A 48-year-old man who migrated from southern China ten years ago presents with six weeks of a blocked sensation and reduced hearing in the right ear. On several recent mornings he has noticed streaks of blood in mucus drawn back from the nose and spat out. Otoscopy shows a dull, retracted right tympanic membrane with a fluid level behind it; the left ear is normal. A 512 Hz tuning fork placed on the middle of his forehead is heard louder in the right ear. Which one of the following is the most appropriate next step?
Keep going — a set of ten like this one, one at a time.
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