<prompt> 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 -Topical antibiotics and decongestants for 4 weeksIV antibiotics and follow up after a monthTympanoplastyTympano-mastoid exploration  <response>: 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 mastoidectomyPreferred treatment would beALSO KNOWRecounstruction of hearing mechanism by tympanoplasty is only the second priority. 