Say what...?!

 

Question:  A 61 year old otherwise healthy gentleman presents to your clinic for evaluation of his ear.  He has no significant otologic history.  However, two days ago he noted a full feeling and ringing in his left ear.  He states he doesn't have any hearing loss and thinks it most likely is "eustachian tube dysfunction".  He denies dizziness, vertigo, facial nerve symptoms, or other neurologic symptoms.  He has a normal otomicroscopic exam.  On tuning fork exam with a 512 Hz fork, he lateralizes to the left on Weber and Rinne is positive (bone greater than air) on the left.  What is your next step? [Answer will be posted with next week's new question]

Answer to last week's question, Break Ya Neck (Apr 13, 2015): 

Most authors would recommend controlling the airway via either orotracheal intubation or tracheotomy, with subsequent direct laryngoscopy and esophagoscopy.  This constitutes a Schaefer-Fuhrman Type II laryngeal fracture.