During examination of an unsafe ear with atticoantral CSOM, a fleshy aural polyp is seen arising from the attic. Why must this polyp NOT be avulsed blindly in the outpatient department?

• A It may be attached to the facial nerve, dura, or labyrinth, and blind avulsion can cause facial palsy, CSF leak, or vertigo ✓
• B Avulsion invariably precipitates malignant transformation of the polyp
• C Bleeding from the polyp obscures the tympanic membrane permanently
• D Avulsion converts a safe ear into an unsafe ear

Explanation

In an unsafe ear, an aural polyp of granulation tissue may be continuous with cholesteatoma and can be adherent to vital deep structures such as the facial nerve, dura mater, or lateral semicircular canal. Blind avulsion risks facial palsy, CSF otorrhoea, or sensorineural deafness with vertigo. The polyp should be removed under direct vision in the operating theatre, with histopathology sent to exclude rare malignancy. Avulsion does not alter the safe or unsafe status of the underlying ear.

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

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Written and medically reviewed by the StethoPrep medical team.