Best of five
- A. Repeat topical drops alone
- B. Immediate facial-nerve decompression
- C. Routine microsuction and discharge
- D. Assume canal carcinoma without biopsy
- E. Urgent admission-level multidisciplinary treatment for skull-base osteomyelitis
FRCS (ORL-HNS) · SECTION 1 SBA
Necrotising otitis externa
An 81-year-old with diabetes has severe nocturnal otalgia, granulation at the bony-cartilaginous canal junction and new House–Brackmann IV facial weakness despite topical treatment. What is the best management principle?
E. Urgent admission-level multidisciplinary treatment for skull-base osteomyelitis
Cranial neuropathy with refractory pain and granulation indicates advanced invasive disease requiring tissue diagnosis, antipseudomonal therapy, imaging, metabolic control and prolonged specialist follow-up.
Why every option is right or wrong
A. Repeat topical drops alone: Topical treatment is inadequate for invasive skull-base infection.
B. Immediate facial-nerve decompression: Neuropathy reflects skull-base inflammation; decompression is not the initial disease-control strategy.
C. Routine microsuction and discharge: Instrumentation without systemic management risks delay and harm.
D. Assume canal carcinoma without biopsy: Malignancy is an important differential, but tissue and microbiology are needed rather than an unsupported label.
E. Urgent admission-level multidisciplinary treatment for skull-base osteomyelitis: Cranial neuropathy with refractory pain and granulation indicates advanced invasive disease requiring tissue diagnosis, antipseudomonal therapy, imaging, metabolic control and prolonged specialist follow-up.
What if the scenario changed?
If biopsy demonstrated squamous carcinoma, the pathway would switch to cancer staging rather than prolonged empirical antimicrobial treatment.
Independent Clinora preparation material; not official JCIE content, an accredited programme or a substitute for local policy and specialist judgement.
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