A patient with CSOM-unsafe type develops sudden facial palsy and vertigo. CT temporal bone shows erosion of the tegmen and lateral semicircular canal. The MOST appropriate management is:

• A Urgent surgical exploration, cholesteatoma removal and decompression of facial nerve ✓
• B Intravenous antibiotics and observation
• C High-dose oral steroids and antifungals
• D Tympanoplasty with grommet insertion

Explanation

Facial palsy and labyrinthine fistula (erosion of the semicircular canal) in CSOM-unsafe are surgical emergencies. Cholesteatoma causing these complications requires urgent surgical exploration — typically canal wall down mastoidectomy — to remove the cholesteatoma, address the labyrinthine fistula carefully (matrix preservation to avoid profound SNHL), and decompress the facial nerve. Antibiotics alone are inadequate for cholesteatoma-related complications.

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.