Diseases of the Ear Practice Questions

Q: Most common cause of sensorineural hearing loss (SNHL)

Presbycusis. ***Presbycusis*** - **Presbycusis**, or age-related hearing loss, is the most common cause of **sensorineural hearing loss (SNHL)**, affecting a significant portion of the elderly population. - It typically results from **degenerative changes** in the inner ear, specifically the hair cells and nerve fibers, leading to a gradual, symmetrical, high-frequency SNHL. *Labyrinthitis* - **Labyrinthitis** is an inflammation of the inner ear that can cause sudden SNHL, often accompanied by **vertigo** and **tinnitus**. - While it causes SNHL, it is an acute condition and not the most common overall cause, especially when considering the prevalence of age-related hearing loss. *Meniere's disease* - **Meniere's disease** is characterized by recurrent episodes of **vertigo, fluctuating low-frequency SNHL, tinnitus**, and aural fullness. - It is a specific condition causing SNHL, but its prevalence is much lower than presbycusis, making it a less common overall cause. *Vestibular Schwannoma* - A **vestibular schwannoma** (acoustic neuroma) is a benign tumor that arises from the Schwann cells of the **vestibulocochlear nerve**. - It can cause **progressive unilateral SNHL**, tinnitus, and balance issues, but it is a relatively rare condition compared to presbycusis.

Q: Cold water is not used for ear cleaning because

Caloric stimulation caused by cold water. ***Caloric stimulation caused by cold water*** - Irrigating the ear canal with **cold water** causes significant **caloric stimulation** of the vestibular system. - This can induce **vertigo**, **nausea**, and **vomiting** due to the temperature difference stimulating the semicircular canals. *Damage to tympanic membrane* - While excessive pressure from irrigation can potentially damage the **tympanic membrane**, the temperature of the water itself is not the primary factor for this risk. - Damage is more related to the **force of irrigation** and pre-existing membrane integrity, not cold temperature. *It will cause infection* - The temperature of the water used for irrigation does not directly determine the risk of infection. - **Infection risk** is primarily associated with using unsterile water or introducing bacteria into a compromised ear canal, regardless of water temperature. *It will make the wax hard* - Earwax, or **cerumen**, is softened by water irrigation, not hardened. - **Warm water** is typically preferred because it aids in softening the wax more effectively and comfortably than cold water.

Q: Tobey-Ayer test is done for:

Lateral sinus thrombosis. ***Lateral sinus thrombosis*** - The **Tobey-Ayer test** is used to detect **lateral (transverse) sinus thrombosis**, a serious complication of otogenic infections. - The test involves **lumbar puncture with CSF manometry** while sequentially compressing each **internal jugular vein**. - In a normal response, compression of either jugular vein causes a **rapid rise in CSF pressure** (within 10 seconds) due to venous obstruction, followed by rapid fall on release. - In **lateral sinus thrombosis**, compression of the jugular vein on the **affected side** produces **no rise or delayed/sluggish rise** in CSF pressure, indicating obstruction of venous drainage. - This is distinct from the Queckenstedt-Stookey test, which tests for spinal subarachnoid block. *Ketosis* - **Ketosis** is a metabolic state with elevated **ketone bodies** in blood, detected by urine dipsticks or blood ketone meters. - It has no relation to the Tobey-Ayer test or ENT pathology. *Acantholysis* - **Acantholysis** is loss of intercellular connections between **keratinocytes**, seen in blistering skin diseases like Pemphigus. - It is a histological dermatological finding, completely unrelated to neurological or ENT examination. *Hemoglobinuria* - **Hemoglobinuria** is the presence of free **hemoglobin** in urine due to intravascular hemolysis. - It is detected by urinalysis and has no connection to CSF manometry or lateral sinus assessment.

Q: Most common cause of facial nerve palsy:

Idiopathic Bell's palsy. ***Idiopathic Bell's palsy*** - **Bell's palsy** is the most common cause of **facial nerve palsy**, accounting for approximately 60-75% of cases. - It is an **idiopathic** condition, meaning its exact cause is unknown, although it is often linked to viral infections (e.g., herpes simplex virus). [1] *Mastoid surgery* - **Iatrogenic facial nerve injury** during mastoidectomy is a known complication, but it is a relatively rare cause of facial nerve palsy. - While it can cause significant palsy, the incidence is low compared to Bell's palsy. *Herpes zoster oticus* - This condition, also known as **Ramsay Hunt syndrome**, is a cause of facial nerve palsy associated with a **vesicular rash** (zoster) in the ear canal or on the face. - While it is a significant cause of viral-induced facial palsy, it is less common than idiopathic Bell's palsy. *Chronic suppurative Otitis media* - **Chronic otitis media** can, in rare cases, lead to facial nerve palsy due to persistent inflammation spreading to the facial nerve. [2] - This is a less common etiology than Bell's palsy and would typically present with a history of recurrent ear discharge and hearing loss.

Q: Most common cause of syndromic deafness is:

Waardenburg syndrome. **Waardenburg syndrome** - This is the **most common cause of syndromic deafness**, characterized by hearing loss combined with pigmentary anomalies. - Key features include congenital sensorineural hearing loss, heterochromia iridum (different colored eyes), a white forelock, and premature graying of hair. *Pendred syndrome* - This syndrome is the **second most common cause of syndromic deafness** and is associated with goiter (enlarged thyroid gland). - It results from mutations in the **SLC26A4 gene** and is characterized by sensorineural hearing loss and inner ear malformations (Mondini dysplasia). *Usher syndrome* - This is the **most common cause of combined deafness and blindness**, affecting both hearing and vision. - It involves sensorineural hearing loss and progressive **retinitis pigmentosa**, leading to night blindness and eventual vision loss. *All of the options* - While all listed syndromes cause syndromic deafness, Waardenburg syndrome is specifically identified as the **most common single cause**. - Therefore, choosing "all of the options" would be incorrect as it doesn't pinpoint the *most common* cause.

Q: Gelle's test is for:

Otosclerosis. ***Otosclerosis*** - **Gelle's test** is specifically designed to detect **otosclerosis**, a condition characterized by abnormal bone growth in the middle ear. - In otosclerosis, the **stapes footplate** becomes fixed, leading to a negative Gelle's test where sound perception does not change with pressure alterations in the external auditory canal. *NIHL* - **Noise-induced hearing loss (NIHL)** is a type of **sensorineural hearing loss** caused by prolonged exposure to loud noise. - Diagnostic relies on **audiometry** showing a characteristic notch at 4 kHz, and not Gelle's test. *Sensorineural deafness* - **Sensorineural deafness** affects the **cochlea or auditory nerve**, and is not specifically identified by Gelle's test. - While otosclerosis can lead to a mixed or sensorineural component over time, Gelle's test primarily assesses the **mobility of the ossicular chain**. *None of the options* - This option is incorrect because Gelle's test is a recognized diagnostic tool, particularly for **otosclerosis**. - Its utility is in determining changes in **bone conduction** with altered middle ear pressure.

Q: Bezold's abscess is located in -

Sternocleidomastoid. ***Sternocleidomastoid*** - A **Bezold's abscess** is a deep neck abscess that originates from an acute mastoiditis and breaks through the medial aspect of the mastoid tip. - This condition then tracks along the **sternocleidomastoid muscle**, causing a painful swelling in the neck. *Infratemporal region* - Abscesses in the infratemporal region typically result from infections of the **molars** or local trauma and would not involve the mastoid. - The **anatomy of the infratemporal fossa** makes it a distinct site for abscess formation, separate from the mastoid tip. *Digastric triangle* - The **digastric triangle** is a subregion of the anterior triangle of the neck, and while it can house abscesses, Bezold's abscesses specifically track along the sternocleidomastoid. - This region is more commonly associated with infections spreading from the **submandibular gland** or lymph nodes within its borders. *Submandibular region* - The submandibular region is located below the jaw and is a common site for abscesses due to infections of the **submandibular gland** or **dental origin**. - A Bezold's abscess, originating from mastoiditis, would track inferiorly from the mastoid tip, not typically into the submandibular space.

Q: Which of the following tests is positive in lateral sinus thrombophlebitis:

Griesinger sign. ***Griesinger sign*** - This sign is characterized by **edema** and **tenderness** over the **mastoid process** due to thrombophlebitis of the **mastoid emissary vein**, which drains into the lateral sinus. - Its presence indicates an obstruction of venous outflow, strongly suggesting **lateral sinus thrombophlebitis**. *Tobey Ayer test* - The Tobey Ayer test involves **compression of the jugular veins** and observing for changes in CSF pressure. - While it can be indicative of **intracranial pathology** or spinal block, it is not specific to lateral sinus thrombophlebitis. *Queckenstedt test* - The Queckenstedt test is similar to the Tobey Ayer test, assessing the rise and fall of **CSF pressure** in response to **jugular vein compression**. - It is primarily used to detect a **spinal subarachnoid block** and is not a direct or specific indicator of lateral sinus thrombophlebitis. *All of the options* - While other tests might be used in the general evaluation of a patient with suspected intracranial pathology, only the **Griesinger sign** is directly and specifically associated with **lateral sinus thrombophlebitis** due to its anatomical relationship with the mastoid emissary vein.

Q: True about Pendred syndrome:

Bilateral sensorineural deafness. ***Bilateral sensorineural deafness*** - Pendred syndrome is characterized by **bilateral sensorineural hearing loss**, often congenital or early-onset, and can range from moderate to profound. - This deafness results from a defect in the **pendrin protein** (encoded by the *SLC26A4* gene), which is crucial for iodine transport and inner ear function. - Associated inner ear abnormalities include **Mondini dysplasia** and **enlarged vestibular aqueduct**. *Generalized edema* - **Generalized edema** is not a characteristic feature of Pendred syndrome. - Edema is typically associated with conditions like **congestive heart failure**, **kidney disease**, or **liver failure**, which are distinct from Pendred syndrome. *Intellectual disability* - **Intellectual disability** is not a direct or characteristic manifestation of Pendred syndrome. - While other genetic conditions can lead to developmental delays, Pendred syndrome primarily affects **hearing** and **thyroid function**. *No goiter* - Pendred syndrome is associated with a **goiter** in about 60-75% of cases due to impaired thyroid hormone synthesis. - The goiter often appears in late childhood or adolescence and may be accompanied by **hypothyroidism**.

Q: All of the following are true regarding Bell's palsy except:

Immediate nerve decompression is required. ***Immediate nerve decompression is required*** - **Bell's palsy** is typically managed with medical therapy, primarily **steroids**, to reduce inflammation and promote recovery. - **Surgical decompression** of the facial nerve is rarely indicated and is not a standard or immediate treatment. *Unilateral facial weakness* - This is the **hallmark symptom** of Bell's palsy, affecting one side of the face. - Patients experience difficulty with facial expressions, eye closure, and oral competence [1]. *Steroids are the treatment of choice* - **Corticosteroids**, such as prednisone, are the primary treatment to reduce inflammation of the **facial nerve (cranial nerve VII)** [1]. - Early initiation of steroids significantly improves the chances of full recovery [1]. *Herpes simplex virus is commonly implicated* - **Reactivation of HSV-1** is thought to be a major underlying cause, leading to inflammation and swelling of the facial nerve. - Other viruses, such as **varicella-zoster virus (VZV)**, can also cause facial paralysis (Ramsay Hunt syndrome), which is clinically distinct.

Question 1

Most common cause of sensorineural hearing loss (SNHL)

Accepted Answer

Presbycusis

Answer

Labyrinthitis

Answer

Meniere's disease

Answer

Vestibular Schwannoma

Question 2

Cold water is not used for ear cleaning because

Accepted Answer

Caloric stimulation caused by cold water

Answer

Damage to tympanic membrane

Answer

It will cause infection

Answer

It will make the wax hard

Question 3

Tobey-Ayer test is done for:

Accepted Answer

Lateral sinus thrombosis

Answer

Ketosis

Answer

Acantholysis

Answer

Hemoglobinuria

Question 4

Most common cause of facial nerve palsy:

Accepted Answer

Idiopathic Bell's palsy

Answer

Mastoid surgery

Answer

Herpes zoster oticus

Answer

Chronic suppurative Otitis media

Question 5

Most common cause of syndromic deafness is:

Accepted Answer

Waardenburg syndrome

Answer

Pendred syndrome

Answer

Usher syndrome

Answer

All of the options

Question 6

Gelle's test is for:

Accepted Answer

Otosclerosis

Answer

NIHL

Answer

Sensorineural deafness

Answer

None of the options

Question 7

Bezold's abscess is located in -

Accepted Answer

Sternocleidomastoid

Answer

Infratemporal region

Answer

Digastric triangle

Answer

Submandibular region

Question 8

Which of the following tests is positive in lateral sinus thrombophlebitis:

Accepted Answer

Griesinger sign

Answer

Tobey Ayer test

Answer

Queckenstedt test

Answer

All of the options

Question 9

True about Pendred syndrome:

Accepted Answer

Bilateral sensorineural deafness

Answer

Generalized edema

Answer

Intellectual disability

Answer

No goiter

Question 10

All of the following are true regarding Bell's palsy except:

Accepted Answer

Immediate nerve decompression is required

Answer

Unilateral facial weakness

Answer

Steroids are the treatment of choice

Answer

Herpes simplex virus is commonly implicated

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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