A 28-year-old man presents with right-sided foul-smelling ear discharge for 3 years. Examination shows a white, pearly mass in the posterior-superior quadrant of the tympanic membrane with marginal perforation. CT temporal bone demonstrates erosion of the scutum. The most appropriate management is:

• A Prolonged antibiotic ear drops
• B Myringoplasty
• C Cortical mastoidectomy
• D Modified radical mastoidectomy ✓

Explanation

This presentation is consistent with an acquired attic cholesteatoma — pearly white epithelial mass, posterior-superior marginal perforation, and CT evidence of scutum erosion. Cholesteatoma is a dangerous form of CSOM because it erodes bone and can cause intracranial complications; surgery is the only definitive treatment. Modified radical mastoidectomy (canal wall down procedure) ensures complete removal and adequate exteriorisation.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.