Diseases of the Ear Practice Questions

Q: The image shows presence of the following:

Cryptotic ear. ***Cryptotic ear*** - This image clearly depicts a **cryptotic ear**, where the superior helix is abnormally buried beneath the skin of the temporal region. - This deformity is characterized by the **lack of a normal superior auricular fold**, making the ear appear compressed or partially hidden. *Macrotia* - **Macrotia** refers to abnormally large ears, a characteristic not evident in the provided image. - The size of the ears in the image appears to be within a normal range, despite the abnormal folding. *Stahl's ear deformity* - **Stahl's ear deformity** is characterized by an extra fold of cartilage, often creating a pointed or "Spock ear" appearance, which is not what is shown. - The distinctive feature of Stahl's ear is a **third crus** in the antihelix, leading to a prominent, pointed upper helix. *Cauliflower ear* - **Cauliflower ear** results from trauma to the ear cartilage, leading to a lumpy, scarred appearance due to hematoma and subsequent fibrosis. - This condition is typically seen in boxers or wrestlers and presents with a **deformed, irregular ear surface**, unlike the smooth appearance in the image.

Q: Which is correct about the incisions in tympanic membrane?

C= Otitis media with effusion and R= ASOM. ***C= Otitis media with effusion and R= ASOM*** - The **"C" incision** (curvilinear) in the anterior-inferior quadrant is ideal for **otitis media with effusion (OME)** as it provides optimal access for **grommet/ventilation tube insertion** and allows controlled drainage of thick mucoid fluid. - The **"R" incision** (radial) is preferred for **acute suppurative otitis media (ASOM)** because it facilitates rapid drainage of **purulent discharge** and heals quickly due to natural tension lines. *C= ASOM and R= Otitis media with effusion* - **Radial incisions** heal faster and are better suited for **ASOM** where immediate pus drainage and quick healing are priorities, not for chronic effusion management. - **Curvilinear incisions** remain open longer and are specifically designed for **OME** cases requiring **ventilation tube placement**, not for acute purulent infections. *C= CSOM and R= Otitis media* - **Chronic suppurative otitis media (CSOM)** typically involves pre-existing **tympanic membrane perforation** and requires surgical repair rather than simple myringotomy incisions. - "Otitis media" is too **non-specific** a term, and neither incision type is universally applicable without considering the specific pathology and treatment goals. *Both incisions for ASOM* - Different incision types serve **distinct clinical purposes** - curvilinear for **long-term ventilation** and radial for **acute drainage**. - Using both incision types for the same condition would be **clinically inappropriate** as each is optimized for different pathophysiological requirements and healing characteristics.

Q: The image shows ear syringing/irrigation being performed in an adult. Which is the correct technique for this procedure?

Ear pushed up and backwards, syringe posterosuperior. ***Ear pushed up and backwards, syringe posterosuperior*** - For **adults**, the earlobe is typically pulled **upwards and backwards** to straighten the ear canal for optimal irrigation. - The syringe tip is directed **posterosuperiorly** (towards the back and top) along the ear canal to avoid direct pressure on the tympanic membrane and allow for effective wax removal. *Ear pushed down and backwards, syringe anterosuperior* - Pulling the ear **down and backwards** is the technique used for **children**, not adults, to straighten their ear canal due to anatomical differences. - Directing the syringe **anterosuperiorly** (forward and up) in an adult could direct fluid towards the eardrum, increasing risk of injury. *Ear pushed down and forwards, syringe anteroinferior* - Pulling the ear **down and forwards** is an incorrect maneuver for ear irrigation in both adults and children, as it does not straighten the ear canal effectively. - Directing the syringe **anteroinferiorly** (forward and down) would be ineffective for wax removal and could cause discomfort or injury. *Ear pushed up and forwards, syringe anterosuperior* - While pulling the ear **upwards** is correct for adults, pulling it **forwards** does not optimally straighten the canal. - Directing the syringe **anterosuperiorly** increases the risk of impacting the tympanic membrane with the irrigation stream.

Q: What is the preferred site of insertion of device shown below?

Posteroinferior. ***Posteroinferior*** - The **posteroinferior quadrant** of the **tympanic membrane** is the preferred site for **myringotomy** and insertion of a **tympanostomy tube** (the device shown). - This quadrant is generally **thinner** and **less vascular**, and it avoids vital structures like the **ossicles** and nerve bundles. *Posterosuperior* - The **posterosuperior quadrant** should be avoided due to the proximity of the **ossicular chain** (especially the incus and stapes) and the niche of the **facial nerve**. - Incision in this area carries a higher risk of **ossicular damage** or **facial nerve injury**. *Anteroinferior* - While relatively safe, the **anteroinferior quadrant** is not the primary choice because it is often **thicker** and less accessible than the posteroinferior quadrant. - The **annulus** (fibrous ring) tends to be thicker in the anterior quadrants, making incision slightly more challenging. *Anterosuperior* - The **anterosuperior quadrant** contains the **eustachian tube orifice** and is close to the **tensor tympani muscle**. - Placing a tube here can lead to increased discomfort and is less ideal for effective ventilation.

Q: The test shown in the image is used for identifying a lesion in which cranial nerve?

VII. ***VII*** - The image shows a **Schirmer's test** being conducted, which measures **tear production**. - Tear production is primarily innervated by the **facial nerve (cranial nerve VII)**, making this test relevant for evaluating its function related to lacrimation. *III* - Cranial nerve III (oculomotor nerve) controls most **extraocular muscles**, pupillary constriction, and lid elevation. A lesion would manifest as issues with eye movement, ptosis, or pupil dilation, not tear production. - The Schirmer's test does not directly assess the function of the **oculomotor nerve**. *VI* - Cranial nerve VI (abducens nerve) innervates the **lateral rectus muscle**, responsible for abducting the eye (moving it outwards). - A lesion in CN VI would cause **diplopia** and inability to move the eye laterally, which is unrelated to tear production. *VIII* - Cranial nerve VIII (vestibulocochlear nerve) is responsible for **hearing** and **balance**. - Lesions affect hearing (e.g., deafness, tinnitus) or balance (e.g., vertigo, nystagmus), and have no direct involvement in tear production.

Q: What does the following image show?

Politzer test. ***Politzer test*** - The image shows a **Politzer bag** being used to insufflate air into the nasal cavity while the patient swallows, which is the procedure for the Politzer test. - This test is used to assess the patency of the **Eustachian tube** and to aerate the middle ear. *Toynbee's test* - This test involves the patient **swallowing with their mouth and nose closed**. - It assesses the function of the **Eustachian tube** under negative pressure. *Sonotubometry* - This is a **diagnostic method** that uses sound waves to assess Eustachian tube function. - It involves emitting a sound into the nasopharynx and detecting it in the external ear canal. *Frenzel maneuver* - This is a **hands-free Valsalva-like maneuver** used by divers to equalize pressure in the middle ear. - It involves closing the glottis and contracting muscles in the neck and pharynx to force air into the Eustachian tubes.

Q: What does the following image show?

Preauricular sinus. **Preauricular sinus** - The image shows a small opening or pit (indicated by arrows) located anterior to the **helix** of the ear, which is characteristic of a **preauricular sinus**. These are congenital malformations. - While often asymptomatic, they can become infected, leading to pain, swelling, and discharge. *Preauricular cyst* - A preauricular cyst is a **closed sac** filled with fluid or debris, and it would typically present as a palpable, swollen lump rather than a visible opening or pit. - While it can occur in the same area, its appearance would be distinctly different from the sinus shown. *Auricular hematoma* - An auricular hematoma is a collection of blood between the **perichondrium** and the cartilage of the ear, usually caused by trauma. - It would present as a **swollen, tender, and discolored ear**, giving a "cauliflower ear" appearance if left untreated, which is not seen here. *Cryptotia* - **Cryptotia** is a congenital ear deformity where the upper pole of the ear is partially buried beneath the skin of the temporal region. - This condition involves an abnormal ear shape and position, entirely different from the small opening depicted in the image.

Q: All are true about the lesion marked except:

Lined by stratified columnar epithelium. ***Lined by stratified columnar epithelium*** - The lesion shown is a **preauricular sinus or fistula**, which is typically lined by **stratified squamous epithelium** (similar to skin) or occasionally by ciliated columnar epithelium when it extends deeper. - It is **never lined exclusively by stratified columnar epithelium**, therefore this statement is incorrect. *Faulty union of hillocks of first and second brachial arches* - **Preauricular sinuses/fistulae** result from the **incomplete fusion** of the six auricular hillocks, which are derived primarily from the **first and second branchial arches**. - This developmental anomaly leads to the formation of a **blind tract or pit** in the preauricular region. *Repeated infections* - These sinuses have a **tendency to get infected** due to trapped debris, desquamated epithelium, and bacteria within the epithelial-lined tract, forming a cyst or abscess. - Infections can lead to **pain, swelling, discharge**, and potentially surgical intervention. *Located anterior to crus of helix* - As depicted in the image, the lesion (preauricular sinus) is characteristically located at the anterior margin of the ascending limb of the helix, specifically **anterior to the crus of the helix**. - This anatomical position is typical for the majority of these congenital anomalies.

Question 1

The image shows presence of the following:

Accepted Answer

Cryptotic ear

Answer

Macrotia

Answer

Stahl's ear deformity

Answer

Cauliflower ear

Question 2

Which is correct about the incisions in tympanic membrane?

Accepted Answer

C= Otitis media with effusion and R= ASOM

Answer

C= ASOM and R= Otitis media with effusion

Answer

C= CSOM and R= Otitis media

Answer

Both incisions for ASOM

Question 3

The image shows ear syringing/irrigation being performed in an adult. Which is the correct technique for this procedure?

Accepted Answer

Ear pushed up and backwards, syringe posterosuperior

Answer

Ear pushed down and backwards, syringe anterosuperior

Answer

Ear pushed down and forwards, syringe anteroinferior

Answer

Ear pushed up and forwards, syringe anterosuperior

Question 4

What is the preferred site of insertion of device shown below?

Accepted Answer

Posteroinferior

Answer

Posterosuperior

Answer

Anteroinferior

Answer

Anterosuperior

Question 5

The test shown in the image is used for identifying a lesion in which cranial nerve?

Accepted Answer

VII

Answer

III

Answer

VI

Answer

VIII

Question 6

Which is correct about the location of abscess formation secondary to mastoiditis?

Accepted Answer

A= Bezold's abscess, B= Postauricular abscess, C= Zygomatic abscess

Answer

A= Zygomatic abscess, B= Postauricular abscess, C= Bezold's abscess

Answer

A= Citelli's abscess, B= Postauricular abscess, C= Luc's abscess

Answer

A= Luc's abscess, B= Postauricular abscess, C= Citelli's abscess

Question 7

What does the following image show?

Accepted Answer

Politzer test

Answer

Toynbee's test

Answer

Sonotubometry

Answer

Frenzel maneuver

Question 8

What does the following image show?

Accepted Answer

Preauricular sinus

Answer

Preauricular cyst

Answer

Auricular hematoma

Answer

Cryptotia

Question 9

All are true about the lesion marked except:

Accepted Answer

Lined by stratified columnar epithelium

Answer

Faulty union of hillocks of first and second brachial arches

Answer

Repeated infections

Answer

Located anterior to crus of helix

Question 10

A 1-year-old child presents with high grade fever for 2 days with multiple episodes of loose motions. The child is inconsolable. The otoscopic finding is given below. All of the following lead to the development of this condition except:

Accepted Answer

Breastfeeding child in supine position

Answer

Cystic fibrosis

Answer

Ciliary dyskinesia

Answer

Cleft Palate

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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