A 40-year-old with a known right-sided atticoantral CSOM develops sudden onset right facial palsy (House-Brackmann Grade IV) and purulent ear discharge. The most appropriate immediate management is:

• A Emergency combined cortical mastoidectomy and facial nerve decompression ✓
• B IV dexamethasone to reduce facial nerve oedema and defer surgery
• C Oral prednisolone + topical antibiotic drops for 2 weeks
• D Tympanocentesis and culture-directed antibiotics, with surgery in 6 weeks

Explanation

Facial palsy in the setting of active atticoantral CSOM/cholesteatoma is a surgical emergency, caused by direct bony erosion of the fallopian canal exposing the facial nerve to infection and pressure. Immediate surgical mastoidectomy with removal of cholesteatoma/infected debris and facial nerve decompression is required. Steroids alone delay definitive treatment and may mask worsening. Deferred surgery risks permanent facial nerve damage from ischaemia and infection.

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.