A child presents with right ear hearing loss of three month duration. On examination, foul smelling purulent discharge is seen with perforation in pars flaccida. What is the MOST appropriate management?
The history and examination of the patient suggests atticoantral type of CSOM. It is also called unsafe or dangerous type; it involes posterosuperior pa of the cleft and is associated with attic or marginal perforation. The discharge is usually scanty, but always fouls smelling due to bone destruction. The mainstay of treatment for this type is surgery. The primary aim is to remove the disease process by tympano-mastoid exploration and render the ear safe.
Topical antibiotics and decongestants for 4 weeks
Tympano-mastoid exploration
Aural toileting
Type I tympanoplasty.