Finn is a 35-year-old business manager who presents with a six-month history of intermittent left otalgia accompanied by reduced hearing.

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<p>Finn is a 35-year-old business manager who presents with a six-month history of intermittent left otalgia accompanied by reduced hearing.</p><p>He reports associated foul-smelling otorrhea.</p><p>There is no past history of ear trauma, infection or surgery.</p><p>He was using soft earplugs to sleep, but stopped, without any improvement.</p><p>On initial examination vital signs are normal.</p><p>The left the tympanic membrane cannot be seen because of profuse otorrhoea and canal oedema; the right appears normal.</p><p>There are no other findings of note on initial assessment.</p><p>The GP prescribes topical antibiotic and steroid drops and arranges review in five days.</p><p>As there is no improvement, ENT review is arranged.</p><p>The ENT sends the GP an image of the findings following aural toilet (pictured).</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.