To Treat or Not To Treat

Question:  A 42 year old male is referred to you for an abnormality detected on routine otoscopy.  His head and neck examination is otherwise normal except for a bulge in the posterior aspect of the right tympanic membrane and external auditory canal.  His facial nerve function is House-Brackmann grade 1.  He has not had any prior episodes of facial weakness.  Imaging reveals an enhancing mass measuring 1.2 cm along the mastoid segment of the facial nerve.  What is the most likely diagnosis and what would you recommend for treatment?  [Answer will be posted with next week's new question]

Answer to last week's question, "Voice Rest" (March 13, 2017)

Strict voice rest, with or without PPI or H2-blocker therapy.