Virtual Patients - Otology - Otorrhea

During the clinic review, you obtain some more information. The patient informs you the hearing in the affected ear has deteriorated significantly. There is no associated tinnitus or vertigo.

Past medical history includes grommets as a child.

On examination, otoscopy reveals the following appearance;

 

Question

 

Now with the benefit of the examination findings, which of the following is the most likely diagnosis?