Talk to Ent Specialist on Ear Severe Pain Infection Discharge And Itching

kindly guide regarding this case.

23-year-old with severe bilateral ear itching, pain, and recurrent watery/pus-like discharge for several years. He has already been evaluated and completed a course of IV vancomycin, but the problem did not resolve.

Ear culture report shows:

- MRSA, resistant to beta-lactam antibiotics including penicillins, cephalosporins and carbapenems. - Fungal culture: Aspergillus flavus growth after 5 days.

Kindly advise on the appropriate ENT workup and treatment according to current international/UK/US guidelines. Should we repeat culture and sensitivity, perform microscopic ear cleaning/aural toilet, assess the tympanic membrane for perforation, and consider audiometry/CT temporal bone? Also, what would be the preferred management if both MRSA and Aspergillus are clinically significant?

Any advice regarding definitive treatment and when surgery may be indicated like mastiodectomy±tympnoplasty