A 6-year-old girl has painless, odourless ear discharge for 4 months unresponsive to two courses of antibiotics. Otoscopy reveals multiple small perforations of the tympanic membrane with pale granulations, and there is a firm 1 cm jugulodigastric lymph node. The most likely diagnosis is:

• A Langerhans cell histiocytosis of temporal bone
• B Malignant otitis externa
• C Atticoantral CSOM with cholesteatoma
• D Tuberculous otitis media ✓

Explanation

Tubercular otitis media classically causes painless otorrhoea, multiple small perforations that may later coalesce into a single large one, pale granulation tissue, and marked cervical lymphadenopathy. It is notoriously unresponsive to ordinary antibiotics, which explains the failed courses here. Cholesteatoma gives foul discharge with a single attic or marginal defect, and malignant otitis externa occurs mainly in elderly diabetics with severe pain.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.