A 45-year-old patient develops post-auricular fistula 3 months after canal wall-up mastoidectomy for cholesteatoma. The most likely cause is:
- A Wound infection with Pseudomonas aeruginosa
- B Residual cholesteatoma with erosion through mastoid cortex ✓
- C Facial nerve injury during surgery
- D Failure of ossicular reconstruction
Correct answer: B. Residual cholesteatoma with erosion through mastoid cortex
Explanation
Post-auricular fistula appearing weeks to months after closed mastoidectomy is a classic presentation of residual cholesteatoma whose expanding keratin matrix erodes through the mastoid cortex. This is one of the most common complications of canal wall-up surgery and mandates re-exploration. Pseudomonas wound infection typically presents acutely; facial nerve injury produces paralysis, not fistula.
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.