Question: A 14 year old male with developmental delay, seizures, and quadriplegia is referred for a recurrent tympanic membrane perforation with relentless otorrhea. He has had two prior tympanoplasty surgeries with cartilage but still has a subtotal perforation. As he is nonverbal and has chronic otorrhea, a bone conduction ABR was performed that showed BC thresholds in the moderate-severe range. The contralateral ear is normal with a 20 dB purely conductive hearing loss. What is the next best step in management?

a) Revision tympanoplasty with Biodesign

b) Tympanomastoidectomy with conchal cartilage

c) Subtotal petrosectomy with EAC closure

d) Observation with ototopical drops PRN

[Answer will be posted with next week's new question]

Answer to last week's question, “Head Bleed” (November 7, 2022)

B - Subarachnoid hemorrhage causing Cushing’s triad.