A 35-year-old man with left-sided CSOM (atticoantral type) presents with sudden onset severe otalgia, high fever, and retroauricular swelling with displacement of the auricle forward and downward. CT shows a sub-periosteal abscess over the mastoid. What is the MOST appropriate initial surgical management?

• A Modified radical mastoidectomy with meatoplasty
• B Incision and drainage of the sub-periosteal abscess alone
• C Cortical mastoidectomy with drainage of the abscess ✓
• D Canal-wall-up mastoidectomy with tympanoplasty

Explanation

Acute mastoiditis with sub-periosteal abscess is a surgical emergency requiring cortical (Schwartze) mastoidectomy. This procedure exenterates all mastoid air cells, drains the abscess, and removes the source of infection while preserving the posterior meatal wall. Isolated incision and drainage is inadequate as it does not address the underlying mastoid disease. Modified radical mastoidectomy is reserved for cholesteatoma with extensive disease rather than acute suppurative mastoiditis.

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.