A child presents with ear infection with foul smelling discharge. On fuher exploration, a small perforation is found in the pars flaccida of the tympanic membrane. Most appropriate next step in the management would be
ASSESSMENT Examination under the microscope: All the patients of chronic middle ear disease should be examined under the microscope. It may reveal presence if cholecystectomy, it's site and extent, evidence of bone destruction, granuloma, condition of ossicles and pockets of discharge. Tuning fork tests and audiogram: They are essential for preoperative assessment and to confirm the degree and type of hearing loss. X-ray mastoids/CT scan temporal bone: They indicate the extent of bone destruction and the degree of the mastoid pneumatisation. They are useful to indicate a low lying dura or an interposed sigmoid sinus when the operation is being contemplated on a sclerosis mastoid. Cholesteatoma causes destruction in the area of attic and antrum better seen in the lateral view. Culture and sensitivity of ear discharge: It helps to select proper antibiotic for local or systemic use. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 80)
Topical antibiotics and decongestants for 4 weeks
IV antibiotics and follow up after a month
Tympanoplasty
Tympano-mastoid exploration
Ear