Type V chronic suppurative otitis media.

The otoscopic view is that of a right ear that is acutely infected and draining thick, yellow pus. There is a 70% perforation of the pars tensa. The malleus appears to be grossly normal. The drum remnant has a rim of granulation tissue around the perforation, and a large granulation tissue polyp protrudes through the anterior and inferior part of the perforation. This is a Pulec-Deguine type V chronic suppurative otitis media.

Treatment first involves systemic antibiotics and topical otic drops that contain antibiotics and a steroid. In many cases, the ear can be made dry, and the granulation tissue will resolve. In such cases, surgical treatment might involve a myringoplasty.

When a reasonable trial of 2 or 3 weeks of medical therapy is unsuccessful in producing a dry ear, a type V Pulec tympanoplasty and mastoidectomy is performed. The attic is left untouched. Drainage is established through the facial recess from the mastoid to the tubotympanum. The pars tensa perforation is repaired with fascia. This conservative approach usually allows the infection to subside, the edematous polypoid mucosa obstructing the attic to heal, and in most cases the hearing to be restored to normal without the need for ossicular reconstruction. This type of ear infection represents 50% of cases that require mastoidectomy.