Diseases of the Ear Practice Questions

Q: 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. What is the diagnosis?

Acute otitis media. ***Acute otitis media*** - The image shows a **red, bulging tympanic membrane** with loss of bony landmarks, which are classic signs of acute otitis media. The child's symptoms of high fever, inconsolability, and loose motions (potentially due to a viral infection predisposing to ear infection) are also consistent with AOM. - The presence of pus or fluid behind the eardrum causes it to bulge, and the inflammation leads to its characteristic red appearance. *Foreign body* - A foreign body in the ear canal would typically be **visible directly** on otoscopy and would not usually cause the drum to bulge in this manner. - While it can cause pain and discomfort, it is less likely to present with systemic symptoms like high fever unless an infection has supervened (which would then manifest as AOM). *Aero otitis media* - **Aero-otitis media**, also known as barotrauma, is caused by rapid changes in air pressure. - While it can cause ear pain, the eardrum typically appears **retracted** or shows **hemorrhage**, not the diffuse bulging seen in the image. *Retraction pockets* - **Retraction pockets** indicate a chronically retracted tympanic membrane, often due to chronic negative middle ear pressure. - The image clearly shows a **bulging, inflamed eardrum**, inconsistent with retraction.

Q: Which of the following is correct about ear speculum insertion?

Pinna : upward, backward and laterally; Tragus: forward. ***Pinna : upward, backward and laterally; Tragus: forward*** - To properly visualize the **tympanic membrane** and ear canal in adults, the **pinna** (auricle) should be gently pulled **upward, backward, and laterally**. This maneuver helps to straighten the **ear canal**. - The **tragus** should be gently pushed **forward** to stabilize the ear and facilitate speculum insertion, minimizing discomfort [1]. *Pinna : downward, backward and laterally; Tragus: forward* - Pulling the **pinna downward** is typically recommended for **children** to straighten their ear canal. - Doing so in adults may not adequately straighten the **ear canal**, hindering visualization. *Pinna : upward, backward and medially; Tragus: forward* - While pulling the pinna **upward and backward** is correct, pulling it **medially** would likely obstruct the view or cause discomfort. - The goal is to open the **ear canal** for better visualization [1]. *Pinna : upward, forward and laterally ; Tragus: forward* - Pulling the pinna **forward** would likely curl the helix and obstruct the **external auditory canal**, making it difficult to insert the speculum. - The correct direction is **backward** to align the cartilaginous and bony parts of the canal [1].

Q: A 2-year-old child presents with profuse odorless ear discharge following a URTI. Otoscopic examination shows:

Tubotympanic chronic suppurative otitis media. ***Tubotympanic chronic suppurative otitis media*** - Presents with **large central perforation** with **profuse, odorless, mucopurulent discharge** - Classic "safe type" CSOM without bone erosion or cholesteatoma - Common in children following **URTI** which causes Eustachian tube dysfunction - Otoscopy shows **central perforation** with granulation tissue and pus - Discharge is odorless (vs foul-smelling in unsafe type) *Atticoantral chronic suppurative otitis media* - The "unsafe type" characterized by **marginal or attic perforation** - Associated with **cholesteatoma** and produces **foul-smelling discharge** - Often involves bone erosion and serious complications - Clinical presentation here lacks foul smell and marginal perforation *Aero otitis media* - Acute **barotrauma** from rapid atmospheric pressure changes (flying, diving) - Presents with acute pain, hearing loss, hemotympanum - Does not cause chronic profuse discharge or perforation - Self-limiting condition, not chronic inflammation *Ear polyp* - **Pedunculated inflammatory mass** arising from middle ear mucosa - Appears as discrete pale/pink growth protruding through perforation - Can occur secondary to chronic otitis media - The description indicates diffuse discharge with granulation tissue, not a discrete polyp

Q: What is the diagnosis shown in the following image?

Perichondritis. ***Perichondritis*** - The image exhibits signs of **inflammation and swelling** of the external ear, consistent with **perichondritis**, an infection of the tissue surrounding the ear cartilage. - This condition can lead to **redness**, **pain**, and fluid collection (abscess formation) that distorts the ear's normal architecture. - Typically spares the **lobule** (which lacks cartilage) and presents as an **acute inflammatory condition**. *Hyperinsulinism* - **Hyperinsulinism** is a metabolic disorder characterized by excessive insulin secretion and has no relationship to external ear pathology. - This is not an appropriate option for an acute inflammatory ear condition shown in clinical images. *Conductive hearing defect* - A **conductive hearing defect** is a functional diagnosis, not a structural/pathological diagnosis visible on examination. - It refers to problems in sound transmission through the **external or middle ear**, but is not itself visible as inflammation or swelling. - The image shows an **acute inflammatory condition**, not a hearing disorder. *Mucopolysaccharidosis* - **Mucopolysaccharidoses** are lysosomal storage disorders that can cause progressive dysmorphic facial features, including ear structure changes. - However, these present with **chronic, diffuse structural changes** rather than acute inflammation and swelling. - The acute inflammatory presentation in the image is inconsistent with this genetic storage disorder.

Q: Which one of the following conditions produces sensorineural deafness ?

Mixed otosclerosis. ***Mixed otosclerosis*** - **Otosclerosis** is a bone remodeling disease primarily affecting the **ossicles** and **otic capsule**. - **Mixed otosclerosis** involves both **stapes fixation (conductive component)** and **cochlear involvement (sensorineural component)**. - Among the given options, this is the **only condition that produces sensorineural hearing loss**, although it presents as a mixed hearing loss with both conductive and sensorineural components. - The **cochlear otosclerosis** component causes the sensorineural deafness through involvement of the **otic capsule** and **cochlear structures**. *Atelectatic middle ear* - This condition involves the collapse of the **tympanic membrane** onto the ossicles due to **negative middle ear pressure**. - It causes **pure conductive hearing loss** by impairing sound transmission through the middle ear, with no sensorineural component. *Eustachian tube blockage* - Blockage of the **Eustachian tube** leads to **negative pressure** in the middle ear space. - This results in **pure conductive hearing loss** due to impaired movement of the tympanic membrane and ossicles, with no sensorineural component. *Tympanic membrane rupture* - A rupture in the **tympanic membrane** creates a direct opening between the external ear canal and the middle ear. - This condition causes **pure conductive hearing loss** by disrupting the normal sound conduction mechanism, with no sensorineural component.

Q: A female patient aged 30 years with bilateral conductive deafness is wearing a hearing aid. What is the probable diagnosis?

Otosclerosis. ***Otosclerosis*** - **Otosclerosis** is a common cause of **conductive hearing loss** in young to middle-aged adults, often presenting bilaterally. - It involves abnormal bone remodeling in the **otic capsule**, primarily affecting the **stapes footplate**, which leads to fixation and impaired sound transmission. *Presbycusis* - **Presbycusis** is an **age-related sensorineural hearing loss** that typically affects older individuals, not a 30-year-old. - It is characterized by difficulty hearing high-frequency sounds, not conductive hearing loss. *Chronic suppurative otitis media* - **Chronic suppurative otitis media (CSOM)** involves a **perforated tympanic membrane** with chronic discharge and hearing loss. - While it causes conductive hearing loss, it is typically associated with a history of recurrent infections and ear discharge, which are not mentioned here. *Meniere's disease* - **Meniere's disease** is characterized by episodic **vertigo**, **tinnitus**, **fluctuating sensorineural hearing loss**, and aural fullness. - It causes sensorineural, not conductive, hearing loss and is associated with additional symptoms absent in this case.

Q: A patient presents with ear discharge. The CT image is shown below. Based on the clinical presentation and imaging, what is the most likely diagnosis?

Temporal lobe abscess. ***Temporal lobe abscess*** - The CT scan shows a **ring-enhancing lesion** in the **temporal lobe**, which is characteristic of a brain abscess. - **Ear discharge** (otorrhea), particularly from otitis media, is a common predisposing factor for temporal lobe abscesses due to the proximity of the middle ear and mastoid to the temporal lobe. - Otogenic brain abscesses account for a significant proportion of intracranial complications from ear infections, with the temporal lobe being the most common location. *Extradural abscess* - An **extradural abscess** would typically be located between the dura mater and the skull, often presenting as a **lenticular or biconvex collection** displacing the dura and brain, not within the brain parenchyma as seen here. - While ear infections can lead to extradural abscesses, the imaging clearly shows an intraparenchymal lesion. *Cerebellar abscess* - A **cerebellar abscess** would be located in the cerebellum (posterior fossa), which is a different anatomical location from the lesion seen in the image (which is in the supratentorial compartment, consistent with the temporal lobe). - Although ear infections can also lead to cerebellar abscesses, the lesion's position on the CT scan does not correspond to the cerebellum. *Meningitis* - **Meningitis** is an inflammation of the meninges and typically manifests on CT as **leptomeningeal enhancement**, particularly in the sulci and basal cisterns, rather than a discrete, encapsulated mass lesion like an abscess. - While ear discharge can be associated with meningitis, the imaging findings strongly point to an abscess, not diffuse meningeal inflammation.

Q: A patient with a history of chronic ear infection now presents with manifestations, including headache and vomiting. A CT brain image is shown. What is the most probable diagnosis?

Temporal lobe Abscess. ***Temporal lobe Abscess*** - The CT scan shows a **ring-enhancing lesion** with significant surrounding edema, which is characteristic of a **brain abscess**. - Given the history of a **chronic ear infection**, the temporal lobe is a common site for bacterial spread from the mastoid air cells or middle ear. *Meningitis* - Meningitis involves inflammation of the **meninges** and typically presents with diffuse changes on imaging, such as sulcal effacement or leptomeningeal enhancement, rather than a focal, encapsulated lesion. - While it can cause headache and vomiting, the CT image does not show findings typical of meningitis. *Extradural Abscess* - An extradural (or epidural) abscess is located **between the dura mater and the skull bone**. - It would typically appear as a collection outside the brain parenchyma, potentially causing mass effect but distinct from an intraparenchymal lesion seen in the image. *Cerebral Abscess* - The image does show a **cerebral abscess**, but this option is less specific than "Temporal lobe abscess." - The question asks for the **most probable diagnosis**, and combining the imaging findings with the patient's history of ear infection points to a specific location within the cerebrum.

Q: A 72-year-old man presents to his primary care physician with progressively worsening hearing loss. He states that his trouble with hearing began approximately 7-8 years ago. He is able to hear when someone is speaking to him; however, he has difficulty with understanding what is being said, especially when there is background noise. In addition to his current symptoms, he reports a steady ringing in both ears, and at times experiences dizziness. Medical history is significant for three prior episodes of acute otitis media. Family history is notable for his father being diagnosed with cholesteatoma. His temperature is 98.6°F (37°C), blood pressure is 138/88 mmHg, pulse is 74/min, and respirations are 13/min. On physical exam, when a tuning fork is placed in the middle of the patient's forehead, sound is appreciated equally on both ears. When a tuning fork is placed by the external auditory canal and subsequently on the mastoid process, air conduction is greater than bone conduction. Which of the following is most likely the cause of this patient's symptoms?

Cochlear hair cell degeneration. ***Cochlear hair cell degeneration*** - The patient's **progressive, bilateral hearing loss** over several years, difficulty understanding speech in noise, and **tinnitus** are classic symptoms of **presbycusis**, which results from age-related **degeneration of cochlear hair cells**. - The **normal Weber test** (no lateralization) and **Rinne test** (air conduction > bone conduction) indicate a **sensorineural hearing loss**, consistent with cochlear pathology rather than conductive issues. *Stapedial abnormal bone growth* - This condition (**otosclerosis**) causes **conductive hearing loss** due to fixation of the stapes, which would present with an **abnormal Rinne test** (bone conduction > air conduction) in the affected ear. - While it can cause progressive hearing loss and tinnitus, the normal Rinne test contradicts this diagnosis. *Endolymphatic hydrops* - This is the underlying pathology of **Ménière's disease**, which typically presents with episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. - The patient's dizziness is non-episodic, and the absence of fluctuating hearing loss and aural fullness makes Ménière's less likely. *Accumulation of desquamated keratin debris* - This describes a **cholesteatoma**, which typically causes **conductive hearing loss** and often presents with otorrhea, earache, and possibly vestibular symptoms. - The normal Rinne test (indicating sensorineural loss) and lack of otorrhea or earache make cholesteatoma unlikely, despite a family history.

Q: Mainstay of treatment of glue ear -

Myringotomy + aeration to middle ear. ***Myringotomy + aeration to middle ear*** - **Myringotomy** involves creating a small incision in the eardrum to drain fluid, and inserting a **grommet (ventilation tube)** to aerate the middle ear, which is the primary treatment for persistent glue ear (otitis media with effusion). - This procedure aims to restore ventilation to the middle ear, allowing trapped fluid to drain and preventing recurrent fluid accumulation, which improves hearing. *Temporal bone resection* - This is a major surgical procedure involving the removal of part of the temporal bone, typically reserved for extensive **malignant tumors** or severe infections, and is not indicated for glue ear. - It carries significant risks and is disproportionate to the treatment of a benign condition like glue ear. *Tonsillectomy & adenoidectomy* - While **adenoidectomy** can sometimes be performed in conjunction with grommet insertion if enlarged adenoids contribute to eustachian tube dysfunction, it is not the **primary treatment** for glue ear itself. - **Tonsillectomy** is generally performed for recurrent tonsillitis and has no direct role in treating glue ear. *Radical Mastoidectomy* - This is a highly invasive surgical procedure involving the removal of the mastoid air cells and part of the external auditory canal, typically performed for severe **cholesteatoma** or chronic mastoiditis. - It is an extensive and risky operation that is not appropriate for the management of glue ear, which is a much milder condition.

Question 1

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. What is the diagnosis?

Accepted Answer

Acute otitis media

Answer

Foreign body

Answer

Aero otitis media

Answer

Retraction pockets

Question 2

Which of the following is correct about ear speculum insertion?

Accepted Answer

Pinna : upward, backward and laterally; Tragus: forward

Answer

Pinna : downward, backward and laterally; Tragus: forward

Answer

Pinna : upward, backward and medially; Tragus: forward

Answer

Pinna : upward, forward and laterally ; Tragus: forward

Question 3

A 2-year-old child presents with profuse odorless ear discharge following a URTI. Otoscopic examination shows:

Accepted Answer

Tubotympanic chronic suppurative otitis media

Answer

Atticoantral chronic suppurative otitis media

Answer

Aero otitis media

Answer

Ear polyp

Question 4

What is the diagnosis shown in the following image?

Accepted Answer

Perichondritis

Answer

Hyperinsulinism

Answer

Conductive hearing defect

Answer

Mucopolysaccharidosis

Question 5

Which one of the following conditions produces sensorineural deafness ?

Accepted Answer

Mixed otosclerosis

Answer

Atelectatic middle ear

Answer

Eustachian tube blockage

Answer

Tympanic membrane rupture

Question 6

A female patient aged 30 years with bilateral conductive deafness is wearing a hearing aid. What is the probable diagnosis?

Accepted Answer

Otosclerosis

Answer

Presbycusis

Answer

Chronic suppurative otitis media

Answer

Meniere’s disease

Question 7

A patient presents with ear discharge. The CT image is shown below. Based on the clinical presentation and imaging, what is the most likely diagnosis?

Accepted Answer

Temporal lobe abscess

Answer

Extradural abscess

Answer

Cerebellar abscess

Answer

Meningitis

Question 8

A patient with a history of chronic ear infection now presents with manifestations, including headache and vomiting. A CT brain image is shown. What is the most probable diagnosis?

Accepted Answer

Temporal lobe Abscess

Answer

Meningitis

Answer

Extradural Abscess

Answer

Cerebral Abscess

Question 9

A 72-year-old man presents to his primary care physician with progressively worsening hearing loss. He states that his trouble with hearing began approximately 7-8 years ago. He is able to hear when someone is speaking to him; however, he has difficulty with understanding what is being said, especially when there is background noise. In addition to his current symptoms, he reports a steady ringing in both ears, and at times experiences dizziness. Medical history is significant for three prior episodes of acute otitis media. Family history is notable for his father being diagnosed with cholesteatoma. His temperature is 98.6°F (37°C), blood pressure is 138/88 mmHg, pulse is 74/min, and respirations are 13/min. On physical exam, when a tuning fork is placed in the middle of the patient's forehead, sound is appreciated equally on both ears. When a tuning fork is placed by the external auditory canal and subsequently on the mastoid process, air conduction is greater than bone conduction. Which of the following is most likely the cause of this patient's symptoms?

Accepted Answer

Cochlear hair cell degeneration

Answer

Stapedial abnormal bone growth

Answer

Endolymphatic hydrops

Answer

Accumulation of desquamated keratin debris

Question 10

Mainstay of treatment of glue ear -

Accepted Answer

Myringotomy + aeration to middle ear

Answer

Temporal bone resection

Answer

Tonsillectomy & adenoidectomy

Answer

Radical Mastoidectomy

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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