Key Points

• In smokers with otalgia, the clinician should suspect laryngopharyngeal carcinoma.

• A white mass behind the tympanic membrane might be a cholesteatoma.

• Pneumatic otoscopy is most useful in confirming middle ear fluid.

• Tympanometry and acoustic reflex testing are complementary to audiometry in determining the location of hearing loss.

• A neoplastic process should be considered when a presumed infection does not respond to usual medical treatment.

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