60 year old man presented with left sided ear discharge for 7 years with dull ear ache. 0/e intact tympanic membrane on both sides, mass is seen in the posterior canal wall on left side. Diagnosis is?
## **Core Concept**
The patient's presentation suggests a chronic condition affecting the ear, specifically with a long-standing history of ear discharge and a mass in the posterior canal wall. This clinical picture points towards a condition that causes chronic otitis externa or a specific type of tumor.
## **Why the Correct Answer is Right**
The correct answer, **cholesteatoma** or more specifically in this context, **external auditory canal cholesteatoma** or **EAC cholesteatoma**, is a condition where skin grows in the wrong place in the middle ear or mastoid or, less commonly, in the external auditory canal. The presence of a mass in the posterior canal wall with a history of chronic ear discharge and dull ear ache, along with an intact tympanic membrane, supports this diagnosis. EAC cholesteatomas can cause localized destruction and are associated with chronic otorrhea.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is not provided, but typically, incorrect options might include conditions like otitis media, which usually presents with a perforated tympanic membrane and not a mass in the canal wall.
- **Option B:** Similarly, this option is not provided, but another incorrect option could be a diagnosis like a benign tumor (e.g., adenoma), which might not fully explain the chronic discharge and specific location of the mass.
- **Option C:** Again, without specifics, another incorrect diagnosis could be an inflammatory condition that doesn't account for the mass.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **cholesteatomas**, whether in the middle ear or external auditory canal, can cause significant local destruction and complications, including hearing loss, vertigo, and facial paralysis if not treated properly. Early recognition is crucial.
## **Correct Answer:** D. Cholesteatoma.