An elderly man had long-standing ear discharge and now presented with facial palsy, pain in the ear which is worse at night and a friable polyp in the ear with tendency to bleed. The likely diagnosis is:

Carcinoma of middle ear occurs in cases of long-standing ear discharge - the chronic irritation is probably its causative factor.Glomus tumour presenting as a polyp bleeds profusely on touch but the bleeding polyp or granulation tissue which is also friable is typical of carcinoma.Nocturnal pain is again a feature of carcinoma and differentiates it from CSOM. Features which should alert an otolaryngologist to possibility of carcinoma of middle ear include:Severe nocturnal painFriable granulations or a polyp with tendency to bleedFacial paralysisOtitis externa refractor) to treatment.