Diseases of the Ear Practice Questions

Q: A patient hears better in noise. What is the diagnosis?

Paracusis. **Explanation:** The phenomenon where a patient hears better in a noisy environment is known as **Paracusis Willisii**. This is a classic clinical feature of **Otosclerosis**. **Why Paracusis is the correct answer:** In patients with conductive hearing loss (specifically Otosclerosis), the background noise masks low-frequency sounds for people with normal hearing. Consequently, people around the patient tend to speak louder to be heard over the noise. Since the patient has a conductive barrier that filters out the ambient low-frequency background noise, they perceive the increased volume of the speaker's voice more clearly than they would in a quiet room. **Analysis of Incorrect Options:** * **Hyperacusis:** This is an abnormal sensitivity to ordinary environmental sounds, often perceived as painfully loud. It is commonly seen in Bell’s palsy (due to stapedius muscle paralysis). * **Hypoacusis:** A general term for reduced hearing acuity or hearing loss of any type. * **Presbyacusis:** This is age-related sensorineural hearing loss. Patients with presbyacusis typically hear **worse** in noise because they lose the ability to discriminate speech frequencies against background interference (the "cocktail party effect"). **High-Yield Clinical Pearls for NEET-PG:** * **Paracusis Willisii** is a pathognomonic sign of **Otosclerosis**. * **Schwartz Sign:** A flamingo-pink flush seen on the promontory through the tympanic membrane, indicating active otosclerosis. * **Carhart’s Notch:** A characteristic dip in the bone conduction threshold at **2000 Hz** seen on an Audiogram in Otosclerosis. * **Gelle’s Test:** Used to differentiate ossicular fixation from a mobile chain; it is negative in Otosclerosis.

Q: What is not true about auricular hematoma?

Resolves spontaneously.. **Explanation:** **Auricular Hematoma** (also known as Othematoma) is a collection of blood between the perichondrium and the auricular cartilage, typically resulting from blunt trauma. **Why Option C is the correct answer (What is NOT true):** Auricular hematomas **do not resolve spontaneously**. Because the cartilage depends on the overlying perichondrium for its blood supply, an untreated hematoma creates a barrier that leads to ischemic necrosis of the cartilage. If left alone, the hematoma undergoes organization and fibrosis, resulting in the permanent deformity known as **"Cauliflower Ear."** Therefore, active surgical intervention (aspiration or incision and drainage) is mandatory. **Analysis of other options:** * **Option A (True):** Antibiotics are routinely prescribed to prevent **Perichondritis**, a serious complication that can lead to further cartilage destruction. * **Option B (True):** It is an occupational hazard for athletes involved in contact sports like **rugby, wrestling, and boxing** due to repeated shearing trauma to the pinna. **High-Yield Clinical Pearls for NEET-PG:** 1. **Management:** Small hematomas can be aspirated with a wide-bore needle; large or recurrent ones require **Incision and Drainage (I&D)** followed by a pressure dressing (to prevent re-accumulation). 2. **Complication:** The most common late complication of an untreated hematoma is **Cauliflower Ear** (Boxer’s ear). 3. **Site:** It most commonly occurs on the anterior (lateral) surface of the pinna where the skin is tightly bound to the perichondrium.

Q: A 2-year-old child undergoes tympanostomy tube placement for treatment of chronic bilateral serous otitis media. Which of the following complications is least likely to occur subsequent to surgery?

Scarring of the external auditory canal. **Explanation:** Tympanostomy tube (Grommet) placement is the most common surgical procedure in children for chronic otitis media with effusion. To identify the "least likely" complication, one must distinguish between complications affecting the **tympanic membrane (TM)** versus the **external auditory canal (EAC)**. **Why Option D is Correct:** **Scarring of the external auditory canal** is not a recognized complication of tympanostomy. The procedure involves a radial or curvilinear incision (myringotomy) specifically in the TM (usually the anteroinferior quadrant). Since the EAC skin is not incised or traumatized during standard tube placement, scarring or stenosis of the canal does not occur. **Analysis of Incorrect Options:** * **A. Chronic Perforation:** Occurs in about 1–2% of cases after the tube extrudes. The risk increases with long-term tubes (e.g., T-tubes). * **B. Cholesteatoma:** A rare but serious complication (approx. 0.5%). It can occur if squamous epithelium from the TM surface is accidentally implanted into the middle ear during insertion or if the TM invaginates through a persistent perforation. * **C. Tympanosclerosis:** The **most common** post-operative finding (up to 30–50%). It appears as chalky white patches on the TM due to hyaline and calcium deposits; it rarely affects hearing significantly. **NEET-PG High-Yield Pearls:** * **Most common complication:** Tympanosclerosis (Myringosclerosis). * **Most common "nuisance" complication:** Post-operative otorrhea (discharge). * **Ideal site for Myringotomy:** Anteroinferior quadrant (safest, as it is away from the ossicles and the chorda tympani nerve). * **Indication:** Bilateral effusion for >3 months with associated hearing loss (>20–30 dB).

Q: A patient presents with hearing loss and a sensation of fullness in the left ear. What is the most likely diagnosis?

Fracture of the temporal bone. **Explanation:** The correct answer is **Fracture of the temporal bone**. Temporal bone fractures are a common cause of sudden hearing loss and ear fullness following head trauma. The hearing loss can be **conductive** (due to hemotympanum, tympanic membrane rupture, or ossicular disruption) or **sensorineural** (due to cochlear concussion or involvement of the otic capsule). The sensation of "fullness" is typically attributed to the accumulation of blood in the middle ear cleft (**hemotympanum**). **Analysis of Incorrect Options:** * **A. Cholesteatoma:** While it causes hearing loss, it is a chronic condition characterized by keratinizing squamous epithelium in the middle ear. It typically presents with foul-smelling ear discharge (otorrhea) rather than sudden fullness. * **C. Ochronosis:** This is a systemic manifestation of Alkaptonuria. While it can cause bluish-black pigmentation of the pinna and late-stage hearing loss due to ossicular stiffening, it is an extremely rare cause of acute ear fullness. * **D. Otomycosis:** This fungal infection of the external auditory canal presents with intense itching, pain, and debris. While it causes fullness, the hallmark is the presence of fungal hyphae (e.g., "wet newspaper" appearance for *Aspergillus niger*). **NEET-PG High-Yield Pearls:** * **Longitudinal Fractures (80%):** Most common; usually result in conductive hearing loss and bleeding from the ear. The facial nerve is involved in only 20% of cases. * **Transverse Fractures (20%):** More severe; often result in sensorineural hearing loss and vertigo due to otic capsule involvement. The facial nerve is involved in 50% of cases. * **Battle’s Sign:** Post-auricular ecchymosis indicating a posterior cranial fossa/temporal bone fracture. * **Hemotympanum:** A classic sign of temporal bone fracture where the tympanic membrane appears bright blue or dark red.

Q: Which of the following statements about Pendred syndrome is FALSE?

Thyroidectomy is the treatment.. **Explanation:** **Pendred Syndrome** is an autosomal recessive disorder characterized by the triad of **sensorineural hearing loss (SNHL)**, **goiter**, and an abnormal perchlorate discharge test. 1. **Why Option A is the Correct (False) Statement:** Thyroidectomy is **not** the treatment for Pendred syndrome. Most patients are clinically euthyroid or mildly hypothyroid. The goiter is managed with **Thyroxine (T4) supplementation**, which suppresses TSH levels and reduces the size of the goiter. Surgery is only indicated in rare cases of severe compression symptoms or malignancy. 2. **Analysis of Other Options:** * **Option B:** It is caused by mutations in the **SLC26A4 gene** (located on chromosome 7q31), which encodes the protein **Pendrin**. Pendrin acts as an ion exchanger (chloride/iodide/bicarbonate) in the inner ear and thyroid. * **Option C:** SNHL is a hallmark feature. It is typically congenital, bilateral, and severe. It is classically associated with inner ear malformations, most commonly an **Enlarged Vestibular Aqueduct (EVA)** or Mondini dysplasia. * **Option D:** Goiter usually develops in late childhood or early puberty due to a defect in iodine organification. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic:** "P" for **P**endred, **P**endrin gene, **P**erchlorate discharge test (Positive), and **P**artial organification defect. * **Radiology:** The most common radiological finding is **Enlarged Vestibular Aqueduct (EVA)**. * **Diagnosis:** A **Perchlorate Discharge Test** is used to demonstrate the iodine organification defect (though genetic testing is now the gold standard). * Pendred syndrome is one of the most common causes of syndromic genetic hearing loss.

Q: Which cranial nerve is responsible for referred pain to the ear?

Glossopharyngeal nerve (IX). **Explanation:** The ear has a complex sensory nerve supply, making it a common site for **referred otalgia** (ear pain originating from a distant site). **1. Why Glossopharyngeal nerve (IX) is correct:** The Glossopharyngeal nerve provides sensory innervation to the oropharynx, tonsils, and the posterior third of the tongue. It also gives off the **Jacobson’s nerve (tympanic branch)**, which forms the tympanic plexus and provides sensation to the middle ear and the medial surface of the tympanic membrane. Due to this shared pathway, pathologies in the oropharynx (e.g., post-tonsillectomy pain, peritonsillar abscess, or base of tongue tumors) are perceived as pain in the ear. **2. Why the other options are incorrect:** * **Oculomotor nerve (III):** A motor nerve responsible for most extraocular muscle movements and pupillary constriction. It has no sensory distribution to the ear or pharynx. * **Accessory nerve (XI):** A purely motor nerve supplying the sternocleidomastoid and trapezius muscles. * **Hypoglossal nerve (XII):** A motor nerve supplying the intrinsic and extrinsic muscles of the tongue (except palatoglossus). It does not carry sensory fibers related to referred pain. **Clinical Pearls for NEET-PG:** * **Nerves causing referred otalgia:** Remember the "Big Five": **V** (Trigeminal - via auriculotemporal), **VII** (Facial), **IX** (Glossopharyngeal - via Jacobson's), **X** (Vagus - via Arnold’s nerve), and **C2/C3** (Greater auricular/Lesser occipital). * **Eagle’s Syndrome:** Elongated styloid process irritating the CN IX, leading to throat pain and referred otalgia. * **Trotter’s Triad:** Associated with Nasopharyngeal Carcinoma; includes conductive hearing loss, palatal palsy, and trigeminal neuralgia (referred pain).

Q: All are causes of sensorineural deafness except?

Rupture of tympanic membrane. **Explanation** Hearing loss is broadly categorized into **Conductive Hearing Loss (CHL)**, caused by pathology in the external or middle ear, and **Sensorineural Hearing Loss (SNHL)**, caused by pathology in the cochlea (sensory) or the VIIIth cranial nerve (neural). **Why Option D is the Correct Answer:** **Rupture of the tympanic membrane** is a classic cause of **Conductive Hearing Loss**. The tympanic membrane is part of the middle ear's sound-conducting apparatus. A perforation disrupts the mechanical transmission of sound vibrations to the ossicles, preventing sound from efficiently reaching the inner ear. Since the inner ear (cochlea) and nerve remain intact, it is not a sensorineural cause. **Analysis of Incorrect Options (Causes of SNHL):** * **A. Old Age (Presbycusis):** This is the most common cause of SNHL. It involves age-related degeneration of the hair cells in the Organ of Corti and the stria vascularis. * **B. Acoustic Neuroma (Vestibular Schwannoma):** This is a benign tumor of the VIIIth cranial nerve. It causes **retrocochlear SNHL** by compressing the cochlear nerve fibers. * **C. Ototoxic Drugs:** Drugs like aminoglycosides (e.g., Gentamicin), loop diuretics, and Cisplatin cause SNHL by damaging the sensory hair cells within the cochlea. **High-Yield Clinical Pearls for NEET-PG:** * **Rinne Test:** In SNHL, Rinne is Positive (AC > BC). In CHL, Rinne is Negative (BC > AC). * **Weber Test:** Lateralizes to the **better** ear in SNHL and to the **affected** (poorer) ear in CHL. * **Audiometry:** SNHL shows no "Air-Bone Gap," whereas CHL shows a significant gap (>15 dB) between air and bone conduction thresholds. * **Carhart’s Notch:** A specific dip at 2000 Hz in bone conduction, characteristic of Otosclerosis (a CHL condition).

Q: Which cells of the Organ of Corti are vulnerable to noise-induced damage?

Outer hair cells. **Explanation:** **1. Why Outer Hair Cells (OHCs) are the correct answer:** Noise-induced hearing loss (NIHL) primarily targets the **Outer Hair Cells** of the Organ of Corti. OHCs are the "amplifiers" of the cochlea; they are more metabolically active and structurally delicate than inner hair cells. Excessive noise exposure leads to excessive metabolic stress, the formation of Reactive Oxygen Species (ROS), and mechanical exhaustion of the stereocilia. Damage typically begins in the basal turn of the cochlea (high frequencies), specifically at the **4 kHz** mark (the "acoustic notch"). **2. Why other options are incorrect:** * **Inner Hair Cells (IHCs):** These are the primary sensory transducers that send signals to the brain. They are more resilient and are usually only damaged after significant destruction of the OHCs has already occurred. * **Deiter’s Cells:** These are supporting cells that provide a base for the OHCs. While they can be affected in severe trauma, they are not the primary site of initial noise-induced damage. * **Cells of Hensen:** These are supporting cells located lateral to the OHCs. They provide structural support but do not play a direct role in the pathophysiology of noise-induced sensory loss. **3. Clinical Pearls for NEET-PG:** * **Early Sign:** The earliest clinical sign of NIHL on an audiogram is a dip at **4000 Hz (4 kHz notch)**, also known as **Boilermaker's notch**. * **Temporary vs. Permanent:** A "Temporary Threshold Shift" (TTS) involves recovery of OHC function, whereas a "Permanent Threshold Shift" (PTS) involves OHC death and replacement by scar tissue (phalangeal scars). * **Safe Limit:** Prolonged exposure to noise levels above **85 dB** is considered hazardous to the OHCs. * **Presbycusis vs. NIHL:** Both affect high frequencies, but NIHL specifically shows the 4 kHz notch, whereas presbycusis shows a down-sloping curve at the highest frequencies (6-8 kHz).

Q: A 60-year-old man presented with left-sided ear discharge for 7 years accompanied by dull earache. On examination, the tympanic membrane is intact on both sides, and a mass is seen on the posterior canal wall on the left side. What is the most likely diagnosis?

Keratosis obturans. **Explanation:** The clinical presentation of long-standing ear discharge, dull pain, an **intact tympanic membrane (TM)**, and a **mass on the posterior canal wall** in an older patient is classic for **Keratosis Obturans**. **Why Keratosis Obturans is correct:** Keratosis obturans is caused by the accumulation of desquamated keratin scales in the external auditory canal (EAC). Unlike Cholesteatoma, it typically presents with an intact TM. The "mass" described is the keratin plug. Over time, the pressure from this accumulation causes **ballooning of the bony canal** and pressure necrosis, leading to a dull, deep-seated ache and chronic discharge. **Why the other options are incorrect:** * **CSOM:** This diagnosis requires a **perforated tympanic membrane**. The question explicitly states the TM is intact, ruling out CSOM. * **External Otitis:** This is usually an acute, painful inflammatory condition. While it causes discharge, it does not typically present as a localized mass on the posterior wall or persist for 7 years without acute exacerbations. * **Carcinoma of the EAC:** While it can present with pain and discharge in older patients, it usually presents as a friable, bleeding mass or ulcer rather than a keratinous plug, and is often associated with rapid progression and cranial nerve palsies. **High-Yield Clinical Pearls for NEET-PG:** * **Keratosis Obturans vs. Canal Cholesteatoma:** Keratosis obturans involves **circumferential** keratin accumulation and canal widening, often associated with bronchiectasis or sinusitis. Canal Cholesteatoma involves **localized** bone erosion (usually the floor) with a sequestration of bone. * **Triad of Keratosis Obturans:** Severe pain, conductive hearing loss, and a widened bony EAC. * **Management:** Repeated syringing or manual removal of the keratin plug under microscopy.

Question 1

A 65-year-old person with bilateral sensorineural hearing loss and proportionate speech discrimination is suffering from:

Accepted Answer

Presbycusis

Answer

Noise induced hearing loss

Answer

Ototoxic drug-induced hearing loss

Answer

Acoustic neuroma

Question 2

A patient hears better in noise. What is the diagnosis?

Accepted Answer

Paracusis

Answer

Hyperacusis

Answer

Hypoacusis

Answer

Presbyacusis

Question 3

What is not true about auricular hematoma?

Accepted Answer

Resolves spontaneously.

Answer

All cases should receive antibiotics.

Answer

Commonly seen in rugby players.

Answer

All of the above.

Question 4

A 2-year-old child undergoes tympanostomy tube placement for treatment of chronic bilateral serous otitis media. Which of the following complications is least likely to occur subsequent to surgery?

Accepted Answer

Scarring of the external auditory canal

Answer

Chronic perforation

Answer

Cholesteatoma

Answer

Tympanosclerosis

Question 5

A patient presents with hearing loss and a sensation of fullness in the left ear. What is the most likely diagnosis?

Accepted Answer

Fracture of the temporal bone

Answer

Cholesteatoma

Answer

Ochronosis

Answer

Otomycosis

Question 6

Which of the following statements about Pendred syndrome is FALSE?

Accepted Answer

Thyroidectomy is the treatment.

Answer

It is caused by mutation of the PENDRIN gene.

Answer

It is associated with sensorineural deafness.

Answer

Goitre is a common feature.

Question 7

Which cranial nerve is responsible for referred pain to the ear?

Accepted Answer

Glossopharyngeal nerve (IX)

Answer

Oculomotor nerve (III)

Answer

Accessory nerve (XI)

Answer

Hypoglossal nerve (XII)

Question 8

All are causes of sensorineural deafness except?

Accepted Answer

Rupture of tympanic membrane

Answer

Old age

Answer

Acoustic neuroma

Answer

Ototoxic drugs

Question 9

Which cells of the Organ of Corti are vulnerable to noise-induced damage?

Accepted Answer

Outer hair cells

Answer

Inner hair cells

Answer

Deiter's cells

Answer

Cells of Hensen

Question 10

A 60-year-old man presented with left-sided ear discharge for 7 years accompanied by dull earache. On examination, the tympanic membrane is intact on both sides, and a mass is seen on the posterior canal wall on the left side. What is the most likely diagnosis?

Accepted Answer

Keratosis obturans

Answer

Chronic suppurative otitis media (CSOM)

Answer

External otitis

Answer

Carcinoma of the external auditory canal

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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