A child presents with ear infection with foul smelling discharge. On further exploration a small perforation is found in the pars flaccida of the tympanic membrance. Most appropriate next step in the management would be -

Child presenting with foul smelling discharge with perforation in the pars flaccida of the tympanic membrane suggests unsafe CSOM. Conservative management is not of much help in these cases; surgery is the mainstay of treatment. Tympano mastoid exploration is the ideal option in such cases. Tympano-mastiod exploration can be done through various procedures: ––Canal wall down procedures: Atticotomy, and rarely radical mastoidectomy. ––Canal wall up procedures: Cortical mastoidectomy Preferred treatment would be ALSO KNOW Recounstruction of hearing mechanism by tympanoplasty is only the second priority.