Question:
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
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The Correct Option is B
Solution and Explanation
Step 1: A year-long ear discharge with new severe earache and a CT showing ring enhancement indicates chronic suppurative otitis media (CSOM) that has developed an intracranial complication, namely a brain abscess.
Step 2: The discharge culture grew gram positive cocci, which points towards organisms such as Staphylococcus and Streptococcus rather than the typical acute otitis media flora.
Step 3: The classic and most frequent organisms in CSOM-related abscesses are Pseudomonas (a major CSOM pathogen) and Staphylococcus, both well-recognised causes here, so these are likely.
Step 4: Haemophilus influenzae and Streptococcus pneumoniae are organisms of ACUTE otitis media, not chronic disease; among the options, Streptococcus pneumoniae is the least likely organism to be cultured from this chronic case complicated by abscess.
Conclusion: The least likely cause is Streptococcus pneumoniae, so option 2 is correct, in keeping with the printed key.
Step 2: The discharge culture grew gram positive cocci, which points towards organisms such as Staphylococcus and Streptococcus rather than the typical acute otitis media flora.
Step 3: The classic and most frequent organisms in CSOM-related abscesses are Pseudomonas (a major CSOM pathogen) and Staphylococcus, both well-recognised causes here, so these are likely.
Step 4: Haemophilus influenzae and Streptococcus pneumoniae are organisms of ACUTE otitis media, not chronic disease; among the options, Streptococcus pneumoniae is the least likely organism to be cultured from this chronic case complicated by abscess.
Conclusion: The least likely cause is Streptococcus pneumoniae, so option 2 is correct, in keeping with the printed key.
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