An adult with worsening conductive hearing loss has a firm external-canal mass that prevents visualisation of the tympanic membrane and prevents an impression for amplification. What is the best next step?
NICE recommends ENT referral when canal obstruction prevents full examination or an aural impression. The lesion needs careful microscopy and, depending on findings, imaging or biopsy planning.
A. Force a probe past the lesion to assess the drum: Blind instrumentation risks trauma and does not establish the lesion's nature.
B. Refer to ENT for diagnostic assessment rather than attempting blind instrumentation: NICE recommends ENT referral when canal obstruction prevents full examination or an aural impression. The lesion needs careful microscopy and, depending on findings, imaging or biopsy planning.
C. Prescribe a hearing aid from the audiogram alone: An impression cannot safely be taken and potentially important canal pathology remains unexplained.
D. Treat empirically with oral antihistamine: A firm obstructing lesion is not explained by allergic rhinitis.
E. Discharge because the loss is conductive: Conductive loss does not make an obstructing mass benign.
If the obstruction were clearly soft wax, evidence-based wax removal would precede referral unless removal were unsafe or unsuccessful.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
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