QuestionSBA
QuestionChoice
Also known as malignant otitis externa, this is an unlikely cause of this young boy's symptoms. Malignant otitis externa typically occurs in immunocompromised patients (most commonly in diabetics). It is characterised by severe ear pain, and purulent discharge, and may feature osteomyelitis of the temporal bone. It is not the most likely diagnosis due to the absence of immunosuppression and no ear pain in the history.
10000303
c
Benign necrotising otitis externa
QuestionChoice
Chronic suppurative otitis media (CSOM) is a complication of unresolved acute otitis media with perforation of the tympanic membrane. Classically CSOM presents with persistent ear discharge and conductive hearing loss. Although an important differential, CSOM would not reveal a crusting cholesteatoma in the tympanic membrane attic.
10000302
b
Chronic suppurative otitis media
QuestionChoice
A common ear condition but not the most likely one in this case. Otitis externa classically presents with otalgia, ear pruritis, and ear discharge. Hearing loss is possible but uncommon in otitis externa. Otoscopy typically reveals ear canal erythema and swelling. A cholesteatoma in the tympanic membrane attic would not be observed in otitis externa and hearing loss is uncommon in this condition.
10000305
e
Otitis externa
QuestionChoice
Tympanosclerosis is scarring/calcification of the tympanic membrane. It presents with conductive hearing loss and calcification of the tympanic membrane is visualized on otoscopy. It is an unlikely diagnosis here due to the history of discharge and absence of tympanic membrane calcification.
10000304
d
Tympanosclerosis
QuestionChoice
This young boy has a cholesteatoma, which is a benign accumulation of squamous epithelium and keratin within the middle ear or mastoid air cell spaces. Symptoms include purulent discharge from the external acoustic meatus and hearing loss and/or tinnitus from the affected ear. Examination may reveal conductive hearing loss and the otoscopy typically reveals a crust of keratin in the attic of the tympanic membrane.
10000301
a
Cholesteatoma
Concept
Chapter
2693
3738
Cholesteatoma
Topic
139
Ear, Nose, and Throat
12607
A 10-year-old boy presents with his father to General Practice. He has a 3-week history of left-sided hearing loss and has been experiencing unpleasant discharge from the left ear. On examination, you note malodorous, purulent discharge from the left ear which has not responded to antibiotics. Rinne's test is negative in the left ear and positive in the right ear. Weber's test lateralizes to the left ear. Otoscopy reveals crusting at the top of the left tympanic membrane.

Which of the following is the most likely diagnosis?
a