A 30-year-old woman has a central perforation with active mucopurulent discharge from her right ear for two weeks. Culture grows Pseudomonas aeruginosa. She desires hearing improvement. What is the appropriate sequence of management before tympanoplasty?

• A Immediate tympanoplasty regardless of discharge status to prevent further bone erosion
• B Canal wall down mastoidectomy first, with tympanoplasty deferred indefinitely
• C Systemic corticosteroids alone until the perforation heals spontaneously
• D Aural toileting, topical antibiotic drops guided by culture, control of upper respiratory sepsis, and surgery once the ear becomes dry ✓

Explanation

For a safe (tubotympanic) ear with active discharge, standard practice is conservative control of infection first: dry mopping, suction clearance, culture-directed topical drops such as fluoroquinolones effective against Pseudomonas, and treatment of contributory nasal or pharyngeal sepsis. Graft failure rates rise sharply if tympanoplasty is done on a wet ear, hence surgery is planned after the ear has been dry for several weeks. Immediate surgery or steroids are not indicated in uncomplicated safe CSOM.

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.