Acute on-chronic middle ear disease.

The discharging ear is a common presenting symptom to GPs and otologists. The commonest causes are otitis externa and otitis media. Less common is cholesteatoma, which presents with a chronic offensive mucopurulent discharge and deafness. Acute mastoiditis as a presenting symptom of cholesteatoma is rare and, with the introduction of antibiotics, the incidence has declined even further. We present three cases of cholesteatoma presenting as mastoiditis.