A patient with CSOM-unsafe develops extradural abscess and meningism. After CT head confirming the extradural collection and active cholesteatoma, what is the correct order of management?
- A Emergency combined neurosurgical drainage of extradural abscess + mastoidectomy in the same or consecutive sitting ✓
- B IV antibiotics alone for 6 weeks then elective surgery
- C Mastoidectomy first, then neurosurgery at a second operation
- D Lumbar puncture and intravenous dexamethasone only
Correct answer: A. Emergency combined neurosurgical drainage of extradural abscess + mastoidectomy in the same or consecutive sitting
Explanation
An extradural abscess complicating cholesteatoma is a surgical emergency. The current standard is combined or staged (within the same admission) neurosurgical drainage of the abscess and mastoidectomy to eliminate the source. Managing only the intracranial collection without eradicating the ear disease leads to recurrence. IV antibiotics complement surgery but are never sufficient alone for an established abscess.
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.