A 12 year old presents with fever, unilateral post auricular pain, mastoid bulging displacing the pinna forward and outwards with loss of bony trabeculae. This patient has history of chronic persistent pus discharge from same ear. Treatment of choice is?

**Core Concept**
The patient is presenting with symptoms of acute mastoiditis, a complication of otitis media, characterized by infection of the mastoid air cells. This condition requires prompt treatment to prevent serious complications such as intracranial spread of infection.

**Why the Correct Answer is Right**
The patient's symptoms, including fever, postauricular pain, mastoid bulging, and loss of bony trabeculae, are indicative of acute mastoiditis. The history of chronic persistent pus discharge from the same ear suggests a chronic infection that has progressed to involve the mastoid air cells. The treatment of choice for acute mastoiditis is surgical drainage, typically through a mastoidectomy, to relieve pressure and allow for healing. The correct answer is **C: Mastoidectomy**.

**Why Each Wrong Option is Incorrect**
**Option A:** Antibiotics alone are often used to treat otitis media, but in this case, the patient requires surgical intervention due to the presence of a mastoid abscess and bony destruction.

**Option B:** Myringotomy with tympanostomy tubes may be used to treat chronic otitis media, but it is not the treatment of choice for acute mastoiditis.

**Option D:** Corticosteroids may be used to reduce inflammation in some cases of otitis media, but they are not the primary treatment for acute mastoiditis.

**Clinical Pearl / High-Yield Fact**
In cases of suspected acute mastoiditis, a high index of suspicion is necessary, and prompt imaging studies (such as CT or MRI) can help confirm the diagnosis and guide treatment.

**Correct Answer: C. Mastoidectomy**

✓ Correct Answer: D. Mastoidectomy with incision, drainage and antibiotics