FRCS (ORL-HNS) · SECTION 1 SBA

Persistent unilateral middle-ear effusion in an adult

A 49-year-old of Chinese family origin develops unilateral conductive hearing loss and a persistent middle-ear effusion without an upper-respiratory infection. What is the most appropriate referral?

CHOOSE ONE ANSWER

Best of five

  1. A. Reassure and repeat audiology in one year
  2. B. Urgent ENT assessment on a suspected-cancer pathway
  3. C. Treat indefinitely with topical ear drops
  4. D. Offer grommets before nasopharyngeal assessment
  5. E. Start vestibular rehabilitation
ANSWER AND REASONING

B. Urgent ENT assessment on a suspected-cancer pathway

NICE advises considering suspected-cancer referral in this presentation because nasopharyngeal pathology must be excluded; this is not routine uncomplicated otitis media.

Why every option is right or wrong

A. Reassure and repeat audiology in one year: Persistent unilateral effusion requires explanation.

B. Urgent ENT assessment on a suspected-cancer pathway: NICE advises considering suspected-cancer referral in this presentation because nasopharyngeal pathology must be excluded; this is not routine uncomplicated otitis media.

C. Treat indefinitely with topical ear drops: The pathology is behind an intact tympanic membrane.

D. Offer grommets before nasopharyngeal assessment: Ventilation may help symptoms but must not precede appropriate investigation.

E. Start vestibular rehabilitation: This does not address conductive hearing loss or effusion.

What if the scenario changed?

If the effusion followed a clear resolving upper-respiratory infection, initial management could be less urgent with defined review.