A 32-year-old man from rural India presents with a 4-year history of foul-smelling otorrhea from the left ear. He reports conductive hearing loss and occasional vertigo. Otoscopy reveals a retraction pocket in the posterosuperior quadrant of the tympanum with granulation tissue. Audiometry shows air-bone gap of 35 dB. High-resolution CT temporal bone reveals erosion of the ossicular chain and lateral semicircular canal. What is the most likely diagnosis?

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