Diseases of the Ear Practice Questions

Q: A young male presents with ear discharge for three years and recently developed swelling in the neck below and behind the angle of the mandible. On examination, the external auditory canal was filled with granulation tissue. What is the diagnosis?

Bezold's abscess. ### Explanation The clinical presentation of chronic ear discharge, granulation tissue in the canal (suggestive of cholesteatoma), and a neck swelling below and behind the angle of the mandible points to a complication of **Chronic Suppurative Otitis Media (CSOM)**. **Why Bezold’s Abscess is Correct:** Bezold’s abscess occurs when pus from a perforated mastoid tip (where the bone is thin) tracks down along the **sternocleidomastoid (SCM) muscle**. Because the mastoid tip is the site of origin for the SCM and the posterior belly of the digastric muscle, the pus is directed deep into the neck. This results in a painful inflammatory swelling situated **below and behind the angle of the mandible**, often causing torticollis. **Analysis of Incorrect Options:** * **Luc’s Abscess:** This is a subperiosteal abscess where pus tracks through the external auditory canal wall. The swelling is typically located in the **meatal wall** or pre-auricular region, not the neck. * **Citelli’s Abscess:** Pus tracks through the digastric fossa along the **posterior belly of the digastric muscle** to the occipital bone/digastric triangle. It is located more posteriorly and superiorly compared to Bezold's. * **Parapharyngeal Abscess:** While it can occur as a complication of ear infections (via the infratemporal fossa), it typically presents with trismus, medial displacement of the tonsil, and swelling at the angle of the jaw, rather than tracking down the SCM. **High-Yield Clinical Pearls for NEET-PG:** * **Mastoid Tip Anatomy:** In children under 2 years, the mastoid tip is not developed; hence, Bezold’s abscess is rare in infants. * **Radiology:** Contrast-enhanced CT (CECT) is the gold standard to visualize the mastoid breakdown and the extent of the neck abscess. * **Management:** Requires a combination of Cortical/Radical Mastoidectomy (to clear the source) and incision and drainage (I&D) of the neck abscess.

Q: What is true in case of perforation of the pars flaccida?

It is associated with cholesteatoma.. **Explanation:** Perforations of the tympanic membrane are clinically divided based on their location: **Pars Tensa** (associated with mucosal disease) and **Pars Flaccida** (associated with squamosal disease). **1. Why Option B is Correct:** The pars flaccida (Shrapnell’s membrane) lacks a robust fibrous middle layer (the *annulus tympanicus* is absent here). This makes it more prone to retraction when there is negative middle ear pressure. A retraction pocket in the pars flaccida is the most common site for the development of **Primary Acquired Cholesteatoma**. As keratin debris accumulates within this pocket, it forms a cholesteatoma, which can erode the scutum and the ossicles (specifically the head of the malleus and body of the incus). **2. Why other options are incorrect:** * **Option A:** Chronic Suppurative Otitis Media (CSOM) is actually the **primary cause** of pars flaccida perforations. Specifically, the "Attico-antral" or "Unsafe" type of CSOM is characterized by disease in the attic/pars flaccida region. * **Option C:** Traumatic perforations (due to a slap, water sports, or instrumentation) almost exclusively involve the **pars tensa**, as it constitutes the largest surface area of the drum. Pars flaccida perforations are nearly always pathological (inflammatory/cholesteatomatous) rather than traumatic. **Clinical Pearls for NEET-PG:** * **Safe vs. Unsafe:** Pars tensa perforations (Central) are "Safe" (low risk of bone erosion); Pars flaccida/Marginal perforations are "Unsafe" (high risk of cholesteatoma). * **Prussak’s Space:** This is the most common initial site for cholesteatoma formation, located lateral to the neck of the malleus and medial to the pars flaccida. * **Management:** Unlike central perforations which may be managed medically, pars flaccida disease usually requires surgical intervention (Mastoidectomy).

Q: A 5-year-old child is brought to the outpatient department by his mother with irritability, poor school performance, and a history of recurrent ear infections. Otoscopic examination shows a dull, retracted tympanic membrane with fluid behind it. There is no blood clot present in the ear. What is the most likely diagnosis?

Otitis media with effusion. ***Otitis media with effusion***- This condition is characterized by the presence of **non-purulent fluid (effusion)** in the middle ear space without signs or symptoms of acute infection (such as fever or severe pain).- The otoscopic findings of a **dull, retracted tympanic membrane** with fluid behind it, coupled with symptoms suggesting chronic hearing loss (**poor school performance** and irritability), are classic for OME, or "**glue ear**." *Acute otitis media*- AOM is generally associated with the acute onset of **otalgia** (ear pain) and often fever, along with a key otoscopic finding of a **bulging**, erythematous, and immobile **tympanic membrane**.- The absence of acute inflammatory signs and the description of a retracted, rather than bulging, TM distinguishes this chronic finding from an acute infection. *Otitis externa*- This condition involves inflammation and infection of the **external auditory canal**; the middle ear and the fluid described are not typically affected.- Key clinical findings involve tenderness upon manipulation of the **tragus** or **pinna**, often with swelling and exudate limited to the ear canal. *Cholesteatoma*- Cholesteatoma is a destructive process involving a collection of **squamous epithelium** (a “pearly mass”) that usually causes **foul-smelling chronic otorrhea** due to bone erosion.- While chronic retraction of the TM can lead to its formation, the primary finding here is simply **effusion (fluid)**, not the characteristic highly destructive epidermal mass.

Q: A 60-year-old man complains of gradual hearing loss over several years. He reports difficulty hearing conversations, especially in noisy environments, and has trouble perceiving high-pitched sounds. There are no episodes of vertigo, tinnitus, or ear fullness. What is the most likely diagnosis?

Presbycusis. ***Correct: Presbycusis*** - It is the most common cause of **gradual, bilateral sensorineural hearing loss** in the elderly, characterized by a protracted course over several years. - The defining feature is difficulty hearing **high-pitched sounds** (loss of high-frequency hearing) and **poor speech discrimination** in noisy environments, consistent with the clinical picture. - This is age-related cochlear degeneration, typically beginning after age 50-60. *Incorrect: Meniere's disease* - This condition is defined by the classic triad of **episodic vertigo**, **fluctuating (usually low-frequency) sensorineural hearing loss**, and **tinnitus** with aural fullness, none of which are present. - The hearing loss is typically episodic and unilateral, contrasting with the patient's chronic, gradual deterioration. *Incorrect: Otosclerosis* - This disorder causes **conductive hearing loss** (or mixed loss) due to abnormal bone growth around the **stapes footplate**, often presenting earlier in life (20s–30s). - Unlike the gradual, high-frequency loss seen here, otosclerosis causes reduced sound transmission to the inner ear, typically improving speech perception in noise (**paracusis Willisii**). *Incorrect: Acoustic neuroma* - Although it causes sensorineural hearing loss, it is typically **unilateral** and often asymmetrical, frequently accompanied by **unilateral tinnitus** and imbalance. - This diagnosis is less likely in a patient with **bilateral**, gradual hearing loss without unilateral symptoms or specific cranial nerve involvement.

Q: The image below shows a lateral view of the face with a highlighted region in front of the ear. Which type of abscess is most likely indicated in this area?

Luc's abscess. ***Luc's abscess*** - This is a **subperiosteal abscess** located in the **preauricular region**, on the external surface of the squamous part of the temporal bone, which corresponds to the highlighted area. - It is a rare complication of **acute otitis media** or **mastoiditis**, occurring when infection spreads through the tympanosquamous suture. *Citelli’s abscess* - This abscess is located at the **tip of the mastoid process** and extends into the **digastric triangle** of the neck, which is posterior and inferior to the area shown. - It is formed when pus from mastoiditis tracks along the posterior belly of the **digastric muscle**. *Bezold's abscess* - This is a **deep neck abscess** that forms when infection erodes through the medial aspect of the mastoid tip and spreads inferiorly into the neck. - The swelling is located deep to the **sternocleidomastoid muscle**, far from the preauricular location shown in the image. *Zygomatic abscess* - This abscess forms over the **zygomatic process** of the temporal bone, which is located superior and anterior to the external auditory canal. - It results from the spread of infection from mastoid air cells into the **root of the zygoma**, a location slightly more superior than what is highlighted.

Q: A patient with CSOM presented to the OPD with seizures. On examination, homonymous hemianopia was present. Identify the condition based on the CT scan given below.

Temporal abscess. ***Temporal abscess*** - The patient's history of **CSOM** (Chronic Suppurative Otitis Media) is a classic risk factor for an **otogenic brain abscess**, with the temporal lobe being the most common site due to its proximity to the middle ear and mastoid. - The clinical signs of **seizures** and **homonymous hemianopia** (from involvement of optic radiations), combined with the characteristic **ring-enhancing lesion** on the CT scan, are pathognomonic for a temporal lobe abscess. *Cerebellar abscess* - A cerebellar abscess would present with signs of **cerebellar dysfunction**, such as **ataxia**, **nystagmus**, and **dysmetria**, which are absent in this patient's presentation. - While also a potential complication of otitis media, the focal neurological deficit of **homonymous hemianopia** localizes the lesion to the cerebrum, not the cerebellum. *Extradural abscess* - An extradural abscess is located between the dura mater and the skull and appears as a **lens-shaped (biconvex)** collection on CT, which is morphologically distinct from the **intraparenchymal, ring-enhancing lesion** shown. - Such an abscess is less likely to cause focal signs like hemianopia unless there is significant mass effect on the underlying brain parenchyma. *Meningitis* - Meningitis involves diffuse inflammation of the meninges and does not typically form a **focal, ring-enhancing mass** on a CT scan; findings are often normal or show diffuse meningeal enhancement. - The presence of a specific focal neurological deficit like **homonymous hemianopia** strongly points towards a localized lesion like an abscess rather than diffuse meningitis.

Q: A 5-year-old child presents with sudden severe ear pain and hearing loss. On otoscopy, you observe hemorrhagic bullae on an inflamed tympanic membrane. What is the most likely diagnosis?

Myringitis bullosa. ***Myringitis bullosa*** - This diagnosis is strongly suggested by the otoscopic image showing **hemorrhagic or serous bullae (blisters)** on an inflamed tympanic membrane, which is the pathognomonic feature of this condition. - It is an acute inflammation of the tympanic membrane, often associated with viral or bacterial infections (e.g., **Mycoplasma pneumoniae**, Influenza virus), and typically presents with sudden, severe otalgia and hearing loss. *Serous otitis media* - This condition, also known as otitis media with effusion, is characterized by the presence of fluid in the middle ear space, leading to a **dull, retracted tympanic membrane** with visible **air-fluid levels or bubbles**, not bullae on the surface. - It typically presents with conductive hearing loss and a feeling of fullness in the ear, but lacks the severe inflammation and bullae seen in the image. *Acute otitis media* - The classic sign of acute otitis media is a **bulging, erythematous, and opaque tympanic membrane** due to purulent effusion in the middle ear, with loss of normal landmarks. - While bullae can occasionally form in severe cases of AOM, the primary feature is the bulging eardrum, and the prominent, multiple vesicles seen here are more specific to myringitis bullosa. *Myringitis granulosa* - This is a chronic inflammatory condition characterized by the presence of **granulation tissue** on the lateral surface of the tympanic membrane. - It typically presents with persistent otorrhea and conductive hearing loss, and the otoscopic appearance is of a raw, granular surface, which is distinctly different from the fluid-filled bullae shown in the image.

Q: Identify the instruments shown in the image:

A= Politzer bag, B= Hartmann catheter. ***A= Politzer bag, B= Hartmann catheter*** - Image A depicts a **Politzer bag**, a rubber bulb device used to inflate air into the middle ear through the Eustachian tube via nasal route (Politzer's maneuver). - Image B shows a **Hartmann Eustachian catheter**, a curved metal catheter with an olive-shaped tip used in conjunction with the Politzer bag for middle ear inflation and Eustachian tube catheterization. *A= Siegel speculum, B= Hartmann catheter* - Image A is not a Siegel speculum, which is an otoscope attachment with a rubber bulb used for pneumatic otoscopy to assess tympanic membrane mobility and compliance. - Image B is correctly identified as Hartmann catheter, but this partial identification makes the option incorrect. *A= Politzer bag, B= Higginson catheter* - Image B is not a Higginson catheter (or Higginson's syringe), which is a double-bulb pump device used for irrigation and aspiration, typically for bowel procedures, not for Eustachian tube work. - Image A is correctly identified as Politzer bag, but this partial identification makes the option incorrect. *A= Siegel speculum, B= Higginson catheter* - Neither instrument is correctly identified in this option. - Image A shows a Politzer bag (not Siegel speculum) and image B shows a Hartmann catheter (not Higginson catheter).

Q: Name the procedure being done:

Ear syringing. ***Ear syringing*** - The image depicts a procedure where fluid is being irrigated into the ear canal from a syringe-like device, with a bowl held under the ear to collect the outflow. This is characteristic of **ear syringing** or **ear irrigation**. - This procedure is commonly performed to remove accumulated **earwax (cerumen)**, foreign bodies, or debris from the external auditory canal. *Caloric stimulation test* - This test involves introducing warm or cold water/air into the external auditory canal to stimulate the **vestibulo-ocular reflex** and assess vestibular function. - While it involves fluid in the ear, the primary purpose is diagnostic for **vestibular disorders**, not for cleaning the ear canal, and the setup shown does not typically reflect the controlled temperature and precise measurement required for this test. *Myringotomy* - **Myringotomy** is a surgical procedure involving a small incision made in the **tympanic membrane (eardrum)** to relieve pressure or drain fluid from the middle ear. - It is an invasive surgical procedure performed by an ENT specialist, not a simple irrigation as shown in the image. *Tympanoplasty* - **Tympanoplasty** is a surgical procedure to repair a perforated eardrum or reconstruct the middle ear sound-conducting mechanism. - This is a complex reconstructive surgery for hearing improvement, entirely different from the simple ear irrigation depicted.

Question 1

An elderly diabetic patient presents with excruciating ear pain, granulation tissue in the ear canal, and signs of skull base infection including facial paralysis. What is the recommended treatment?

Accepted Answer

Penicillin

Answer

Ciprofloxacin

Answer

Second-generation cephalosporin

Answer

Erythromycin

Question 2

A young male presents with ear discharge for three years and recently developed swelling in the neck below and behind the angle of the mandible. On examination, the external auditory canal was filled with granulation tissue. What is the diagnosis?

Accepted Answer

Bezold's abscess

Answer

Luc's abscess

Answer

Citelli's abscess

Answer

Parapharyngeal abscess

Question 3

What is true in case of perforation of the pars flaccida?

Accepted Answer

It is associated with cholesteatoma.

Answer

Chronic suppurative otitis media is a rare cause.

Answer

It is usually due to trauma.

Answer

All of the above.

Question 4

A 5-year-old child is brought to the outpatient department by his mother with irritability, poor school performance, and a history of recurrent ear infections. Otoscopic examination shows a dull, retracted tympanic membrane with fluid behind it. There is no blood clot present in the ear. What is the most likely diagnosis?

Accepted Answer

Otitis media with effusion

Answer

Acute otitis media

Answer

Otitis externa

Answer

Cholesteatoma

Question 5

A 60-year-old man complains of gradual hearing loss over several years. He reports difficulty hearing conversations, especially in noisy environments, and has trouble perceiving high-pitched sounds. There are no episodes of vertigo, tinnitus, or ear fullness. What is the most likely diagnosis?

Accepted Answer

Presbycusis

Answer

Meniere’s disease

Answer

Otosclerosis

Answer

Acoustic neuroma

Question 6

The image below shows a lateral view of the face with a highlighted region in front of the ear. Which type of abscess is most likely indicated in this area?

Accepted Answer

Luc's abscess

Answer

Zygomatic abscess

Answer

Bezold's abscess

Answer

Citelli’s abscess

Question 7

A patient with CSOM presented to the OPD with seizures. On examination, homonymous hemianopia was present. Identify the condition based on the CT scan given below.

Accepted Answer

Temporal abscess

Answer

Meningitis

Answer

Cerebellar abscess

Answer

Extradural abscess

Question 8

A 5-year-old child presents with sudden severe ear pain and hearing loss. On otoscopy, you observe hemorrhagic bullae on an inflamed tympanic membrane. What is the most likely diagnosis?

Accepted Answer

Myringitis bullosa

Answer

Serous otitis media

Answer

Acute otitis media

Answer

Myringitis granulosa

Question 9

Identify the instruments shown in the image:

Accepted Answer

A= Politzer bag, B= Hartmann catheter

Answer

A= Siegel speculum, B= Hartmann catheter

Answer

A= Politzer bag, B= Higginson catheter

Answer

A= Siegel speculum, B= Higginson catheter

Question 10

Name the procedure being done:

Accepted Answer

Ear syringing

Answer

Caloric stimulation test

Answer

Myringotomy

Answer

Tympanoplasty

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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