Diseases of the Ear Practice Questions

Q: What is the most common extracranial complication of chronic suppurative otitis media?

Subperiosteal abscess. **Explanation:** Complications of Chronic Suppurative Otitis Media (CSOM) are categorized into intracranial and extracranial (intratemporal). Among the extracranial complications, **Subperiosteal abscess** is the most common. **1. Why Subperiosteal Abscess is correct:** In CSOM (especially the squamosal type with cholesteatoma), bone erosion or direct extension through the mastoid cortex leads to the collection of pus between the bone and the periosteum. The **Post-auricular (Mastoid) abscess** is the most frequent clinical presentation of a subperiosteal abscess, typically displacing the pinna forwards and downwards. **2. Why other options are incorrect:** * **Labyrinthitis:** While common, it is generally the second most frequent intratemporal complication. It occurs due to toxins or bacteria entering the inner ear, often via a fistula in the lateral semicircular canal. * **Facial nerve paralysis:** This occurs due to erosion of the bony fallopian canal. While a significant complication, its incidence is lower than that of subperiosteal abscesses. * **Petrositis:** This involves the extension of infection into the petrous apex (Gradenigo’s Syndrome). It is relatively rare compared to mastoid-related complications. **Clinical Pearls for NEET-PG:** * **Most common Intracranial complication:** Meningitis (followed by Brain Abscess, specifically in the temporal lobe or cerebellum). * **Most common site for a Fistula:** Lateral Semicircular Canal. * **Bezold’s Abscess:** A type of subperiosteal abscess where pus tracks into the sternocleidomastoid muscle. * **Luc’s Abscess:** Pus tracks into the external auditory canal wall. * **Citelli’s Abscess:** Pus tracks into the digastric fossa.

Q: What is keratosis obturans?

Desquamated epithelial cells and cholesterol.. **Explanation:** **Keratosis Obturans (KO)** is a condition characterized by the accumulation of large plugs of **desquamated keratin (epithelial cells)** in the external auditory canal (EAC). These plugs often contain **cholesterol** and are formed due to a failure in the normal self-cleaning mechanism (epithelial migration) of the ear canal. This leads to the expansion and erosion of the bony canal, often presenting with severe pain and conductive hearing loss. **Why the other options are incorrect:** * **Option A:** While it acts like a "plug," it is an endogenous accumulation of skin cells, not an exogenous **foreign body**. * **Option C:** This description is more characteristic of a **cholesteatoma** (specifically the "cholesteatoma pearls") or dystrophic calcification, rather than the keratinous plug of KO. * **Option D:** **Wax (Cerumen)** is a physiological secretion of the ceruminous and sebaceous glands. Keratosis obturans is pathological and consists of hard, white keratin sheets, which are much more difficult to remove than wax. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Typically presents as **bilateral** severe ear pain (otalgia) and hearing loss in younger patients (5–20 years). * **Association:** Often associated with **bronchiectasis** or sinusitis. * **Differentiation:** Unlike *External Auditory Canal Cholesteatoma (EACC)*, which is usually unilateral, affects older patients, and shows focal bone erosion/sequestrum, KO causes **diffuse widening** of the entire bony canal (ballooning). * **Management:** Repeated syringing or manual debridement under microscopy; topical keratolytics may be used.

Q: A child presents with an ear infection with foul-smelling discharge. On further exploration, a small perforation is found in the pars flaccida of the tympanic membrane. What is the most appropriate next step in the management?

Tympanomastoid exploration. ### Explanation **1. Why the Correct Answer is Right:** The clinical presentation of **foul-smelling discharge** and a **pars flaccida perforation** is a classic indicator of **Attico-antral type** of Chronic Suppurative Otitis Media (CSOM). This type is often associated with **cholesteatoma**, an epithelial-lined sac that produces osteolytic enzymes, leading to bone destruction and life-threatening intracranial complications. Because Attico-antral disease is "unsafe," the primary goal of management is the complete eradication of the disease and making the ear "safe." **Tympanomastoid exploration** (which may include a Modified Radical Mastoidectomy or Canal Wall Up/Down procedures) is the definitive treatment to remove the cholesteatoma and explore the mastoid air cell system. **2. Why the Incorrect Options are Wrong:** * **Options A & B:** Medical management (topical or IV antibiotics) may temporarily reduce the discharge by treating secondary infection, but it **cannot cure** a cholesteatoma. Delaying surgery increases the risk of complications like facial nerve palsy, labyrinthitis, or brain abscess. * **Option C:** Tympanoplasty is a reconstructive procedure aimed at closing a perforation in the pars tensa (Tubotympanic/Safe type). In Attico-antral disease, reconstruction is secondary to the mandatory exploration and clearance of the mastoid and attic. **3. Clinical Pearls for NEET-PG:** * **Pars Flaccida Perforation:** Pathognomonic for Attico-antral (Unsafe) CSOM. * **Foul Smell:** Suggests bone destruction (osteitis) or the presence of anaerobic organisms in a cholesteatoma. * **Marginal Perforation:** Another hallmark of unsafe CSOM, usually involving the posterosuperior quadrant. * **Investigation of Choice:** HRCT Temporal Bone (to assess the extent of bone erosion). * **Treatment Goal:** 1st: Safety (remove disease); 2nd: Dry ear; 3rd: Hearing restoration.

Q: Pain, muscle tenderness, clicking or popping noise in the temporomandibular joint, and limitation of jaw motion are the four cardinal signs and symptoms of which condition?

Myofascial pain dysfunction syndrome. **Explanation:** **Myofascial Pain Dysfunction Syndrome (MPDS)**, also known as Costen’s syndrome (note the spelling), is a psychophysiological disease involving the masticatory muscles. It is the most common cause of temporomandibular pain. The diagnosis is clinical, based on the **four cardinal signs** mentioned in the question: 1. **Pain:** Usually unilateral, dull, and aching, localized to the ear or TMJ area. 2. **Muscle Tenderness:** Specifically involving the masticatory muscles (Masseter, Temporalis, Pterygoids). 3. **Clicking or Popping sounds:** Occurring during jaw movement. 4. **Limitation of jaw motion:** Often manifesting as difficulty opening the mouth fully. **Analysis of Incorrect Options:** * **Casten’s Syndrome (Option A):** This is a distractor spelling. The actual eponymous name is **Costen’s Syndrome**, which is synonymous with MPDS. In exams, always prioritize the descriptive clinical name (MPDS) over eponymous distractors unless specified. * **Traumatic Arthritis (Option B):** This usually follows a specific acute injury (e.g., a blow to the chin). While it causes pain and limited motion, it is characterized by acute inflammation and often hemarthrosis, rather than the chronic muscular dysfunction seen in MPDS. * **Osteoarthritis (Option C):** This is a degenerative joint disease. While it presents with crepitus and pain, it typically shows radiographic evidence of bone changes (e.g., flattening of the condyle, osteophytes), which are absent in MPDS. **NEET-PG High-Yield Pearls:** * **Etiology:** MPDS is often triggered by **bruxism** (teeth grinding) or stress-induced muscle tension. * **Radiology:** In MPDS, X-rays of the TMJ are characteristically **normal**. * **Management:** Treatment is conservative, involving reassurance, soft diet, analgesics, muscle relaxants, and occasionally occlusal splints. Surgery is rarely indicated.

Q: Which of the following statements about ototoxicity is FALSE?

Low frequency hearing loss occurs initially. Ototoxicity typically presents as **bilateral, symmetrical, sensorineural hearing loss (SNHL)**. The hallmark of ototoxic damage is that it affects the **basal turn of the cochlea** first, which is responsible for processing **high-frequency sounds**. ### Explanation of Options: * **Option B (Correct Answer):** This is false because ototoxicity characteristically begins at high frequencies (8,000–20,000 Hz). Patients often do not notice early damage until it progresses to the lower frequencies involved in speech. * **Option A:** Ototoxicity is a systemic effect; therefore, it almost always causes bilateral and symmetrical hearing loss. * **Option C:** Aminoglycosides (e.g., Gentamicin, Amikacin) cause the death of outer hair cells in the Organ of Corti. Since these cells do not regenerate, the resulting hearing loss is permanent. * **Option D:** Prevention is the primary management strategy. Monitoring drug levels (TDM) and withdrawing or substituting the offending agent at the first sign of toxicity (tinnitus or high-frequency loss on serial audiometry) can prevent further progression. ### High-Yield Clinical Pearls for NEET-PG: * **Aminoglycoside Specificity:** Gentamicin and Streptomycin are more **vestibulotoxic** (causing vertigo/disequilibrium), while Amikacin, Neomycin, and Kanamycin are more **cochleotoxic** (causing hearing loss). * **Loop Diuretics:** (e.g., Furosemide) cause reversible hearing loss by affecting the *stria vascularis*. * **Salicylates:** Cause reversible SNHL and are classically associated with high-pitched tinnitus. * **Cisplatin:** A common chemotherapeutic agent that causes significant, permanent high-frequency SNHL. * **Monitoring:** High-frequency audiometry is the most sensitive tool for early detection.

Q: Which of the following best describes glue ear?

It is typically painless.. **Explanation:** **Glue ear**, medically known as **Otitis Media with Effusion (OME)**, is characterized by the accumulation of non-purulent, mucoid, or serous fluid in the middle ear cleft without signs of acute infection. 1. **Why Option B is correct:** Unlike Acute Otitis Media (AOM), glue ear is **typically painless**. The primary symptom is **conductive hearing loss** (the most common cause of hearing loss in children). Because there is no active bacterial suppuration or pressure from pus, patients do not experience otalgia or fever. 2. **Why the other options are incorrect:** * **Option A:** Pain is a hallmark of Acute Otitis Media or Otitis Externa, not OME. * **Option C:** Radical mastoidectomy is an aggressive surgery for cholesteatoma. The primary surgical treatment for glue ear is **Myringotomy with Grommet (ventilation tube) insertion**, often combined with an adenoidectomy if indicated. * **Option D:** Sodium fluoride is used to stabilize active bony resorption in **Otosclerosis** (Schwartze sign), not for middle ear effusions. **High-Yield Clinical Pearls for NEET-PG:** * **Etiology:** Often associated with **Eustachian tube dysfunction** or adenoid hypertrophy. * **Diagnosis:** The gold standard for diagnosis is **Tympanometry**, which typically shows a **Type B (flat) curve**. * **Otoscopy:** Findings include a dull, retracted tympanic membrane with restricted mobility (assessed via pneumatic otoscopy). An "amber-colored" drum or air-fluid bubbles may be seen. * **Management:** Initial management is usually observation (watchful waiting for 3 months) as many cases resolve spontaneously. If persistent, Myringotomy is performed in the **antero-inferior quadrant**.

Q: An axial CT scan of the mastoid is shown below. Which type of pathological mastoid is depicted among the given options?

Sclerotic mastoid. ***Sclerotic mastoid*** - Characterized by **dense, opaque bone** with **absent air cells** on CT, indicating chronic inflammation and bone sclerosis. - Associated with **chronic otitis media** and represents pathological changes due to repeated infections. *Pneumatized mastoid* - Shows **well-aerated air cells** with **thin bony septa** on CT, representing normal healthy mastoid anatomy. - Appears as **dark/black areas** on CT due to air content, which is the opposite of what's shown. *Diploeic mastoid* - Contains **bone marrow spaces** instead of air cells, appearing as **mixed density** on CT. - Shows **trabecular bone pattern** with marrow fat, not the solid dense appearance of sclerosis. *Atrophic mastoid* - Features **enlarged air spaces** with **thin walls** due to bone resorption over time. - Appears as **large, confluent air cavities** on CT, contrasting with the solid bone density seen here.

Q: Which nerve is responsible for referred pain in the ear?

Glossopharyngeal. ### Explanation The sensory innervation of the ear is complex, involving multiple cranial and spinal nerves. This complexity is the basis for **referred otalgia** (ear pain originating from a non-otologic source). **Why Glossopharyngeal (CN IX) is Correct:** The Glossopharyngeal nerve supplies sensory innervation to the middle ear cleft via the **Jacobson’s nerve** (tympanic branch). It also provides sensation to the oropharynx, base of the tongue, and tonsillar fossa. Due to this shared pathway, pathologies in the throat—most commonly **post-tonsillectomy pain, peritonsillar abscess (Quinsy), or glossopharyngeal neuralgia**—are perceived as pain in the ear. **Analysis of Incorrect Options:** * **A. Trochlear (CN IV):** A pure motor nerve supplying the superior oblique muscle of the eye. It has no sensory component or connection to the ear. * **B. Olfactory (CN I):** A special sensory nerve responsible for the sense of smell. It does not carry general somatic sensation. * **D. Abducent (CN VI):** A pure motor nerve supplying the lateral rectus muscle of the eye. It is not involved in sensory pathways. **Clinical Pearls for NEET-PG:** 1. **Nerves causing referred otalgia:** * **CN V3 (Auriculotemporal n.):** Pain from TMJ disorders or dental caries. * **CN IX (Jacobson’s n.):** Pain from the oropharynx/tonsils. * **CN X (Arnold’s n.):** Pain from the larynx or pyriform fossa (e.g., Laryngeal Malignancy). * **C2, C3 (Greater Auricular n.):** Pain from cervical spine issues. 2. **Hilger’s Law:** Any nerve that supplies a muscle also supplies the joint moved by the muscle and the skin over the insertion. 3. **High-Yield Fact:** If a patient presents with ear pain but a **normal-looking tympanic membrane**, always examine the throat and larynx to rule out occult malignancy.

Q: What is the treatment of choice for unsafe CSOM with cholesteatoma and sensorineural deafness?

Modified radical mastoidectomy. **Explanation:** The primary goal in the management of **Unsafe Chronic Suppurative Otitis Media (CSOM)** with cholesteatoma is to create a "permanent, safe, and dry ear" by removing all disease. **1. Why Modified Radical Mastoidectomy (MRM) is the Correct Choice:** MRM is the standard treatment for unsafe CSOM. It involves removing the disease (cholesteatoma/granulations) from the attic and antrum while **preserving the remnants of the tympanic membrane and ossicles** (if present). Even in the presence of sensorineural deafness, MRM is preferred over Radical Mastoidectomy because it maintains the anatomical integrity of the middle ear and allows for future hearing rehabilitation (like a bone-anchored hearing aid) while ensuring the ear is safe. **2. Why other options are incorrect:** * **Simple Mastoidectomy:** This is used for **Acute Mastoiditis** or ASOM complications. It removes air cells without disturbing the posterior meatal wall or middle ear, making it inadequate for cholesteatoma. * **Radical Mastoidectomy:** This involves the total removal of the tympanic membrane, ossicles (except stapes), and closure of the Eustachian tube, converting the middle ear and mastoid into a single cavity. It is reserved for specific cases like **malignancy** or **unreconstructable Eustachian tube dysfunction**, not routine unsafe CSOM. * **Tympanoplasty:** This is the treatment of choice for **Safe (Tubotympanic) CSOM**. It focuses on reconstructing the hearing mechanism but does not address the mastoid disease seen in unsafe CSOM. **High-Yield Clinical Pearls for NEET-PG:** * **Goal Hierarchy in Unsafe CSOM:** 1. Safety (Remove disease) → 2. Dry Ear → 3. Hearing Preservation. * **Canal Wall Down (CWD) Procedure:** MRM is a CWD procedure where the posterior meatal wall is removed to exteriorize the disease. * **Cholesteatoma Hallmark:** Bone erosion due to osteoclast activation and enzymes like acid phosphatase.

Question 1

What is the most common extracranial complication of chronic suppurative otitis media?

Accepted Answer

Subperiosteal abscess

Answer

Petrositis

Answer

Labyrinthitis

Answer

Facial nerve paralysis

Question 2

What is keratosis obturans?

Accepted Answer

Desquamated epithelial cells and cholesterol.

Answer

A foreign body in the external auditory canal.

Answer

Cholesterol crystals surrounded by calcium.

Answer

Wax in the external auditory canal.

Question 3

A child presents with an ear infection with foul-smelling discharge. On further exploration, a small perforation is found in the pars flaccida of the tympanic membrane. What is the most appropriate next step in the management?

Accepted Answer

Tympanomastoid exploration

Answer

Topical antibiotics and decongestants for 4 weeks

Answer

IV antibiotics and follow up after a month

Answer

Tympanoplasty

Question 4

Pain, muscle tenderness, clicking or popping noise in the temporomandibular joint, and limitation of jaw motion are the four cardinal signs and symptoms of which condition?

Accepted Answer

Myofascial pain dysfunction syndrome

Answer

Casten's syndrome

Answer

Traumatic arthritis of TMJ

Answer

Osteoarthritis

Question 5

Which of the following statements about ototoxicity is FALSE?

Accepted Answer

Low frequency hearing loss occurs initially

Answer

Causes bilateral hearing loss

Answer

Aminoglycosides cause permanent hearing loss

Answer

Can be prevented by withdrawing the drug

Question 6

A 70-year-old male with long-standing type 2 diabetes mellitus presents with a complaint of left ear pain and purulent drainage. Examination reveals a tender pinna of the left ear, with a swollen and edematous external auditory canal. The patient is afebrile and has a normal white blood cell count. What is the most likely organism to grow from the ear drainage?

Accepted Answer

P. aeruginosa

Answer

Staphylococcus aureus

Answer

Candida albicans

Answer

Haemophilus influenzae

Question 7

Which of the following best describes glue ear?

Accepted Answer

It is typically painless.

Answer

It is typically painful.

Answer

Radical mastoidectomy is the primary treatment.

Answer

Sodium fluoride is a useful treatment.

Question 8

An axial CT scan of the mastoid is shown below. Which type of pathological mastoid is depicted among the given options?

Accepted Answer

Sclerotic mastoid

Answer

Pneumatized mastoid

Answer

Diploeic mastoid

Answer

Atrophic mastoid

Question 9

Which nerve is responsible for referred pain in the ear?

Accepted Answer

Glossopharyngeal

Answer

Trochlear

Answer

Olfactory

Answer

Abducent

Question 10

What is the treatment of choice for unsafe CSOM with cholesteatoma and sensorineural deafness?

Accepted Answer

Modified radical mastoidectomy

Answer

Simple mastoidectomy

Answer

Radical mastoidectomy

Answer

Tympanoplasty

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

On this page

Practice by Chapter

Want unlimited practice?