risk tasks when his jerks were frequent. That combination, more participation with smarter boundaries, is precisely what success looks like in mitochondrial rehabilitation.

Family feedback

Rohan’s wife reported improved confidence with seizure safety, which she described as the single biggest change. The family demonstrated correct responses during training reviews and maintained the diary consistently. His wife also accepted the principle of regular caregiver breaks, supported by the flexibility of the care plan.

Remaining challenges

• Myoclonus persists, especially with fatigue, and will require ongoing adaptive management.
• Mild hearing difficulty in noisy environments continues, with hearing evaluation encouraged.
• Outdoor independence remains a graded, longer-term project rather than a finished one.
• MERRF is lifelong, and his neurological status will need continued specialist monitoring.

Long-term care direction

Rohan continues regular neurological follow-up and medication management with his specialist team. Home care continues in a supportive role: maintaining function, updating safety plans as his condition evolves, refreshing caregiver training, and watching for any change that needs to travel back to his doctors quickly. The division of labor that made the first four weeks work remains the plan for the long term.

Key Clinical Learnings

1. In mitochondrial disorders, the dose of exercise is the therapy. The same strengthening program can help or harm depending on intensity. Gentle, energy-monitored work preserved Rohan’s function; pushing harder would likely have worsened the fatigue that drives his symptoms.
2. Fatigue is a modifiable trigger, and a diary beats guesswork. The family’s suspicion that “jerks get worse when he’s tired” became actionable only when the diary showed when, and during which activities, it happened. Objective home data changed daily decisions.
3. Seizure first aid is a family skill, not a hospital skill. The most important seizure care in Rohan’s life will be delivered by his wife in a hallway, seconds before any ambulance could arrive. Training her was as clinically important as anything a physician prescribed.
4. Fear of falling is a diagnosis in its own right. It had quietly removed Rohan’s outdoor life before anyone named it. Graded re-exposure, rung by rung, treated it like the clinical problem it is.
5. Fall prevention is environment plus behavior. Removing rugs and adding lighting reduced hazard, but the rules around hot pans, rushed transfers, and asking for help reduced risk just as much. One without the other is incomplete.
6. Home care is additive to neurology, never a replacement. Every meaningful outcome in this case came from two teams respecting a boundary: the specialist owned the disease and its treatment; the home team owned observation, environment, skills, and function. Neither crossed into the other’s territory.
7. Honest documentation builds trust. This case’s value lies partly in what it does not claim: no cure, no miracle, no vanishing symptoms. Families making real decisions deserve real outcomes, including the ones that persist.

Frequently Asked Questions

1. Can a person with MERRF receive home-based rehabilitation?

Yes. Home rehabilitation can support mobility, balance, transfers, daily activities, fatigue management, and caregiver training. The program should be individualized according to the person’s neurological and physical condition.

2. Can physiotherapy cure MERRF?

No. MERRF is a genetic mitochondrial disorder, and physiotherapy does not cure the underlying condition. Rehabilitation is used to maintain function, support safe movement, and improve independence.

3. What should family members do during a seizure?

They should keep the area safe, protect the person’s head if possible, avoid restraining the movements, and never place objects or fingers in the mouth. They should follow the person’s seizure emergency plan and seek emergency help when the situation meets the plan’s emergency criteria.

4. Why is fatigue management important in MERRF?

Mitochondrial disorders can be associated with significant exercise intolerance and fatigue. Pacing activities and taking planned rest breaks can help a person use their available energy more effectively.

5. Should a person with MERRF exercise?

Physical activity may be beneficial when appropriately prescribed, but the program should be individualized. Gentle strengthening, mobility, balance, and functional exercises may be used while avoiding excessive exertion.

6. Can occupational therapy help someone with MERRF?

Yes. Occupational therapy can help modify daily tasks, improve home safety, conserve energy, and identify practical ways to maintain independence with personal care and household activities.

7. When should a change in myoclonus be reported?

A clear increase in frequency or severity, new associated symptoms, repeated falls, loss of awareness, or a change from the person’s usual pattern should be discussed with the treating medical team.

8. Can home care replace neurological follow-up?

No. MERRF requires ongoing medical supervision. Home care provides supportive rehabilitation, monitoring, safety assistance, and caregiver education while specialist teams continue to manage the underlying neurological condition.

9. Can a walking aid help someone with MERRF?

A walking aid may help if a functional assessment shows that extra support reduces fall risk. It is never prescribed automatically. The physiotherapist trials the aid indoors first so the person learns to use it correctly, and it is reviewed again if balance or fatigue changes.

10. What can families do about hearing difficulty linked to mitochondrial disorders?

Families can reduce background noise, face the person while speaking, use written information when it helps, and encourage a hearing evaluation with an appropriate specialist. Any significant change in hearing should be reported to the medical team.