Facharzt FMH Hals-Nasen-Ohren Practice Questions - Facharzt FMH Für Oto-Rhino-Laryngologie Spécialiste FMH En Oto-rhino-laryngologie Exam

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A 42-year-old male with a history of recurrent childhood otitis media presents with persistent, foul-smelling left otorrhea and progressive hearing loss despite multiple courses of topical antibiotic drops. Micro-otoscopy reveals an attic retraction pocket in the pars flaccida containing squameous debris and erosion of the scutum. High-resolution temporal bone CT demonstrates a soft-tissue attenuation mass occupying Prussak's space with erosion of the lateral epitympanic wall and partial erosion of the incus long process, without labyrinthine fistula. What is the standard surgical strategy for this lesion?

Conservative observation with periodic microscopic cleaning and topical steroid-antibiotic powders Tympanomastoidectomy (canal wall up or canal wall down) with complete cholesteatoma eradication and ossicular reconstruction Myringotomy with T-tube insertion into the anterior-inferior quadrant Systemic high-dose IV vancomycin for 6 weeks followed by simple myringoplasty

Correct Answer:

Tympanomastoidectomy (canal wall up or canal wall down) with complete cholesteatoma eradication and ossicular reconstruction

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