A 30-year-old man with chronic suppurative otitis media has a fleshy, reddish polyp filling the external auditory canal. Which is the most appropriate next step in management?
- A Avulse the polyp at the first sitting to relieve obstruction and obtain tissue
- B Send the polyp for histopathology and obtain HRCT temporal bone before any definitive surgery ✓
- C Apply chemical cautery with trichloroacetic acid weekly until it regresses
- D Prescribe systemic steroids and review after four weeks
Correct answer: B. Send the polyp for histopathology and obtain HRCT temporal bone before any definitive surgery
Explanation
An aural polyp in chronic suppurative otitis media must never be avulsed blindly because it may arise from a glomus tumour, carcinoma of the middle ear, or be attached to the facial nerve or an exposed dura. Histopathology establishes its nature, and HRCT defines bony erosion and the extent of disease before definitive mastoid exploration. Blind avulsion risks catastrophic haemorrhage from a glomus tumour or facial nerve injury.
Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.