A 30-year-old patient with atticoantral CSOM develops severe throbbing otalgia, postauricular erythema, and a sagging postauricular sulcus. CT shows coalescent mastoiditis with breakdown of bony septa. The most appropriate immediate management is:

• A Oral amoxicillin-clavulanate and follow-up in 1 week
• B Myringotomy with intravenous antibiotics
• C Radical mastoidectomy after 6 weeks of antibiotic therapy
• D Cortical mastoidectomy with intravenous antibiotics ✓

Explanation

Coalescent mastoiditis with postauricular abscess or subperiosteal abscess requires urgent surgical drainage via cortical mastoidectomy combined with intravenous antibiotics. This is a recognized complication of acute exacerbation of CSOM. Myringotomy alone is insufficient when there is bony coalescence. Delaying surgery risks further complications including intracranial extension.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.