A 70-year-old male presents with hearing loss and tinnitus. On examination, he has a conductive type of deafness and a dull tympanic membrane on the right side. Lymph nodal enlargement of 3x3 cm was noted in the posterior triangle of the neck. Tympanogram revealed a type B wave. The most likely diagnosis is
Due to the obstruction of the eustachian tube, there is a conductive hearing loss with serious or suppurative otitis media. Tinnitus and dizziness may occur. Presence of unilateral serous otitis media in an adult should raise suspicion of nasopharyngeal growth. Rarely, the tumour grows up the tube into the middle ear. (Ref: Diseases of Ear, Nose and Throat, P.L Dhingra, 7th edition, page 284)
Middle ear tumor
Nasopharyngeal malignancy
Acoustic neuroma
Tuberculosis of middle ear
Pharynx