Diseases of the Ear Practice Questions

Q: Identify the condition of the given image:

Keratosis obturans. ***Keratosis obturans*** - The image shows a **plug of desquamated keratin** filling the external auditory canal. This is the characteristic appearance of keratosis obturans. - This condition is often associated with severe pain, conductive hearing loss, and sometimes **bone erosion** of the external auditory canal. *Acquired cholesteatoma* - This condition involves a **retraction pocket** or **perforation** of the tympanic membrane with ingrowth of keratinizing squamous epithelium into the middle ear, forming a sac. - The image does not show a retraction pocket or a middle ear mass, which are typical features of acquired cholesteatoma. *Congenital cholesteatoma* - This is a **pearly white mass** located behind an intact tympanic membrane, without any history of ear infections or perforations. - The image shows an external auditory canal filled with a plug, not a middle ear mass behind an intact tympanic membrane. *Rupture of tympanic membrane* - A rupture of the tympanic membrane would present as a **visible defect or perforation** in the eardrum. - The image shows an accumulation of material within the ear canal, and the tympanic membrane itself is not clearly visible or perforated in a manner indicative of rupture.

Q: A 5-year-old child presents with reduced hearing for the past 2-3 months. Based on the otoscopy findings shown, what is the most likely diagnosis?

Otitis media with effusion. ***Otitis media with effusion*** - The image clearly shows the presence of **bubbles behind the tympanic membrane**, indicating fluid accumulation in the middle ear. - This fluid leads to **reduced hearing**, as reported in the 5-year-old child, consistent with otitis media with effusion (OME), also known as "glue ear." *Myringitis* - Myringitis typically presents with **inflammation of the tympanic membrane**, often with vesicles or bullae on the drum, which are not visible here. - While it can cause pain, it does not typically show the characteristic bubbles signifying middle ear effusion. *Acute ear infection* - An **acute otitis media** would show a **bulging, erythematous (red), and opaque tympanic membrane** due to inflammation and pus, which is not consistent with the image. - Systemic symptoms like fever and severe ear pain would also be expected with an acute infection. *Air in the middle ear* - The presence of **air in the middle ear is normal** and indicates a healthy, functioning Eustachian tube. - The visible bubbles in the image are consistent with **fluid and air-fluid levels**, not just air, and indicate a pathological condition affecting hearing.

Q: Most common cause of otitis externa is

Bacterial infection. ***Bacterial infection*** - The most common pathogens causing **otitis externa** are bacteria, primarily **Pseudomonas aeruginosa** and **Staphylococcus aureus**. - This condition, often called "swimmer's ear," is favored by moisture in the ear canal, which creates a conducive environment for bacterial growth. *Fungal infection* - While fungal infections (otomycosis) can cause otitis externa, they are **less common** than bacterial causes. - Fungi like *Aspergillus* and *Candida* are typically involved, often in immunocompromised individuals or after prolonged antibiotic use. *Seborrheic disease* - **Seborrheic dermatitis** can affect the ear canal and surrounding skin, leading to flaking, itching, and inflammation. - However, it is a primary skin condition and does not directly cause infectious otitis externa, although it can predispose to secondary infections. *Herpes Zoster* - **Herpes zoster oticus** (Ramsay Hunt syndrome) is a viral infection affecting the facial nerve, causing a painful rash, facial paralysis, and hearing loss. - It is a specific viral etiology with distinct neurological symptoms and is not a common cause of general otitis externa.

Q: Which of the following is a cause of objective tinnitus?

Carotid artery aneurysm. ***Carotid artery aneurysm*** - An **aneurysm** of the **carotid artery** can cause pulsatile tinnitus that is audible to others (objective) due to turbulent blood flow. - The sounds originate from vascular structures within or near the ear, making them detectable by a clinician. *Impacted Wax* - **Impacted cerumen** is a common cause of **subjective tinnitus**, where the sound is heard only by the patient. - It can muffle external sounds and alter the perception of internal body sounds, but it does not produce a sound audible to others. *Meniere's disease* - **Meniere's disease** is characterized by **subjective tinnitus**, along with vertigo, hearing loss, and aural fullness. - The tinnitus in Meniere's is typically a low-pitched roaring or buzzing sound, audible only to the affected individual. *Ototoxic drugs* - **Ototoxic drugs** (e.g., aspirin, aminoglycosides) commonly induce **subjective tinnitus** as a side effect. - These medications primarily damage inner ear structures, leading to perceived sounds that are not externally measurable.

Q: Which perforation of the tympanic membrane is most commonly seen with tubotympanic CSOM?

Central. ***Central*** - A **central perforation** of the tympanic membrane is the most common type seen in **tubotympanic chronic suppurative otitis media (CSOM)**. - This type of perforation involves the **pars tensa** of the tympanic membrane, leaving an intact annulus. *Anterosuperior* - While perforations can occur anywhere, an **anterosuperior perforation** is not the hallmark of tubotympanic CSOM. - This location does not specifically correlate with the characteristic inflammatory patterns seen in tubotympanic disease. *Posterosuperior* - A **posterosuperior perforation** is more often associated with **atticoantral CSOM** due to **cholesteatoma formation**. - **Cholesteatoma** typically begins in the pars flaccida or posterosuperior pars tensa, which is different from tubotympanic CSOM. *Posteroinferior* - A **posteroinferior perforation** is not the most typical presentation for tubotympanic CSOM. - This location does not specifically differentiate it from other forms of otitis media or reflect the primary pathology of tubotympanic disease.

Q: Otosclerosis affects which bone?

Stapes. ***Stapes*** - **Otosclerosis** is a condition characterized by abnormal bone growth in the middle ear, specifically around the **stapes footplate**. - This abnormal growth fixates the stapes, preventing it from vibrating properly and leading to **conductive hearing loss**. - **Fenestral otosclerosis** (most common type) directly affects the oval window and stapes footplate. *Incus* - The **incus** is the middle ossicle in the chain, between the malleus and the stapes. - While it can be affected by other middle ear pathologies, otosclerosis primarily targets the **stapes**. *Malleus* - The **malleus** is the outermost ossicle, attached to the eardrum. - Its involvement in otosclerosis is rare and indirect, as the primary site of disease is the **stapes**. *Cochlea* - **Cochlear (retrofenestral) otosclerosis** can occur but is less common and typically causes **sensorineural hearing loss**. - The classic presentation of otosclerosis involves **stapedial fixation** causing conductive hearing loss, not primary cochlear involvement.

Q: All of the following are features of Tubotympanic CSOM except which of the following?

Extreme pain. ***Extreme pain*** - **Extreme pain** is NOT a characteristic feature of **tubotympanic CSOM**. This type is typically associated with a history of **painless otorrhea**. - Tubotympanic CSOM is considered the "safe" type with inflammation limited to the mucosa without bone erosion. - The presence of severe pain should raise suspicion for complications or the **atticoantral (unsafe) type** of CSOM. *Profuse discharge* - **Profuse, mucoid** or **mucopurulent discharge** is a hallmark feature of tubotympanic CSOM. - This discharge results from chronic inflammation of the **middle ear mucoperiosteum** through a central perforation in the **pars tensa**. - The discharge is typically non-foul smelling (unlike atticoantral CSOM). *Hearing loss* - **Conductive hearing loss** is a universal feature of tubotympanic CSOM. - Results from **tympanic membrane perforation**, middle ear effusion, and potential ossicular discontinuity. - The degree of hearing loss correlates with the size and location of the perforation. *Facial nerve paralysis* - Facial nerve paralysis is **NOT a typical feature** of tubotympanic (safe) CSOM. - This complication is characteristically associated with **atticoantral (unsafe) CSOM** with cholesteatoma causing bone erosion. - While theoretically possible in very advanced neglected tubotympanic disease, it would indicate transformation to unsafe disease or secondary complications. - **Note:** Some sources may list this as a rare complication, but it is not a characteristic feature distinguishing tubotympanic CSOM, making this option potentially ambiguous in an "EXCEPT" question format.

Q: What are the X-ray findings associated with chronic otitis media?

Sclerosis with cavity in mastoid. ***Sclerosis with cavity in mastoid*** - Chronic otitis media leads to **long-standing inflammation** and **destruction** of the mastoid air cells, resulting in dense, **sclerotic bone** with cavity formation due to bone erosion. - This is the **characteristic X-ray finding** in chronic otitis media, indicating osseous remodeling and bone destruction from persistent infection. - The sclerosis represents reactive bone formation, while cavities form from **coalescence** of destroyed air cells. *Honeycombing of mastoid* - Honeycombing describes a **normal, well-pneumatized mastoid** with numerous small, distinct air cells visible on X-ray. - This appearance indicates a healthy mastoid bone with good aeration and is **inconsistent** with chronic inflammation. - Chronic otitis media causes bone remodeling and sclerosis, **not** preserved pneumatization. *Clear-cut distinct bony partition between cells* - This describes **normal mastoid anatomy** where air cells are well-defined and separated by thin, intact bony septa. - In chronic otitis media, these septa are typically **eroded or thickened** by inflammation, leading to loss of distinctness. - The inflammatory process causes destruction and sclerosis, **not** preservation of normal architecture. *Increased pneumatization of mastoid cells* - Increased pneumatization indicates **excessive air cell development**, which is opposite to the changes seen in chronic infection. - Chronic otitis media causes **destruction and sclerosis** of air cells, not increased pneumatization. - This would be seen in normal developmental variants, not chronic inflammatory disease.

Q: In otosclerosis, the tympanogram is:

Low compliance. ***Low compliance*** - In **otosclerosis**, the **stapes footplate** becomes fixed in the **oval window**, hindering sound transmission. - This fixation leads to reduced movement of the **tympanic membrane** and ossicular chain, resulting in a **low-compliance tympanogram** (Type As). *High compliance* - **High compliance** (Type Ad tympanogram) indicates a very mobile or **flaccid tympanic membrane**, often seen in conditions like **ossicular discontinuity**. - This is opposite to the stiffening effect seen in otosclerosis. *Normal compliance* - A **normal tympanogram** (Type A) signifies healthy middle ear function with appropriate pressure and mobility. - This would not be observed in otosclerosis, where there is a clear pathology affecting the **ossicular chain** and sound conduction. *None of the options* - This is incorrect because **otosclerosis** presents with a characteristic **low-compliance tympanogram**. - The disease specifically impairs the **mobility of the middle ear system**, which directly impacts tympanometric findings.

Q: Most common bone affected by otosclerosis?

Stapes. ***Stapes*** - **Otosclerosis** is characterized by abnormal bone remodeling in the otic capsule, primarily affecting the **stapes footplate**. - This leads to its fixation in the oval window, causing **conductive hearing loss**. - The **stapediovestibular joint** is the most common site, occurring in over 90% of cases. *Bony labyrinth* - While otosclerosis originates in the **otic capsule** (which forms the bony labyrinth), the term refers to a broader anatomical structure. - The specific site of clinical significance is the **stapes footplate**, not the labyrinth as a whole. *Mastoid process* - The **mastoid process** is part of the temporal bone but is structurally distinct from the middle ear and otic capsule. - It is not involved in otosclerosis pathology. *Incus* - While the **incus** is a middle ear ossicle, it is rarely affected by otosclerosis. - The disease process specifically targets the **stapes footplate** at the oval window, not other ossicles.

Question 1

Identify the condition of the given image:

Accepted Answer

Keratosis obturans

Answer

Acquired cholesteatoma

Answer

Congenital cholesteatoma

Answer

Rupture of tympanic membrane

Question 2

A 5-year-old child presents with reduced hearing for the past 2-3 months. Based on the otoscopy findings shown, what is the most likely diagnosis?

Accepted Answer

Otitis media with effusion

Answer

Myringitis

Answer

Acute ear infection

Answer

Air in the middle ear

Question 3

Most common cause of otitis externa is

Accepted Answer

Bacterial infection

Answer

Fungal infection

Answer

Seborrheic disease

Answer

Herpes Zoster

Question 4

Which of the following is a cause of objective tinnitus?

Accepted Answer

Carotid artery aneurysm

Answer

Impacted Wax

Answer

Meniere's disease

Answer

Ototoxic drugs

Question 5

Which perforation of the tympanic membrane is most commonly seen with tubotympanic CSOM?

Accepted Answer

Central

Answer

Anterosuperior

Answer

Posterosuperior

Answer

Posteroinferior

Question 6

Otosclerosis affects which bone?

Accepted Answer

Stapes

Answer

Incus

Answer

Malleus

Answer

Cochlea

Question 7

All of the following are features of Tubotympanic CSOM except which of the following?

Accepted Answer

Extreme pain

Answer

Profuse discharge

Answer

Hearing loss

Answer

Facial nerve paralysis

Question 8

What are the X-ray findings associated with chronic otitis media?

Accepted Answer

Sclerosis with cavity in mastoid

Answer

Honeycombing of mastoid

Answer

Clear-cut distinct bony partition between cells

Answer

Increased pneumatization of mastoid cells

Question 9

In otosclerosis, the tympanogram is:

Accepted Answer

Low compliance

Answer

High compliance

Answer

Normal compliance

Answer

None of the options

Question 10

Most common bone affected by otosclerosis?

Accepted Answer

Stapes

Answer

Bony labyrinth

Answer

Mastoid process

Answer

Incus

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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