Diseases of the Ear Practice Questions

Q: External auditory canal exostosis occurs due to what?

Recurrent prolonged cold water exposure. **Explanation:** **External Auditory Canal (EAC) Exostosis**, also known as **"Surfer’s Ear,"** is a benign condition characterized by the formation of multiple, bilateral, sessile bony outgrowths in the bony portion of the external auditory canal. 1. **Why Option D is Correct:** The primary etiology is **recurrent and prolonged exposure to cold water** (and occasionally cold wind). This thermal stimulus triggers a reactive osteoblastic activity in the periosteum of the bony canal, leading to the formation of new lamellar bone. It is most commonly seen in surfers, divers, and swimmers. 2. **Why Other Options are Incorrect:** * **A & B:** Repeated instrumentation or chronic inflammation (Otitis Externa) typically leads to skin thickening, stenosis, or scarring (fibrosis), but does not stimulate the deep-seated periosteal bone growth characteristic of exostosis. * **C:** A wide meatus is a structural variation and does not have a causal relationship with bony overgrowth. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** Exostoses are usually **multiple, bilateral, and sessile** (broad-based). They are typically found in the deeper (bony) part of the EAC. * **Osteoma vs. Exostosis:** This is a frequent point of confusion. * **Osteoma:** Usually **solitary, unilateral, and pedunculated**. It is a true benign neoplasm. * **Exostosis:** Usually **multiple, bilateral, and sessile**. It is a reactive hyperplasia. * **Clinical Presentation:** Often asymptomatic but can lead to conductive hearing loss or recurrent otitis externa due to the "trapping" of wax and water behind the bony protrusions. * **Management:** Conservative (earplugs) for mild cases; **Canalplasty** (surgical removal) if there is significant hearing loss or persistent infection.

Q: Which of the following viruses does NOT cause hearing loss?

Rotavirus. **Explanation:** The correct answer is **Rotavirus**. Hearing loss caused by viral infections is typically due to direct damage to the inner ear structures (cochlea or auditory nerve) or an inflammatory response within the labyrinth. **Why Rotavirus is the correct answer:** Rotavirus is a double-stranded RNA virus that primarily infects the enterocytes of the small intestine, leading to severe gastroenteritis. It does not exhibit neurotropism or the ability to invade the inner ear; therefore, it is not associated with sensorineural hearing loss (SNHL). **Analysis of incorrect options:** * **Measles (Rubeola):** Causes severe bilateral SNHL. The virus reaches the inner ear via the bloodstream, leading to permanent damage to the Organ of Corti. * **Mumps:** Historically one of the most common causes of **unilateral** Sausalito SNHL in children. It causes endolymphatic labyrinthitis. The hearing loss is often sudden and profound. * **Rubella:** A classic cause of congenital SNHL. If a mother is infected during the first trimester, the virus interferes with the development of the cochlea (Scheibe dysplasia), leading to the "Cookie-bite" audiogram pattern. **High-Yield Clinical Pearls for NEET-PG:** * **Most common viral cause of congenital SNHL:** Cytomegalovirus (CMV). * **Most common viral cause of acquired unilateral SNHL:** Mumps. * **Labyrinthitis vs. Neuronitis:** Viral labyrinthitis presents with both hearing loss and vertigo, whereas vestibular neuronitis presents with vertigo only (hearing is preserved). * **Ramsay Hunt Syndrome:** Caused by Herpes Zoster Oticus; presents with facial palsy, vesicles on the auricle, and SNHL/vertigo.

Q: Which of the following is NOT true about glue ear?

Myringotomy with curvilinear incision. **Explanation:** **Glue Ear**, clinically known as **Otitis Media with Effusion (OME)**, is characterized by the accumulation of non-purulent mucoid fluid in the middle ear cleft. **Why Option A is the correct answer (The False Statement):** In Glue Ear, the fluid is thick and tenacious. A **radial incision** (not curvilinear) is preferred for myringotomy. A radial incision is less traumatic to the circular fibers of the tympanic membrane, heals faster, and allows for better evacuation of the thick "glue." Curvilinear (circumferential) incisions are generally avoided as they can lead to wider scarring or permanent perforation. **Analysis of other options:** * **Option B:** **Grommet insertion** (ventilation tube) is the definitive surgical treatment. It bypasses the Eustachian tube to provide long-term ventilation and drainage. * **Option C:** **Otitis media with effusion** is the standard medical synonym for glue ear. * **Option D:** Myringotomy is performed in the **anteroinferior quadrant**. This is the safest site as it avoids injury to the ossicular chain (incudostapedial joint) and the chorda tympani nerve, which are located in the posterior quadrants. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of hearing loss in children:** Glue Ear. * **Audiometry:** Shows Conductive Hearing Loss (CHL) with a characteristic **B-type (flat) tympanogram**. * **Otoscopy:** Appearance of a dull, retracted tympanic membrane with restricted mobility; "air bubbles" or an amber-colored fluid level may be seen. * **Associated conditions:** Often linked to adenoid hypertrophy, cleft palate, or Eustachian tube dysfunction. In an adult with unilateral glue ear, always rule out **Nasopharyngeal Carcinoma**.

Q: Which statement about deafness in Alport syndrome is true?

Deafness always accompanied by evidence of renal disease. ### Explanation **Alport Syndrome** is a hereditary disorder caused by mutations in the genes encoding **Type IV collagen** (specifically the $\alpha3$, $\alpha4$, and $\alpha5$ chains). Since Type IV collagen is a structural component of basement membranes in the kidney (glomerulus), eye, and cochlea, the clinical manifestations are multisystemic. #### Why Option C is Correct: The auditory involvement in Alport syndrome is a **progressive sensorineural hearing loss (SNHL)**. Crucially, the hearing loss never occurs in isolation; it is **always accompanied by renal manifestations**, such as hematuria or proteinuria, which typically precede the deafness. The defect lies in the stria vascularis of the cochlea, which shares similar basement membrane characteristics with the renal glomerulus. #### Why Other Options are Incorrect: * **Option A:** The deafness is **Sensorineural**, not conductive. It typically affects high frequencies (2000–8000 Hz) initially. * **Option B:** It is **not congenital**. Hearing is usually normal at birth; the deficit typically manifests during late childhood or adolescence (usually before age 20). * **Option C:** The progression is generally **gradual**, not "fast progressing," though it can lead to significant impairment by early adulthood. #### NEET-PG High-Yield Pearls: * **Inheritance:** Most common is **X-linked Dominant** (COL4A5 mutation). * **Classic Triad:** 1. **Renal:** Progressive hematuria leading to End-Stage Renal Disease (ESRD). 2. **Ocular:** **Anterior Lenticonus** (pathognomonic) and "dot-and-fleck" retinopathy. 3. **Auditory:** Bilateral high-frequency SNHL. * **Diagnosis:** Electron microscopy of renal biopsy shows a characteristic **"Basket-weave" appearance** of the Glomerular Basement Membrane (GBM).

Q: How is Eustachian tube patency assessed?

All of the above. The Eustachian tube (ET) serves three primary functions: ventilation, protection, and clearance of the middle ear. Assessing its patency is crucial in diagnosing middle ear pathologies. **Explanation of Options:** * **Valsalva Maneuver:** This is an **active** test of ET patency. The patient forcibly exhales against a closed glottis, nose, and mouth. This increases nasopharyngeal pressure, forcing air into the ET. Success is confirmed by seeing the tympanic membrane (TM) move outward on otoscopy or hearing a "pop." * **Toynbee Test:** This is considered more physiological than Valsalva. The patient swallows while the nose is pinched shut. This creates negative pressure in the nasopharynx, drawing air out of the middle ear and causing inward movement of the TM. * **Methylene Blue Test:** This is a test of the **mucociliary clearance** function of the ET. A dye (like methylene blue or saccharin) is instilled into the middle ear through a perforation or grommet. If the ET is patent, the dye will appear in the nasopharynx (seen on posterior rhinoscopy) or the patient will report a metallic/sweet taste. **Clinical Pearls for NEET-PG:** 1. **Politzerization:** A method of inflating the middle ear using a Politzer bag; useful in children who cannot perform Valsalva. 2. **Tympanometry:** The most objective way to assess ET function. A **Type C tympanogram** (negative pressure) indicates ET dysfunction. 3. **Patulous Eustachian Tube:** A condition where the tube remains abnormally open. Patients complain of **autophony** (hearing their own voice/breath sounds). 4. **Siegle’s Speculum:** Can be used to observe TM mobility during Valsalva/Toynbee maneuvers.

Q: Schirmer test is done for?

Facial nerve. Explanation: The **Schirmer test** is a clinical diagnostic tool used to measure tear production (lacrimation). It is primarily used to evaluate dry eye syndrome or conditions like Sjögren’s syndrome. **Why Facial Nerve is the Correct Answer:** The **Facial nerve (CN VII)** provides parasympathetic innervation to the **lacrimal gland** via the Greater Petrosal Nerve. In cases of proximal facial nerve palsy (e.g., Bell’s palsy or lesions at the geniculate ganglion), tear production is significantly reduced. The Schirmer test is used topographically to determine the level of the facial nerve lesion; if lacrimation is absent, the lesion is at or proximal to the geniculate ganglion. **Why Other Options are Incorrect:** * **Oculomotor Nerve (CN III):** This nerve controls most extraocular muscles, the levator palpebrae superioris (eyelid elevation), and pupillary constriction. It does not control lacrimation. * **Optic Nerve (CN II):** This is a purely sensory nerve responsible for vision and the afferent limb of the pupillary light reflex. It has no motor or secretomotor function. **High-Yield Clinical Pearls for NEET-PG:** * **Procedure:** A filter paper (Whatman No. 41) is placed in the lower conjunctival fornix for 5 minutes. * **Interpretation:** Normal wetting is >15 mm. Wetting <5 mm is diagnostic of **Keratoconjunctivitis Sicca (Dry Eye)**. * **Topographic Diagnosis:** In Facial Nerve palsy, the Schirmer test helps differentiate a lesion in the Internal Auditory Meatus/Geniculate ganglion (abnormal test) from a lesion in the Stylomastoid foramen (normal test). * **Sjögren’s Syndrome:** Often presents with a positive Schirmer test along with xerostomia (dry mouth).

Q: Unilateral sensorineural hearing loss may occur in which of the following viral infections?

Mumps. **Explanation:** **Mumps** is the most common viral cause of **unilateral sudden sensorineural hearing loss (SNHL)**. The virus causes endolymphatic labyrinthitis, leading to the destruction of the hair cells in the Organ of Corti and atrophy of the stria vascularis. While the hearing loss is typically sudden and profound, it is characteristically unilateral in about 80% of cases, though bilateral involvement can occur. **Analysis of Options:** * **Coronavirus:** While COVID-19 has been associated with rare cases of SNHL and tinnitus, it is not a classic or frequently tested cause of unilateral SNHL in the context of standard ENT textbooks. * **Pertussis:** Caused by *Bordetella pertussis*, this is a respiratory bacterial infection (Whooping cough) and is not associated with direct viral labyrinthitis or SNHL. * **Rotavirus:** This is a primary cause of viral gastroenteritis in children and does not have neurotropic or ototropic properties. **Clinical Pearls for NEET-PG:** * **Mumps:** Most common cause of unilateral SNHL in children. * **Measles:** Often causes **bilateral** and symmetrical SNHL. * **Congenital Rubella:** Classically associated with "cookie-bite" SNHL and the "Salt and Pepper" retinopathy. * **Herpes Zoster Oticus (Ramsay Hunt Syndrome):** Presents with SNHL, facial palsy, and vesicles on the auricle (caused by VZV). * **Cytomegalovirus (CMV):** The most common **non-genetic** cause of congenital SNHL.

Q: A child underwent adenoidectomy and subsequently developed middle ear effusion. What is the ideal surgical management step?

Grommet insertion. **Explanation:** The middle ear is ventilated via the **Eustachian tube (ET)**. In children, adenoid hypertrophy is a common cause of ET dysfunction, leading to negative middle ear pressure and **Otitis Media with Effusion (OME)**. When a child develops persistent middle ear effusion despite an adenoidectomy, it indicates that the ET function has not fully recovered or that the effusion is thick ("glue ear") and unlikely to resolve spontaneously. **Why Option A is correct:** **Grommet insertion (Myringotomy with ventilation tube)** is the gold standard for persistent OME. The grommet bypasses the dysfunctional Eustachian tube, providing continuous ventilation to the middle ear, equalizing pressure, and allowing the drainage of fluid. This restores hearing and prevents complications like ossicular necrosis or cholesteatoma. **Why other options are incorrect:** * **B. Mastoidectomy:** This is indicated for chronic suppurative otitis media (CSOM) with cholesteatoma or mastoiditis. It is too invasive for simple middle ear effusion. * **C. Tympanoplasty:** This is a reconstructive surgery to repair a perforated tympanic membrane or ossicular chain. In OME, the drum is intact but retracted; creating a permanent graft is not indicated. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site for Grommet:** Antero-inferior quadrant of the tympanic membrane (to avoid injury to the incudostapedial joint). * **Indications for Adenoidectomy in OME:** Recurrent OME, nasal obstruction, or if the effusion persists after a previous myringotomy. * **Hearing Loss type:** OME typically causes a **Conductive Hearing Loss** of 25–40 dB. * **Bilateral OME in an adult:** Always rule out **Nasopharyngeal Carcinoma** (NPC) obstructing the ET opening.

Q: What is the commonest cause for grommet insertion?

Secretory otitis media. **Explanation:** **1. Why Secretory Otitis Media (SOM) is correct:** Secretory Otitis Media (also known as Otitis Media with Effusion - OME) is characterized by the accumulation of non-purulent fluid in the middle ear cleft. The primary pathophysiology involves **Eustachian tube dysfunction**, leading to negative middle ear pressure. A **Grommet (Myringotomy with Ventilation Tube)** is the surgical treatment of choice when medical management fails. It serves two purposes: it provides an alternative route for ventilation of the middle ear and allows for the continuous drainage of fluid, thereby restoring hearing and preventing complications like retraction pockets. **2. Why other options are incorrect:** * **Otosclerosis:** This is a disease of the bony labyrinth causing stapes fixation. The treatment is primarily medical (Sodium Fluoride), surgical (**Stapedotomy/Stapedectomy**), or hearing aids. Grommets have no role here as there is no fluid or pressure issue. * **CSOM:** Chronic Suppurative Otitis Media involves a permanent perforation of the TM. Since the drum is already open, a grommet is redundant. Treatment involves **Tympanoplasty** or **Mastoidectomy**. * **Cholesteatoma:** This is a destructive keratinizing squamous epithelium in the middle ear. It requires surgical excision via **Mastoidectomy** to prevent intracranial complications. **Clinical Pearls for NEET-PG:** * **Most common site for Myringotomy:** Postero-inferior quadrant (to avoid injury to the ossicles and chorda tympani). * **Indications for Grommet:** Recurrent SOM (>3 months), Reversion of retraction pockets, and Barotrauma. * **Commonest complication of Grommet:** Otorrhoea; long-term complication includes Tympanosclerosis. * **Hearing loss in SOM:** Usually a Conductive Hearing Loss of 20-40 dB; the audiogram shows a **Type B (Flat) Tympanogram**.

Question 1

External auditory canal exostosis occurs due to what?

Accepted Answer

Recurrent prolonged cold water exposure

Answer

Repeated instrumentation

Answer

Recurrent otitis externa

Answer

Wide external auditory meatus

Question 2

Which of the following viruses does NOT cause hearing loss?

Accepted Answer

Rotavirus

Answer

Measles

Answer

Mumps

Answer

Rubella

Question 3

Which of the following is NOT true about glue ear?

Accepted Answer

Myringotomy with curvilinear incision

Answer

Grommet insertion is the treatment

Answer

Also known as otitis media with effusion

Answer

Myringotomy performed in the anteroinferior quadrant

Question 4

The Tobey-Ayer test is positive in which of the following conditions?

Accepted Answer

Lateral sinus thrombosis

Answer

Petrositis

Answer

Cerebral abscess

Answer

Subarachnoid haemorrhage

Question 5

Which statement about deafness in Alport syndrome is true?

Accepted Answer

Deafness always accompanied by evidence of renal disease

Answer

High-tone conductive deafness

Answer

Congenital deafness

Answer

Deafness is fast progressing

Question 6

How is Eustachian tube patency assessed?

Accepted Answer

All of the above

Answer

Valsalva maneuver

Answer

Methylene blue test

Answer

Toynbee test

Question 7

Schirmer test is done for?

Accepted Answer

Facial nerve

Answer

Oculomotor nerve

Answer

Optic nerve

Answer

All

Question 8

Unilateral sensorineural hearing loss may occur in which of the following viral infections?

Accepted Answer

Mumps

Answer

Coronavirus

Answer

Pertussis

Answer

Rotavirus

Question 9

A child underwent adenoidectomy and subsequently developed middle ear effusion. What is the ideal surgical management step?

Accepted Answer

Grommet insertion

Answer

Mastoidectomy

Answer

Tympanoplasty

Answer

None of the above

Question 10

What is the commonest cause for grommet insertion?

Accepted Answer

Secretory otitis media

Answer

Otosclerosis

Answer

Chronic suppurative otitis media (CSOM)

Answer

Cholesteatoma

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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