Diseases of the Ear Practice Questions

Q: Mastoid infection in a 10-year-old boy eroding through the outer table of the bone results in which of the following conditions?

Subperiosteal abscess. ### Explanation **Correct Option: B. Subperiosteal abscess** The mastoid bone consists of a honeycomb-like arrangement of air cells. In acute mastoiditis, pus accumulates under pressure. When this infection erodes through the **outer cortex (outer table)** of the mastoid bone, the pus collects between the bone and the overlying periosteum, resulting in a **subperiosteal abscess**. In children, the most common site is the post-aural region (von Bezold’s abscess and Luc’s abscess are other site-specific variations). **Analysis of Incorrect Options:** * **A. Acute coalescent mastoiditis:** This is the *precursor* stage. It refers to the breakdown of the internal bony septa (trabeculae) separating the mastoid air cells, turning them into a single large cavity filled with pus. It becomes a subperiosteal abscess only after it breaches the outer cortex. * **C. Brain abscess:** This occurs if the infection erodes through the **inner table** (tegmen antri or tegmen tympani) into the middle or posterior cranial fossa. * **D. Lateral sinus thrombophlebitis:** This is an intracranial complication caused by the erosion of the **sinus plate** (posterior wall of the mastoid), leading to inflammation and thrombus formation within the sigmoid sinus. **High-Yield Clinical Pearls for NEET-PG:** * **Reservoir Sign:** Re-accumulation of pus in the ear canal immediately after mopping it dry; pathognomonic for mastoiditis. * **Ironing out of Mastoid:** Loss of the normal contour of the mastoid process due to periosteal thickening. * **Sagging of Posterosuperior Meatal Wall:** Occurs due to periostitis adjacent to the antrum. * **Most common organism:** *Streptococcus pneumoniae* (followed by *H. influenzae* and *S. pyogenes*). * **Imaging:** Contrast-enhanced CT (CECT) of the temporal bone is the gold standard for diagnosing complications.

Q: A patient presents with symptoms suggestive of temperomandibular joint dysfunction, including tinnitus, otalgia, headache, dizziness, burning tongue, and throat pain. What is the most likely diagnosis?

Costen syndrome. **Explanation:** The correct answer is **Costen syndrome** (Option B). **1. Understanding Costen Syndrome:** Costen syndrome, also known as **Temporomandibular Joint (TMJ) Dysfunction Syndrome**, occurs due to malocclusion, lack of molar teeth, or degenerative changes in the TMJ. This leads to abnormal pressure on the auriculotemporal nerve and chorda tympani. * **Clinical Presentation:** It presents with a classic constellation of symptoms: **otalgia** (referred ear pain), **tinnitus**, dizziness, headache, and a **burning sensation in the tongue/throat**. The pain is typically exacerbated by chewing or jaw movement. It is a high-yield "masked" ENT condition where the pathology lies in the joint, but the symptoms are primarily otological. **2. Why other options are incorrect:** * **Kostmann syndrome:** A rare genetic disorder characterized by severe congenital neutropenia, leading to recurrent life-threatening infections. * **Marfan syndrome:** A connective tissue disorder (FBN1 mutation) characterized by tall stature, arachnodactyly, ectopia lentis, and aortic root dilation. * **Apert syndrome:** A craniosynostosis syndrome characterized by premature fusion of skull bones, midface hypoplasia, and syndactyly (mitten hands). **3. NEET-PG Clinical Pearls:** * **Referred Otalgia:** Always remember the "Rule of 5" for referred ear pain—the ear is supplied by CN V, VII, IX, X, and C2-C3. Costen syndrome involves the **Mandibular division of the Trigeminal nerve (V3)**. * **Diagnosis:** Primarily clinical; tenderness over the TMJ during mouth opening is a key sign. * **Management:** Includes dental correction (bite alignment), NSAIDs, and soft diet.

Q: Areas of spontaneous healed perforation of the tympanic membrane are called as?

Perforations. **Explanation:** The correct answer is **Perforations** (specifically referred to as **monomeric membranes** or "false membranes"). **1. Why "Perforations" is correct:** When a tympanic membrane (TM) perforation heals spontaneously, it often lacks the middle fibrous layer (*lamina propria*), which is responsible for the drum's stiffness and resilience. The healed area consists only of the outer epithelial layer and the inner mucosal layer. Because this area is thin, transparent, and lacks structural support, it is clinically termed a **monomeric membrane**. To an untrained eye or under certain lighting, these areas look like persistent holes because they are so thin, but they are technically "healed perforations." In the context of this question, these thin, atrophic areas are classified under the pathology of healed perforations. **2. Why other options are incorrect:** * **Atelectasis:** This refers to the collapse or retraction of the tympanic membrane into the middle ear space due to prolonged negative middle ear pressure (Eustachian tube dysfunction). While a monomeric (healed) area is more prone to atelectasis because it is weak, the term "atelectasis" describes the *displacement* of the drum, not the healed area itself. * **Both/None:** Since "Perforations" (specifically healed/monomeric) is the standard clinical description for these thin areas, these options are incorrect. **Clinical Pearls for NEET-PG:** * **Monomeric Membrane:** A hallmark of a spontaneously healed TM. On otoscopy, it looks like a "hole" but moves with a Siegle’s bulb (unlike a true perforation). * **Layers of TM:** Normal TM has 3 layers; a healed perforation (monomeric) has only 2. * **Myringosclerosis:** If the healing process involves the deposition of hyaline and calcium in the fibrous layer, it appears as chalky white patches, often seen after chronic otitis media or ventilation tube insertion.

Q: Griesinger sign is otalgia along with pain and edema over mastoid. It is typically seen in?

Lateral sinus thrombosis. **Explanation:** **Griesinger’s Sign** is a classic clinical indicator of **Lateral (Sigmoid) Sinus Thrombosis (LST)**, a serious extracranial complication of chronic suppurative otitis media. 1. **Why Lateral Sinus Thrombosis is correct:** The sign refers to edema and tenderness over the posterior part of the mastoid process. It occurs due to **thrombosis of the mastoid emissary vein**, which normally drains into the sigmoid sinus. When the sigmoid sinus is obstructed by a thrombus, retrograde congestion leads to localized inflammation and swelling over the mastoid bone. 2. **Why other options are incorrect:** * **Acoustic Neuroma:** This is a benign tumor of the 8th cranial nerve. It typically presents with progressive sensorineural hearing loss, tinnitus, and equilibrium issues, not acute inflammatory signs like mastoid edema. * **Otosclerosis:** A metabolic bone disease of the otic capsule causing conductive hearing loss (stapedial fixation). It presents with a normal-looking tympanic membrane and no external swelling or pain. * **CSOM:** While LST is a *complication* of CSOM, CSOM itself refers to chronic ear discharge and perforation. Griesinger’s sign specifically indicates that the infection has progressed to involve the venous sinuses. **High-Yield Clinical Pearls for NEET-PG:** * **Delta Sign:** Seen on contrast-enhanced CT, representing a thrombus in the sigmoid sinus (empty triangle). * **Tobey-Ayer Test:** A clinical test where compression of the internal jugular vein on the diseased side fails to raise CSF pressure (measured via lumbar puncture). * **Crowe-Beck Test:** Engorgement of retinal veins upon compression of the jugular vein on the healthy side. * **Picket-fence Fever:** The characteristic hectic temperature spikes seen in LST due to septicemia.

Q: What is the commonest cause of acute otitis media in children?

Streptococcus pneumoniae. **Explanation:** **Streptococcus pneumoniae** is the most common bacterial pathogen responsible for Acute Otitis Media (AOM) across all age groups, particularly in children. It accounts for approximately 30–50% of bacterial isolates. The pathogenesis typically involves an antecedent viral upper respiratory tract infection that causes Eustachian tube dysfunction, allowing nasopharyngeal flora to migrate into the middle ear. **Analysis of Options:** * **A. Haemophilus influenzae:** This is the second most common cause (non-typeable strains). However, since the introduction of the pneumococcal conjugate vaccine (PCV), the relative prevalence of *H. influenzae* has increased, sometimes rivaling *S. pneumoniae* in specific populations, but *S. pneumoniae* remains the standard answer for exams. * **C. Staphylococcus aureus:** While it can cause middle ear infections, it is a much less common primary cause of acute AOM and is more frequently associated with chronic suppurative otitis media (CSOM) or postoperative infections. * **D. Pseudomonas:** This is the hallmark pathogen for **Otitis Externa** and **CSOM**, but it is rarely a cause of primary AOM in immunocompetent children. **High-Yield Clinical Pearls for NEET-PG:** * **Top 3 Pathogens in AOM:** 1. *S. pneumoniae*, 2. *H. influenzae*, 3. *Moraxella catarrhalis*. * **Viral Etiology:** Viruses (RSV, Rhinovirus) are often the initial triggers, but bacterial secondary infection is what defines clinical AOM. * **Drug of Choice:** Amoxicillin remains the first-line antibiotic. * **Complication:** The most common extracranial complication of AOM is **Acute Mastoiditis**.

Q: What is the cause of myringosclerosis?

Grommet insertion. **Explanation:** **Myringosclerosis** refers to the deposition of hyaline and calcium in the lamina propria of the tympanic membrane. It is a localized form of tympanosclerosis, often appearing as chalky white patches on the eardrum. **Why Grommet Insertion is the Correct Answer:** The most common cause of myringosclerosis is trauma to the tympanic membrane, specifically **Grommet (Ventilation Tube) insertion**. The procedure triggers an inflammatory response and oxidative stress within the fibrous layer of the drum. Studies show that up to 40–50% of children undergoing grommet insertion develop these white patches. Other causes include chronic otitis media and recurrent episodes of otitis media with effusion. **Analysis of Incorrect Options:** * **Genetic predisposition:** While some individuals may be more prone to scarring, there is no established genetic inheritance pattern for myringosclerosis. * **Otosclerosis:** This is a metabolic bone disease involving the otic capsule (specifically the stapes footplate), leading to conductive hearing loss. It does not involve the tympanic membrane. * **Idiopathic:** While some cases occur without a clear history, the vast majority are secondary to identifiable clinical triggers like trauma or infection. **High-Yield Clinical Pearls for NEET-PG:** * **Tympanosclerosis vs. Myringosclerosis:** If the calcification is limited to the drum, it is *myringosclerosis*. If it involves the ossicles or middle ear mucosa (leading to "frozen" ossicles), it is *tympanosclerosis*. * **Clinical Significance:** Myringosclerosis is usually asymptomatic and rarely causes significant hearing loss unless it is extensive. * **Horseshoe Appearance:** Extensive myringosclerosis can sometimes present as a "horseshoe" shaped white patch on the tympanic membrane. * **Chalky White Patch:** This is the classic otoscopic description used in exam questions.

Question 1

Acute suppurative otitis media is treated using which of the following agents?

Accepted Answer

Streptomycin

Answer

Erythromycin

Answer

Cephalosporin

Answer

Penicillin

Question 2

Mastoid infection in a 10-year-old boy eroding through the outer table of the bone results in which of the following conditions?

Accepted Answer

Subperiosteal abscess

Answer

Acute coalescent mastoiditis

Answer

Brain abscess

Answer

Lateral sinus thrombophlebitis

Question 3

A 30-year-old male has attic cholesteatoma of the left ear with lateral sinus thrombophlebitis. Which of the following will be the operation of choice?

Accepted Answer

Canal wall down mastoidectomy

Answer

Intact canal wall mastoidectomy

Answer

Simple mastoidectomy with tympanoplasty

Answer

Mastoidectomy with cavity obliteration

Question 4

Referred pain in the ear is commonly associated with which of the following conditions?

Accepted Answer

Carcinoma of the tongue

Answer

Mandibular cancer

Answer

Nasopharyngeal cancer

Answer

Maxillary carcinoma

Question 5

A 31-year-old female patient complains of bilateral impairment of hearing for the past 5 years. On examination, tympanic membrane is normal, and audiogram shows a bilateral conductive loss. Impedance audiometry shows an AS type of curve and an absent acoustic reflex. All constitute part of the treatment except?

Accepted Answer

Gentamicin therapy

Answer

Hearing aid

Answer

Stapedectomy

Answer

Sodium fluoride

Question 6

A patient presents with symptoms suggestive of temperomandibular joint dysfunction, including tinnitus, otalgia, headache, dizziness, burning tongue, and throat pain. What is the most likely diagnosis?

Accepted Answer

Costen syndrome

Answer

Kostmann syndrome

Answer

Marfan syndrome

Answer

Apert syndrome

Question 7

Areas of spontaneous healed perforation of the tympanic membrane are called as?

Accepted Answer

Perforations

Answer

Atelectasis

Answer

Both of the above

Answer

None of the above

Question 8

Griesinger sign is otalgia along with pain and edema over mastoid. It is typically seen in?

Accepted Answer

Lateral sinus thrombosis

Answer

Acoustic neuroma

Answer

Otosclerosis

Answer

Chronic suppurative otitis media (CSOM)

Question 9

What is the commonest cause of acute otitis media in children?

Accepted Answer

Streptococcus pneumoniae

Answer

Haemophilus influenzae

Answer

Staphylococcus aureus

Answer

Pseudomonas

Question 10

What is the cause of myringosclerosis?

Accepted Answer

Grommet insertion

Answer

Genetic predisposition

Answer

Otosclerosis

Answer

Idiopathic

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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