Image Based Question-72058

A 35-year-old presents with unilateral hearing loss that has been gradual but progressive over the last 6 months.Autoscopic picture is shown in the image. Appropriate treatment of the above condition consists of

A. Prolonged antibiotics for up to 4 weeks.

B. Decongestant and antihistamine administration.

C. Corticosteroid treatment for 2 weeks.

D. Tympanomastoidectomy.

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Correct Answer » D Explanation

Ans:D. Tympanomastoidectomy.

Image shows:Attic Cholesteatoma.

CHOLESTEATOMA

• Presence of keratinizing squamous epithelium in the middle ear or mastoid – cholesteatoma

• Cholesteatoma is skin in wrong place

• Most common site of origin – posterior epitympanum.It is seen in Atticoantral type of CSOM.

Signs and symptoms

• The majority (98%) of patients with cholesteatoma have ear discharge or hearing loss or both in the affected ear.

Theories of Cholesteatoma

• Presence of congenital cell rests

• Wittmaack’s theory→ invagination of TM from the attic or posterior-superior par tof pars tensa in the

• form of retraction pockets

• Ruedi’s theory→ basal cell hyperplasia

• Habermann’s theory → epithelial invasion

• Sade’s theory → metaplasia

Surgery is the mainstay of treatment:Tympanomastoidectomy