An 18-year-old presents with painless, scanty, odourless ear discharge unresponsive to three courses of antibiotics. Otoscopy shows two small central perforations in the pars tensa with pale granulations. The most likely diagnosis is:
- A Tubotympanic CSOM due to Pseudomonas aeruginosa
- B Tuberculous otitis media ✓
- C Atticoantral CSOM with early cholesteatoma
- D Malignant otitis externa
Correct answer: B. Tuberculous otitis media
Explanation
Tuberculous otitis media classically presents with painless, odourless discharge that fails to respond to conventional antibiotics, multiple small perforations in the pars tensa, pale granulation tissue, and disproportionately early facial palsy relative to the size of disease. Pseudomonas infection gives foul-smelling discharge with a single perforation. Malignant otitis externa is excruciatingly painful, occurs in diabetics, and involves the external canal rather than the middle ear cleft.
Reference: Dhingra, Diseases of Ear, Nose and Throat, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.