Diseases of the Ear Practice Questions

Q: Bullous myringitis is caused by?

Mycoplasma pneumoniae. ***Mycoplasma pneumoniae*** - **Bullous myringitis** is characterized by the formation of **blisters** (bullae) on the **tympanic membrane**, which is a classic presentation associated with *Mycoplasma pneumoniae* infection. - While other bacteria can cause otitis media, *Mycoplasma pneumoniae* has a strong association with the development of **hemorrhagic bullae** on the eardrum. *Streptococcus pneumoniae* - This bacterium is the **most common cause** of **acute otitis media (AOM)**, but it typically presents with inflammation and bulging of the tympanic membrane **without** the characteristic bullae. - While it can cause severe ear infections, its typical presentation does not involve the **blister formation** seen in bullous myringitis. *Haemophilus influenzae* - This is another **common bacterial cause** of **acute otitis media**, especially in children, often leading to bulging and redness of the eardrum. - Similar to *Streptococcus pneumoniae*, it is not typically associated with the development of **bullae** on the tympanic membrane. *Candida* - **Candida** species are **fungi** and are a cause of **otitis externa** (ear canal infection) or, less commonly, **chronic otitis media**, particularly in immunocompromised individuals. - Fungal infections of the ear, including Candida, do **not** typically cause the characteristic **bullous myringitis** presentation.

Q: Retraction of tympanic membrane touching the promontory. What is the classification according to Sade's grading system?

Grade 3. ***Grade 3*** - **Grade 3** retraction involves the tympanic membrane making contact with the **promontory** of the middle ear. - This contact indicates significant retraction, often with loss of definition of the malleus handle. *Grade 1* - **Grade 1** retraction is characterized by mild retraction with an **intact cone of light** and good mobility. - The tympanic membrane does not touch any middle ear structures. *Grade 2* - **Grade 2** retraction shows the tympanic membrane touching the **incudostapedial joint** or posterior wall of the middle ear. - The handle of the malleus may appear significantly foreshortened. *Grade 4* - **Grade 4** retraction involves **adhesive otitis media**, where the tympanic membrane is severely retracted and fully adherent to the middle ear structures. - This often results in a nearly complete obliteration of the middle ear space.

Q: What is the most common cause of ASOM?

Pneumococci. ***Pneumococci*** - **_Streptococcus pneumoniae_ (Pneumococci)** is the **most common bacterial cause** of Acute Suppurative Otitis Media (ASOM) in all age groups, particularly in young children. - It accounts for an estimated 25-50% of all ASOM cases, often leading to significant inflammation and **purulent discharge**. *Meningococci* - **_Neisseria meningitidis_ (Meningococci)** is rarely a cause of ASOM. - It is primarily known for causing **meningitis** and **sepsis**, not typically middle ear infections. *H. influenzae* - **_Haemophilus influenzae_ (non-typable)** is the **second most common cause** of ASOM, accounting for 20-40% of cases. - While significant, it is generally less prevalent than _Streptococcus pneumoniae_. *Moraxella catarrhalis* - **_Moraxella catarrhalis_** is another common causative agent of ASOM, responsible for 10-20% of cases. - It is frequently seen in conjunction with other pathogens but is not the most common on its own.

Q: What is the most common fungal cause of otomycosis?

Aspergillus. ***Aspergillus*** - **Aspergillus niger** and **Aspergillus flavus** are the most frequently isolated fungal species in cases of **otomycosis**. - These fungi thrive in warm, moist environments like the **external auditory canal** and produce spores that can cause infection. *Histoplasma* - **Histoplasma capsulatum** is associated with **histoplasmosis**, a systemic fungal infection that primarily affects the lungs. - It is not a common cause of otomycosis, as it typically causes **pulmonary and disseminated disease**, not external ear canal infections. *Rhinosporidium* - **Rhinosporidium seeberi** causes **rhinosporidiosis**, a chronic granulomatous disease that primarily affects the **mucous membranes of the nose and nasopharynx**. - While it can affect other mucous membranes, it is not a typical cause of **otomycosis**. *Actinomyces* - **Actinomyces** is a genus of **gram-positive bacteria**, not fungi, known for causing **actinomycosis**. - Actinomycosis is characterized by **abscess formation and fistulas** and does not typically present as otomycosis.

Q: The treatment of choice for atticoantral variety of chronic suppurative otitis media is:

Mastoidectomy. **Correct: Mastoidectomy** - The **atticoantral** variety of chronic suppurative otitis media (CSOM) is typically associated with **cholesteatoma**, which necessitates surgical eradication to prevent complications such as intracranial infection, facial nerve palsy, and labyrinthine destruction. - **Mastoidectomy** is the treatment of choice to remove the cholesteatoma and achieve a safe, dry ear by clearing disease from the mastoid air cells and attic. *Incorrect: Medical management* - This approach is typically used for the **tubotympanic** (mucosal/safe) type of CSOM, which involves a central perforation without cholesteatoma. - It is **ineffective in the presence of cholesteatoma**, as antibiotics cannot penetrate the keratinized debris matrix and do not eradicate the underlying pathology. *Incorrect: Underlay myringoplasty* - This procedure repairs a **tympanic membrane perforation** but does not address the underlying cholesteatoma or disease within the mastoid and attic. - It is used for **safe, dry perforations**, usually associated with the tubotympanic type of CSOM after the ear has been rendered inactive. *Incorrect: Insertion of ventilation tube* - Ventilation tubes (grommets) are primarily used for **recurrent acute otitis media** or **otitis media with effusion (glue ear)** to equalize middle ear pressure and facilitate drainage. - They are **not indicated for CSOM**, especially the atticoantral type with cholesteatoma, as they do not resolve the chronic infection or remove the pathological tissue.

Q: Chondritis of the aural cartilage is most commonly due to which of the following?

Pseudomonas. **Pseudomonas** - **Pseudomonas aeruginosa** is the most common pathogen responsible for **chondritis** of the auricular cartilage, especially after trauma or surgery. - This bacterium thrives in moist environments and can lead to aggressive infections in cartilage, which has a limited blood supply. *Staphylococcus* - While **Staphylococcus aureus** can cause skin and soft tissue infections, it is less commonly the primary cause of isolated **auricular chondritis**. - Staphylococcal infections more often present as cellulitis or abscesses, and while they can secondarily involve cartilage, they are not the typical primary pathogen in chondritis. *Candida* - **Candida** species are opportunistic fungi that can cause infections, particularly in immunocompromised individuals or following prolonged antibiotic use. - However, **fungal chondritis** of the ear cartilage is rare and not the most common cause compared to bacterial pathogens. *Neither Staphylococcus nor Pseudomonas* - This option is incorrect because **Pseudomonas** is indeed the most common causative agent for **chondritis** of the aural cartilage. - Attributing chondritis to neither of these common pathogens would overlook the primary infectious agent.

Q: Prior history of ear surgery and scanty, foul-smelling, painless discharge from the ear are characteristic features of which of the following lesions?

Cholesteatoma. ***Cholesteatoma*** - The **combination of all three features** (prior ear surgery + scanty, foul-smelling, painless discharge) is highly characteristic of cholesteatoma. - A prior history of ear surgery, particularly for **chronic otitis media**, can predispose to or be related to an **acquired cholesteatoma**. - **Scanty, foul-smelling, painless discharge** (otorrhea) is a hallmark symptom of cholesteatoma, with the **foul smell** being particularly distinctive due to breakdown of keratin debris and secondary infection. - The **painless** nature helps differentiate it from acute infections. *ASOM (Acute Suppurative Otitis Media)* - ASOM typically presents with **acute otalgia** (ear pain) and a **profuse purulent, non-foul-smelling discharge** following tympanic membrane perforation. - It is an acute infection and usually does not have a prior history of ear surgery as a direct cause of the current discharge. - The presence of **pain** and absence of foul smell distinguish it from cholesteatoma. *Central perforation* - A central perforation of the tympanic membrane often results in **intermittent, mucoid discharge** during upper respiratory tract infections, which is usually not foul-smelling. - While it can be associated with discharge, the characteristic **foul smell** and **prior surgery history** point away from simple central perforation as the primary diagnosis. - The discharge is typically more profuse during active infection. *Otitis externa* - **Otitis externa** primarily affects the ear canal, causing **pain, tenderness, and sometimes a watery or purulent discharge**, but it does not typically present with a foul-smelling discharge associated with a prior ear surgery history. - It is usually due to infection of the external auditory canal skin and not related to middle ear pathology or prior surgery in the way a cholesteatoma is. - The **painful** nature is a key distinguishing feature.

Q: Which of the following statements is NOT true regarding acute suppurative otitis media (ASOM)?

Radical mastoidectomy is often necessary for treatment.. ***Radical mastoidectomy is often necessary for treatment.*** - Radical mastoidectomy is a major surgical procedure reserved for **chronic otitis media with cholesteatoma** or severe complications, not typically for acute suppurative otitis media (ASOM) - ASOM is primarily managed with **antibiotics** and sometimes myringotomy; surgery is only considered in cases of treatment failure or developing complications. *It commonly follows upper respiratory infections.* - **Upper respiratory infections (URIs)** cause inflammation and congestion of the Eustachian tube, leading to its dysfunction and predisposing to ASOM. - The **negative pressure** created in the middle ear due to Eustachian tube dysfunction facilitates bacterial reflux from the nasopharynx. *Streptococcus pneumoniae is a common organism causing ASOM.* - **_Streptococcus pneumoniae_** is one of the most frequently isolated bacterial pathogens in children and adults with ASOM. - Other common pathogens include **_Haemophilus influenzae_** and **_Moraxella catarrhalis_**. *Acute suppurative otitis media (ASOM) commonly resolves without complications.* - While ASOM can be painful, many episodes resolve **spontaneously** or with appropriate antibiotic treatment **without developing serious complications**. - Complications, though rare, can include **mastoiditis**, **meningitis**, or **brain abscess**, but these are not the typical course of untreated ASOM.

Q: Which cranial nerve is most commonly involved in chronic suppurative otitis media?

Cranial Nerve VII. ***Cranial Nerve VII (Facial Nerve)*** - The **facial nerve (CN VII)** is the **most commonly involved cranial nerve** in chronic suppurative otitis media (CSOM). - CN VII runs through the **Fallopian canal** in the temporal bone, in close proximity to the middle ear and mastoid, making it vulnerable to infection and inflammation. - Involvement presents as **facial palsy (House-Brackmann grading)**, which occurs in approximately **0.5-2% of CSOM cases**. - This is a serious complication requiring urgent medical and sometimes surgical intervention. *Cranial Nerve IX (Glossopharyngeal)* - The **glossopharyngeal nerve (CN IX)** is located in the posterior cranial fossa and is **rarely involved** in CSOM. - While referred otalgia can occur through Jacobson's nerve (tympanic branch of CN IX), direct pathological involvement causing glossopharyngeal dysfunction is extremely uncommon in CSOM. *Cranial Nerve XI (Spinal Accessory)* - The **spinal accessory nerve (CN XI)** controls the sternocleidomastoid and trapezius muscles. - This nerve is **not involved** in CSOM complications due to its anatomical location away from the middle ear and temporal bone. *Cranial Nerve V (Trigeminal)* - The **trigeminal nerve (CN V)** provides sensory innervation to the face and motor innervation for mastication. - While the auriculotemporal branch (V3) provides some sensory supply to the external auditory canal, direct CN V involvement in CSOM is **not a recognized complication**.

Q: In Ramsay Hunt syndrome, the most commonly involved nerve is?

b. VII. ***VII*** - Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of the **varicella-zoster virus** in the **geniculate ganglion**, which is part of the **facial nerve (cranial nerve VII)** [1]. - This reactivation leads to **unilateral facial paralysis**, often accompanied by **painful vesicular rash** in the ear or mouth, and sometimes **hearing loss** or **vertigo** [1]. *a. V* - Cranial nerve V, the **trigeminal nerve**, is responsible for **facial sensation** and **mastication**. - While **trigeminal neuralgia** can cause severe facial pain, it is not primarily affected in Ramsay Hunt syndrome, nor does it cause facial paralysis. *d. IX* - Cranial nerve IX, the **glossopharyngeal nerve**, is involved in **taste** from the posterior tongue, **swallowing**, and **salivation**. - Involvement of this nerve typically manifests as issues with taste or difficulty swallowing, which are not hallmark features of Ramsay Hunt syndrome. *c. VIII* - Cranial nerve VIII, the **vestibulocochlear nerve**, is responsible for **hearing** and **balance**. - While Ramsay Hunt syndrome can sometimes affect the vestibulocochlear nerve leading to hearing loss or vertigo, the primary and most commonly involved nerve causing the characteristic facial paralysis is the facial nerve (VII).

Question 1

Bullous myringitis is caused by?

Accepted Answer

Mycoplasma pneumoniae

Answer

Haemophilus influenzae

Answer

Candida

Answer

Streptococcus pneumoniae

Question 2

Retraction of tympanic membrane touching the promontory. What is the classification according to Sade's grading system?

Accepted Answer

Grade 3

Answer

Grade 1

Answer

Grade 2

Answer

Grade 4

Question 3

What is the most common cause of ASOM?

Accepted Answer

Pneumococci

Answer

Meningococci

Answer

H. influenzae

Answer

Moraxella catarrhalis

Question 4

What is the most common fungal cause of otomycosis?

Accepted Answer

Aspergillus

Answer

Histoplasma

Answer

Rhinosporidium

Answer

Actinomyces

Question 5

The treatment of choice for atticoantral variety of chronic suppurative otitis media is:

Accepted Answer

Mastoidectomy

Answer

Medical management

Answer

Underlay myringoplasty

Answer

Insertion of ventilation tube

Question 6

Chondritis of the aural cartilage is most commonly due to which of the following?

Accepted Answer

Pseudomonas

Answer

Staphylococcus

Answer

Candida

Answer

Neither Staphylococcus nor Pseudomonas

Question 7

Prior history of ear surgery and scanty, foul-smelling, painless discharge from the ear are characteristic features of which of the following lesions?

Accepted Answer

Cholesteatoma

Answer

ASOM

Answer

Central perforation

Answer

Otitis externa

Question 8

Which of the following statements is NOT true regarding acute suppurative otitis media (ASOM)?

Accepted Answer

Radical mastoidectomy is often necessary for treatment.

Answer

Streptococcus pneumoniae is a common organism causing ASOM.

Answer

It commonly follows upper respiratory infections.

Answer

Acute suppurative otitis media (ASOM) commonly resolves without complications.

Question 9

Which cranial nerve is most commonly involved in chronic suppurative otitis media?

Accepted Answer

Cranial Nerve VII

Answer

Cranial Nerve V

Answer

Cranial Nerve XI

Answer

Cranial Nerve IX

Question 10

In Ramsay Hunt syndrome, the most commonly involved nerve is?

Accepted Answer

b. VII

Answer

a. V

Answer

d. IX

Answer

c. VIII

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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