Adult unilateral middle-ear effusion

A. ENT assessment including examination of the nasopharynx

Persistent adult unilateral effusion warrants specialist assessment for obstructive pathology, including a nasopharyngeal lesion. Treating it as uncomplicated childhood-type glue ear risks missing malignancy or another mechanical cause.

Why every option is right or wrong

A. ENT assessment including examination of the nasopharynx: Persistent adult unilateral effusion warrants specialist assessment for obstructive pathology, including a nasopharyngeal lesion. Treating it as uncomplicated childhood-type glue ear risks missing malignancy or another mechanical cause.

B. Repeated topical antibiotic drops: Drops do not ventilate an intact middle ear or investigate the cause of Eustachian-tube obstruction.

C. Reassure and discharge: Persistence after the respiratory illness is specifically a reason for specialist referral.

D. Fit a hearing aid without investigating the effusion: Hearing rehabilitation may be considered, but the unilateral obstructive cause must first be assessed.

E. Request vestibular testing: The presentation is conductive middle-ear disease, not a vestibular syndrome.

What if the scenario changed?

If effusions were bilateral during an active viral illness and resolving, a period of observation could be reasonable provided red flags were absent.