MKSAP Quiz: 3-week history of ‘stuffiness'

A 28-year-old man is evaluated for a 3-week history of “stuffiness,” decreased hearing, and discomfort in his left ear. He has no other symptoms and otherwise feels well except for mild nasal congestion that he attributes to seasonal allergies. Medical history is unremarkable, and he takes no medications.

On physical examination, temperature is normal, blood pressure is 122/62 mm Hg, pulse rate is 90/min, and respiration rate is 11/min. Examination of the left ear is shown.

There is no lymphadenopathy. The remainder of the examination is unremarkable.

Which of the following is the most appropriate next step in management?

A. Amoxicillin
B. Neomycin, polymyxin B, and hydrocortisone ear drops
C. Tympanostomy tube placement
D. Clinical observation