A 34 year old man was slapped over his right ear in a fight. There is blood coming from his external auditory canal and he has pain, deafness and ringing in his ears. What is the most appropriate initial investigation?

The key is C. Otoscopy. [Traumatic perforation of the tympanic membrane (TM) can cause pain, bleeding, hearing loss, tinnitus, and vertigo. Diagnosis is based on otoscopy. Treatment often is unnecessary. Antibiotics may be needed for infection. Surgery may be needed for perforations persisting more than 2 months, disruption of the ossicular chain, or injuries affecting the inner ear. Reference: Merck Manual (Prefessional version) [www.merckmanuals.com/professional/ear,-nose,-and-throat- disorders/middle-ear-and-tympanic-membrane-disorders/traumatic-perforation-of-the-tympanic- membrane].