What is the diagnosis

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k12b5

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The patient has had tinnitus in his left ear for 2 months. He only notices the tinnitus in quiet environment (ie when he in bed). He had no history of ears problem.
Right ear is normal on otoscopy.
Left ear: something abnormal on the posterior upper quadrant. (see picture)
Valsava (+) on both ears.

What is the likely diagnosis?
Thanks.
 

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Results from audiogram? immittance?

Was the TM mobile when performing pneumatic otoscopy?
 
The patient has had tinnitus in his left ear for 2 months. He only notices the tinnitus in quiet environment (ie when he in bed). He had no history of ears problem.
Right ear is normal on otoscopy.
Left ear: something abnormal on the posterior upper quadrant. (see picture)
Valsava (+) on both ears.

What is the likely diagnosis?
Thanks.

Cholesteatoma until proven otherwise.

You didn't describe pneumotoscopy?

Pulsatile or nonpulsatile tinnitus?

Audiogram?

CT?
 
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