Question:hard
A patient with a history of discharge from the right ear for the past 1 year presented with severe earache. The discharge was cultured and the organism was found to be gram positive cocci. CT scan shows ring enhancement. The least likely cause is?
A patient with a history of discharge from the right ear for the past 1 year presented with severe earache. The discharge was cultured and the organism was found to be gram positive cocci. CT scan shows ring enhancement. The least likely cause is?
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Chronic ear disease favours Pseudomonas and Staph; which option is an acute otitis media bug?
Updated On: Jun 24, 2026
- Pseudomonas
- Streptococcus pneumoniae
- Staphylococcus
- Haemophilus influenzae
Show Solution
The Correct Option is B
Solution and Explanation
Read the timeline carefully. Discharge that has run for a whole year is chronic, not acute, so this is chronic suppurative otitis media. The new severe pain together with a CT scan showing a ring-enhancing lesion signals that the chronic ear infection has spread inside the skull to form a brain abscess.
The microbiology of chronic ear disease differs from that of acute otitis media. Chronic suppurative otitis media and its abscess complications are dominated by Pseudomonas and by Staphylococcus species, and the culture here grew gram positive cocci which fits Staphylococcus and Streptococcus well. These organisms are the usual suspects in this scenario.
By contrast, Streptococcus pneumoniae and Haemophilus influenzae are the hallmark organisms of ACUTE otitis media in children, not of long-standing chronic disease. Of the four choices, Streptococcus pneumoniae is the organism least expected in this chronic, abscess-forming picture, so it is the least likely cause.
\[\boxed{\text{Streptococcus pneumoniae}}\]
The microbiology of chronic ear disease differs from that of acute otitis media. Chronic suppurative otitis media and its abscess complications are dominated by Pseudomonas and by Staphylococcus species, and the culture here grew gram positive cocci which fits Staphylococcus and Streptococcus well. These organisms are the usual suspects in this scenario.
By contrast, Streptococcus pneumoniae and Haemophilus influenzae are the hallmark organisms of ACUTE otitis media in children, not of long-standing chronic disease. Of the four choices, Streptococcus pneumoniae is the organism least expected in this chronic, abscess-forming picture, so it is the least likely cause.
\[\boxed{\text{Streptococcus pneumoniae}}\]
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