Question: A 33 year old undergoes surgery for a large epitympanic cholesteatoma. The incudostapedial joint was eroded and a partial ossicular replacement prosthesis was placed. At three months, the cartilage tympanoplasty appears fully healed and there is no perforation or middle ear effusion. Audiometry reveals a 40 dB air-bone gap throughout the low to mid frequency range, decreasing to a 20 dB air bone gap in the high frequencies. What is your next step in management?

a) Follow up as needed

b) MRI with non-EPI DWI 18 months after surgery and amplification

c) “Second look” procedure at this time (3 months after surgery) with revision ossiculoplasty

d) “Second look” procedure 9 months after surgery with revision ossiculoplasty

e) B or D

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

Answer to last week's question, “Sniff Sniff" (January 6, 2020)

A - Adenocarcinoma.