A 70-year-old male presents with hearing loss and tinnitus. On examination, he was observed to have a conductive type of deafness and a dull tympanic membrane on the right side. Lymph nodal enlargement of 3 × 3 cm was noted in the posterior triangle of the neck. Tympanogram revealed a type B wave. The most likely diagnosis is -

Conductive deafness, dull tympanic membrane and Type B wave on tympanogram suggest fluid in the middle ear or serous otitis media. Presence of unilateral serous otitis media in an adult should always raise the suspicion of nasopharyngeal growth. The presence of enlarged cervical lymph nodes further suggests the diagnosis of nasopharyngeal cancer as these are present in up to 60% of patients when first seen. The age of the patient (70 years) is also consistent with the diagnosis as nasopharyngeal carcinomas mostly present in the fifth to seventh decade of life.