1st April 2022

A 65-year-old lady presented to the GP clinic with hearing difficulties in both ears

A 65-year-old lady presented to the GP clinic with hearing difficulties in both ears. On questioning, she described that her right ear is worse than her left ear in terms of hearing and has been deteriorating for the past 8 months. Otherwise, she described no vertigo, disequilibrium, tinnitus, aural fullness, headache, dizziness, blackout, weakness, swallowing difficulties and otalgia. She has a past medical history of hypertension and high cholesterol which she took ramipril and simvastatin for. No previous history of ear surgery and no significant family history. On physical examination, the GP noticed hearing reduction in keeping with her history. Neurological examination and cranial nerve exam revealed no abnormalities. On otoscopy, the tympanic membrane in both ears cannot be seen due to ear wax. An initial diagnosis of impacted ear wax is made. Hence, the GP decided to irrigate the ear with water to remove the ear wax in both ears.

What investigation should be performed next to determine the actual cause of the hearing difficulty post-treatment?

Select the SINGLE most appropriate option from the list below. Select ONE option only.