During the Commander-in-Chief forum held in New York City on Sept. 7, close-up photos of Hillary Clinton’s left ear showed she had some sort of earpiece in it, prompting concerns she was receiving on-the-fly coaching from her campaign while taking questions.


Now, a Reuters photo of Clinton shows she may have had the same type of device in her ear again on Monday evening during the first presidential debate with Donald Trump. Was she getting instructions from her campaign team while she was engaged in the debate?


The earpiece used Sept. 7 was a pearl color. The object in her ear Monday night was meant to match her skin tone almost perfectly. But when one zooms in to the photo, her outline of her tragus can be seen overlapping whatever it is.


Ultimately, that’s the most important question, though. What does she have in her ear? There are three possibilities:


A hearing aid—loss of hearing or dulled hearing is not uncommon for people of Clinton’s age, particularly for those who have suffered a traumatic head injury, like a concussion. Many different companies market hearing aids that are meant to be concealed. An inductive earpiece—stage actors often use these to help with cues and missed lines during performances. They are meant to be concealed, and with Bluetooth technology, those speaking to Clinton through it wouldn’t even have to be in the same city. An anti-seizure device—sound can trigger certain forms of seizures. A German-engineered device called the Epitect fits inside the ear and can detect and warn of an impending seizure, but more closely resembles a more traditional hearing aid with a component that hangs behind the ear.


None of these paint a particularly good picture for the Democratic presidential nominee. Either she has an as-yet undisclosed health condition, ranging from mild to severe, or she’s been cheating during the televised debates.

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