Diseases of the Ear Practice Questions

Q: All the following are TRUE of Ramsay-Hunt syndrome EXCEPT

Results of spontaneous recovery of facial nerve are 85%. ***Results of spontaneous recovery of facial nerve are 85%*** - The **prognosis** for **facial nerve recovery** in Ramsay Hunt syndrome is significantly poorer than in Bell's palsy, with complete recovery rates often cited between 21% and 75%, and sometimes as low as 30-50%. [1] - The 85% recovery rate refers more commonly to **Bell's palsy**, not Ramsay Hunt syndrome, which typically involves more severe nerve damage due to direct viral neuritis. [1] *Ear ache is a symptom* - **Severe pain** in the ear, often preceding the rash, is a characteristic and prominent symptom of Ramsay Hunt syndrome, which is caused by the **reactivation of varicella-zoster virus** in the geniculate ganglion. - This pain is typically more intense and debilitating than in Bell's palsy, reflecting the inflammatory involvement of sensory nerves. *VII nerve involved* - Ramsay Hunt syndrome is specifically defined by **facial paralysis**, which results from the involvement and **inflammation of the facial nerve (cranial nerve VII)**. [1] - The virus reactivates in the **geniculate ganglion**, affecting the facial nerve, leading to paralysis on one side of the face. *Viral aetiology* - The syndrome is caused by the **reactivation of the varicella-zoster virus (VZV)**, the same virus that causes chickenpox and shingles. - VZV reactivation leads to **inflammation of the geniculate ganglion** and surrounding structures, resulting in characteristic symptoms like facial paralysis and vesicular rash.

Q: A patient with Bell's palsy comes on day 3. Treatment given to him would be:

Oral steroids + vitamin B. ***Oral steroids + vitamin B*** - **Oral steroids** are the cornerstone of Bell's palsy treatment, especially when initiated within **72 hours** of symptom onset, to reduce inflammation and swelling of the facial nerve [1]. - While **vitamin B** (particularly B12) is often co-administered for its neurotrophic properties, its specific benefit in Bell's palsy is not as strongly evidence-based as steroids, but it may aid in nerve regeneration and recovery. *Oral steroids + Acyclovir* - **Acyclovir** (or other antiviral agents) is sometimes used in Bell's palsy, but primarily when there's suspicion of a **viral etiology** like herpes simplex virus (e.g., in Ramsay Hunt syndrome), which is not explicitly stated here. Antiviral drugs are generally not considered effective for standard idiopathic Bell's palsy [1]. - Antivirals provide minimal additional benefit when given alongside steroids for idiopathic Bell's palsy unless there are specific indications. *Intratympanic steroids* - **Intratympanic steroids** are typically reserved for conditions like **sudden sensorineural hearing loss** or Meniere's disease, where local anti-inflammatory effects in the inner ear are desired. - This route of administration is not the standard treatment for systemic impact on the facial nerve in Bell's palsy. *Vitamin B + vasodilators* - While **vitamin B** may support nerve health, there is no strong evidence to support the use of **vasodilators** in the treatment of Bell's palsy. - The pathophysiology of Bell's palsy is primarily inflammatory, not related to vascular insufficiency that would be amenable to vasodilators.

Q: A case of CSOM presenting with vertigo can have any of the following except -

Dural sinus thrombosis. ***Dural sinus thrombosis (Correct - Does NOT typically cause vertigo)*** - Dural sinus thrombosis is an intracranial complication of CSOM that presents with **headache**, **papilledema**, **seizures**, and **focal neurological deficits** - **Vertigo is NOT a characteristic feature** of dural sinus thrombosis - While it's a serious complication of CSOM, it does not directly affect the vestibular system, making it the exception in this list *Cerebellar abscess (Incorrect - DOES cause vertigo)* - Cerebellar abscess is a serious intracranial complication of CSOM that **commonly causes vertigo** - Due to proximity to the **vestibular nuclei** and brainstem pathways, cerebellar pathology disrupts balance and coordination - Presents with prominent **vertigo**, **ataxia**, **nystagmus**, and other cerebellar signs *Fistula with semicircular canal (Incorrect - DOES cause vertigo)* - **Labyrinthine fistula** is a direct cause of vertigo in CSOM - Erosion from chronic infection creates an abnormal communication between the middle ear and inner ear (commonly affects the **lateral semicircular canal**) - Produces **pressure-induced vertigo** (positive fistula test) as pressure changes directly stimulate the vestibular system - Classic presentation: vertigo triggered by loud sounds (Tullio phenomenon) or pressure changes *Any of the above (Incorrect)* - This option is incorrect because NOT all listed complications cause vertigo - While cerebellar abscess and labyrinthine fistula are well-established causes of vertigo in CSOM, dural sinus thrombosis does not typically present with vertigo - Therefore, "any of the above" is not accurate

Q: True about Ramsay-hunt syndrome except -

Surgical removal gives excellent prognosis. ***Surgical removal gives excellent prognosis*** - Ramsay Hunt Syndrome (RHS) is caused by **reactivation of varicella-zoster virus (VZV)** [2], not a condition treated by surgical removal. [3] - Prognosis depends on the **degree of nerve damage** and **timely antiviral treatment** [1], not surgery. [3] *May involves VIII nerve* - Reactivation of VZV in RHS can affect the **vestibulocochlear nerve (VIII)**, leading to symptoms like **vertigo, hearing loss, and tinnitus**. [4] - This involvement is due to the close proximity of the geniculate ganglion to the VIII nerve, allowing for viral spread. *Causative agent is virus* - The causative agent of Ramsay Hunt Syndrome is the **varicella-zoster virus (VZV)** [4], which is the same virus that causes chickenpox and shingles. [2] - VZV reactivation in the geniculate ganglion of the facial nerve leads to the characteristic symptoms. *Involves VII nerve* - Ramsay Hunt Syndrome primarily involves the **facial nerve (VII)**, leading to symptoms such as **facial muscle paralysis (Bell's palsy)**, taste disturbances, and dry eye/mouth on the affected side. [3] - The classic presentation includes **vesicular rash in the external auditory canal** or on the auricle in the distribution of the VII nerve. [2]

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

Lateral sinus thrombosis. ***Lateral sinus thrombosis*** - The **Tobey-Ayer test** (or Queckenstedt's maneuver) assesses the patency of the **internal jugular vein** by observing changes in CSF pressure during compression. - In **lateral sinus thrombosis**, compression of the unaffected internal jugular vein leads to a rise in CSF pressure, but compression of the affected side yields **no or a blunted rise**, indicating obstruction. *Subarachnoid haemorrhage* - This condition involves bleeding into the subarachnoid space, which can elevate **intracranial pressure (ICP)**, but it isn't directly diagnosed by a differential CSF pressure response to jugular compression. - The primary diagnostic methods are **CT scans** and **lumbar puncture** showing xanthochromia. *Petrositis* - Also known as Gradenigo's syndrome, petrositis is an infection of the **petrous apex** of the temporal bone, often presenting with ear discharge, facial pain, and abducens nerve palsy. - While it's a complication of otitis media, it does not typically involve obstruction of the internal jugular vein or present with a positive Tobey-Ayer test. *Cerebral abscess* - A cerebral abscess is a localized collection of pus within the brain parenchyma, which can cause **localized neurological deficits** and increased ICP. - The Tobey-Ayer test would not specifically diagnose a cerebral abscess, as it assesses venous outflow from the brain rather than focal brain lesions.

Q: Pendred's syndrome is:

Deaf and goitrous patient since infancy.. ***Deaf and goitrous patient since infancy*** - **Pendred's syndrome** is an autosomal recessive disorder characterized by **sensorineural hearing loss** and a **goiter** due to a defect in iodine organification [1]. - The symptoms typically manifest from **infancy** or early childhood, with profound deafness being one of the earliest signs [1]. *Thyroiditis extending into adjacent structures* - This describes an inflammatory process of the thyroid gland that has spread, which is not characteristic of **Pendred's syndrome**. - **Pendred's syndrome** is a genetic developmental disorder, not primarily an inflammatory condition causing direct tissue invasion. *None* - This option is incorrect because there is a correct description of Pendred's syndrome provided. - **Pendred's syndrome** is a well-defined genetic condition with specific clinical manifestations. *Autoimmune thyroiditis* - **Autoimmune thyroiditis** (e.g., Hashimoto's thyroiditis) involves the immune system attacking the thyroid gland, leading to hypothyroidism and goiter. - While it can cause a goiter, it does not typically present with congenital **sensorineural deafness** as a primary feature.

Q: A 35-year-old patient presents with hearing loss and discomfort in the right ear. Examination reveals keratin accumulation in the ear canal. What is the most likely diagnosis?

Keratosis obturans. ***Keratosis obturans*** - This condition is characterized by an **accumulation of desquamated keratin** and epithelial debris in the bony external auditory canal, leading to earache, conductive hearing loss, and sometimes widening of the ear canal. - The patient's presentation of **hearing loss**, **discomfort in the right ear**, and **keratin accumulation** aligns directly with the description of keratosis obturans. *Exostosis* - Exostoses are **bony growths** in the ear canal, often associated with cold water exposure. - While they can cause hearing loss and earwax impaction, they do not involve primary **keratin accumulation** as described. *Cerumen* - **Cerumen** is normal earwax, which is a mix of secretions and desquamated cells. - While excessive cerumen can cause hearing loss, the description of **keratin accumulation** suggests a more organized, dense plug than typical cerumen impaction. *Otitis externa* - **Otitis externa** is an inflammation or infection of the ear canal, presenting with pain, redness, swelling, and discharge. - While it can cause discomfort and sometimes lead to debris, the primary finding is **inflammation**, not specifically a large accumulation of keratin.

Q: Tobey-Ayer test and Crowe-Beck test are used for?

Lateral sinus thrombosis. ***Lateral sinus thrombosis*** - The **Tobey-Ayer test** and **Crowe-Beck test** are classical methods used to diagnose **lateral sinus thrombosis**. - These tests rely on observing changes in **cerebrospinal fluid (CSF) pressure** upon compression of the jugular veins, which will be altered in the presence of a thrombus. *Subarachnoid hemorrhage* - Diagnosed primarily by **CT scan of the head** and analysis of **CSF for xanthochromia**. - While CSF is involved, these specific tests are not used for its diagnosis. *Petrositis* - This is an inflammation of the **petrous apex** of the temporal bone, often diagnosed with **CT or MRI** imaging. - The Tobey-Ayer and Crowe-Beck tests are not relevant to its diagnosis. *Cerebral abscess* - A localized collection of pus within the brain, diagnosed with **contrast-enhanced CT or MRI** of the brain. - These specific tests are irrelevant for the diagnostic workup of a cerebral abscess.

Q: Which cancers can cause referred otalgia (referred pain in the ear)? Select the most comprehensive answer.

Cancer of the pharynx, oral cavity, and larynx. ***Cancer of the pharynx, oral cavity, and larynx*** - Cancers in these locations can cause **referred otalgia** due to shared innervation of the ear by cranial nerves that also supply these areas. - Specifically, the **glossopharyngeal nerve (IX)**, **vagus nerve (X)**, and **trigeminal nerve (V3)** are involved in both sensation from these head and neck regions and the ear. *Cancer of the pharynx* - While pharyngeal cancer can cause **referred otalgia** through cranial nerves IX and X, it is not the most comprehensive answer as other sites are also involved. - This option exclusively mentions the pharynx, missing other important anatomical locations that can also refer pain to the ear. *Cancer of the oral cavity* - Cancer here can cause **referred otalgia**, primarily through the **trigeminal nerve (V3)**, which innervates parts of the oral cavity and the ear. - However, similar to pharyngeal cancer, this option is not comprehensive as it omits other regions related to referred ear pain. *Cancer of the larynx* - Laryngeal cancer can cause **referred otalgia** via the **vagus nerve (X)**, specifically its superior laryngeal branch. - This option is also incomplete as it does not include cancers of the pharynx or oral cavity, which are equally important causes of referred ear pain.

Q: Tuberculous otitis media of the middle ear has all of the following except:-

Painful otorrhea is seen. ***Painful otorrhea is seen*** - **Tuberculous otitis media** is often characterized by **painless otorrhea**, making painful otorrhea an unlikely finding. - The absence of pain is attributed to the **insidious** and slow-growing nature of the infection, which often delays diagnosis. *Multiple perforations are seen* - **Multiple tympanic membrane perforations** are a classic sign of tuberculous otitis media, differentiating it from other chronic otitis media forms. - These perforations are often **small and non-healing**, contributing to persistent discharge. *Pale granulomas are seen* - The presence of **pale granulomas** in the middle ear is a histological hallmark of tuberculosis, reflecting the characteristic **caseating granulomatous inflammation**. - These granulomas can lead to **ossicular erosion** and subsequent conductive hearing loss. *ATT should be started* - **Anti-tubercular treatment (ATT)** is the definitive therapy for tuberculous otitis media, targeting the underlying Mycobacterium tuberculosis infection. - Early initiation of ATT is crucial to prevent further **destruction** of middle ear structures and hearing loss.

Question 1

All the following are TRUE of Ramsay-Hunt syndrome EXCEPT

Accepted Answer

Results of spontaneous recovery of facial nerve are 85%

Answer

Ear ache is a symptom

Answer

VII nerve involved

Answer

Viral aetiology

Question 2

A patient with Bell's palsy comes on day 3. Treatment given to him would be:

Accepted Answer

Oral steroids + vitamin B

Answer

Oral steroids + Acyclovir

Answer

Intratympanic steroids

Answer

Vitamin B + vasodilators

Question 3

A case of CSOM presenting with vertigo can have any of the following except -

Accepted Answer

Dural sinus thrombosis

Answer

Cerebellar abscess

Answer

Fistula with semicircular canal

Answer

Any of the above

Question 4

True about Ramsay-hunt syndrome except -

Accepted Answer

Surgical removal gives excellent prognosis

Answer

May involves VIII nerve

Answer

Causative agent is virus

Answer

Involves VII nerve

Question 5

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

Accepted Answer

Lateral sinus thrombosis

Answer

Subarachnoid haemorrhage

Answer

Petrositis

Answer

Cerebral abscess

Question 6

Pendred's syndrome is:

Accepted Answer

Deaf and goitrous patient since infancy.

Answer

Thyroiditis extending into adjacent structures.

Answer

None.

Answer

Autoimmune thyroiditis.

Question 7

A 35-year-old patient presents with hearing loss and discomfort in the right ear. Examination reveals keratin accumulation in the ear canal. What is the most likely diagnosis?

Accepted Answer

Keratosis obturans

Answer

Exostosis

Answer

Cerumen

Answer

Otitis externa

Question 8

Tobey-Ayer test and Crowe-Beck test are used for?

Accepted Answer

Lateral sinus thrombosis

Answer

Subarachnoid hemorrhage

Answer

Petrositis

Answer

Cerebral abscess

Question 9

Which cancers can cause referred otalgia (referred pain in the ear)? Select the most comprehensive answer.

Accepted Answer

Cancer of the pharynx, oral cavity, and larynx

Answer

Cancer of the pharynx

Answer

Cancer of the oral cavity

Answer

Cancer of the larynx

Question 10

Tuberculous otitis media of the middle ear has all of the following except:-

Accepted Answer

Painful otorrhea is seen

Answer

Multiple perforations are seen

Answer

Pale granulomas are seen

Answer

ATT should be started

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

On this page

Practice by Chapter

Want unlimited practice?