A 6-year-old with acute exacerbation of CSOM has fever, deep-seated ear pain, and sagging of the posterosuperior wall of the external auditory canal. HRCT shows breakdown of mastoid trabeculae with coalescence into a single cavity. The appropriate next step is:

• A Continue intravenous antibiotics alone and review in 48 hours
• B Cortical mastoidectomy with drainage of the abscess ✓
• C Canal wall down modified radical mastoidectomy
• D Insertion of a grommet under local anaesthesia

Explanation

Sagging of the posterosuperior canal wall with coalescent mastoiditis on CT indicates pus under tension in the mastoid threatening further bone destruction and intracranial spread. Intravenous antibiotics alone are inadequate once coalescence has occurred, and cortical mastoidectomy with drainage of the collection is the definitive step. Canal wall down surgery is reserved for extensive cholesteatomatous disease, and grommet insertion addresses otitis media with effusion, not coalescent suppuration.

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.