An adult with longstanding foul otorrhoea develops severe otalgia and a new lower-motor-neurone facial palsy. Otoscopy shows attic keratin debris. What is the most appropriate next step?
New facial weakness in an unsafe ear suggests bony erosion or intratemporal complication. This requires urgent senior ENT care, temporal-bone imaging and planning of antimicrobial and surgical source control.
A. Urgent admission for specialist assessment, imaging and treatment of complicated cholesteatoma: New facial weakness in an unsafe ear suggests bony erosion or intratemporal complication. This requires urgent senior ENT care, temporal-bone imaging and planning of antimicrobial and surgical source control.
B. Routine microsuction in six months: Delay risks progression of facial-nerve and intracranial complications.
C. Topical steroid alone: Steroid does not eradicate cholesteatoma or treat invasive infection.
D. Immediate hearing-aid fitting: Rehabilitation is secondary to controlling dangerous disease.
E. Reassurance because facial palsy is usually idiopathic: The concurrent unsafe ear makes Bell palsy an unsafe assumption.
If the patient also had meningism or altered consciousness, resuscitation, urgent neuroimaging and joint intracranial-complication management would take priority.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.
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