An 8-year-old child has painless, scanty ear discharge for four months that has not responded to multiple courses of antibiotics. Otoscopy shows several small perforations in an otherwise intact-looking tympanic membrane with pale granulations, and audiometry reveals a mild conductive hearing loss. Acid-fast staining of the discharge is positive. The most likely diagnosis is:
- A Atticoantral chronic suppurative otitis media
- B Tuberculous otitis media ✓
- C Malignant otitis externa
- D Wegener granulomatosis with otologic involvement
Explanation
Tuberculous otitis media classically causes painless otorrhoea unresponsive to routine antibiotics, multiple perforations in the tympanic membrane, pale granulation tissue, and early hearing loss disproportionate to the findings. It arises from bacilli reaching the middle ear via the eustachian tube or haematogenous route. Atticoantral disease gives a single attic or marginal perforation with foul discharge rather than multiple perforations, malignant otitis externa is an external canal disease of diabetics with severe pain, and Wegener disease causes refractory granulomatous inflammation with systemic features.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.