Eustachian tube and nasopharynx: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

ENT · Eustachian tube and nasopharynx

Sample item

A 52-year-old man has two months of unilateral reduced hearing without ear pain or recent cold. Otoscopy shows a retracted dull drum with a fluid level, and tympanometry is flat. What is the most appropriate next step?

AReassure and review after three monthsBInsert a grommet and discharge himCPrescribe a hearing aidDNasopharyngeal endoscopy with biopsy of any suspicious lesion

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Nasopharyngeal endoscopy with biopsy of any suspicious lesion

Unilateral middle ear effusion in an adult without an infective cause suggests eustachian tube obstruction by a nasopharyngeal mass until proven otherwise. Examination of the postnasal space is therefore essential before treating the ear, because nasopharyngeal carcinoma may present this way. Grommets alone would treat the effect and miss the cause.

Option by option

A. Reassure and review after three months
Waiting for three months delays diagnosis of a possible tumour.
B. Insert a grommet and discharge him
A grommet treats the fluid but leaves a possible malignancy undiagnosed.
C. Prescribe a hearing aid
A hearing aid does not address the underlying cause.
D. Nasopharyngeal endoscopy with biopsy of any suspicious lesion (correct)
Correct. A nasopharyngeal tumour must be excluded as the cause of the effusion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this ENT question

What is the answer to this ENT question?

The best answer is D, Nasopharyngeal endoscopy with biopsy of any suspicious lesion. Unilateral middle ear effusion in an adult without an infective cause suggests eustachian tube obstruction by a nasopharyngeal mass until proven otherwise.

Why is "Reassure and review after three months" not the answer?

Waiting for three months delays diagnosis of a possible tumour.

Why is "Insert a grommet and discharge him" not the answer?

A grommet treats the fluid but leaves a possible malignancy undiagnosed.

Why is "Prescribe a hearing aid" not the answer?

A hearing aid does not address the underlying cause.

What concept does this question test?

It tests Eustachian tube and nasopharynx in ENT. Examination of the postnasal space is therefore essential before treating the ear, because nasopharyngeal carcinoma may present this way. Grommets alone would treat the effect and miss the cause.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Eustachian tube and nasopharynx?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.