“My right ear’s gone muffled — it’s just wax, isn’t it?”

Gradual, persistent, ASYMMETRIC (unilateral) hearing loss with UNILATERAL tinnitus ± imbalance is the red-flag pattern for a retrocochlear lesion — classically an ACOUSTIC NEUROMA (vestibular schwannoma) — and needs audiology/ENT referral with MRI of the internal auditory meati, NOT just wax removal; finding some wax does not explain a persistent asymmetric sensorineural pattern. Establish the time-course (crucially, SUDDEN sensorineural hearing loss is a SEPARATE same-day ENT emergency needing urgent steroids), unilateral vs bilateral, and associated tinnitus/vertigo/facial numbness or weakness; examine the ears to exclude simple wax/effusion but refer regardless for the asymmetric pattern. Reassure accurately — acoustic neuromas are benign, slow-growing and managed effectively, and many asymmetric losses have other treatable causes — so the referral/MRI is precautionary. The hidden agenda is "just wax" minimisation masking a fear of going deaf (career/identity) and possibly of a brain tumour; surface and address it with proportionate reassurance, acknowledge the work impact, arrange the referral, and safety-net the sudden-loss emergency. Genuinely reassuring: acoustic neuromas are BENIGN, slow-growing, and managed effectively (monitoring, surgery or radiotherapy depending on size) — and many cases of asymmetric loss turn out to have other, treatable explanations. So the referral/MRI is precautionary and good practice, not a sign of disaster.