Sometimes medicine is enthralling, but at others it leaves one with a feeling of trepidation. I was teaching my new trainee today in my clinic in the NHS. He had never done any ENT before and was impressing me with pertinent questions about the patients we were seeing together in a very busy clinic. I had just made the point that there are no short-cuts in medicine when an otherwise well, non-smoking young lady in her 30’s came in with an “ear infection”. Or that’s what her GP referred her as. Turns out she had a nasty cold whilst on holiday and her ear became blocked and full. On return, she received some antibiotics, but five weeks later, it was still blocked. Her hearing test suggested some fluid behind the eardrum, but it really didn’t looked inflamed at all. I asked my trainee to feel her neck carefully for any glands and he asked if you normally get glands in the neck from an ear infection. Meanwhile, I took a fibreoptic endoscope and passed this gently through her nostril to take a look at the postnasal space, where the eustachian tube opens. There, I found a pink, fleshy mass covering over the opening of the tube.

We are making urgent arrangements to biopsy this under general anaesthetic. Problem is, this may well turn out to be a malignant tumour. when it finally dawned on my trainee that this was no simple ear infection his face suddenly dropped. Then he understood what I meant by “no shortcuts”. I think it may have ruined his day.