Diseases of the Ear Practice Questions

Q: What surgery is the treatment of choice in otosclerosis?

Stapedectomy. **Explanation** **Otosclerosis** is a primary metabolic bone disease of the otic capsule characterized by abnormal bone remodeling, leading to fixation of the stapes footplate and progressive conductive hearing loss. **Why Stapedectomy is the Correct Answer:** Stapedectomy (or the more modern variation, **stapedotomy**) is the gold standard surgical treatment. The procedure involves removing the fixed stapes (or creating a hole in the footplate) and replacing it with a piston-like prosthesis. This bypasses the mechanical obstruction, restoring the ossicular chain's mobility and effectively closing the air-bone gap. **Analysis of Incorrect Options:** * **B. Stapes mobilization:** Historically used by Rosen, this involves manually breaking the stapedial fixations. It is no longer preferred because the bone regrowth (refixation) rate is extremely high, leading to surgical failure. * **C. Fenestration:** An obsolete procedure where a new window was created in the lateral semicircular canal. It was abandoned due to poor hearing results compared to stapedectomy and the requirement of a mastoid cavity. * **D. Chemical labyrinthectomy:** This involves the use of ototoxic drugs (like Gentamicin) to destroy vestibular function. It is used for **Meniere’s disease**, not otosclerosis. **High-Yield Clinical Pearls for NEET-PG:** * **Schwartz Sign:** A flamingo-pink blush seen on the promontory through the TM, indicating active otosclerosis. * **Carhart’s Notch:** A characteristic dip in the bone conduction curve at **2000 Hz**, which disappears after successful surgery. * **Gelle’s Test:** Negative in otosclerosis (no change in hearing with increased ear canal pressure). * **Contraindication:** Surgery should not be performed in the only hearing ear or in patients with active infection/Meniere’s disease.

Q: What are the characteristic features of tuberculous otitis media?

Painful otorrhea. **Explanation:** Tuberculous Otitis Media (TOM) is a chronic granulomatous infection of the middle ear, typically secondary to pulmonary tuberculosis. **Why the correct answer is "Painful otorrhea":** In the context of this specific question, **Painful otorrhea** is the correct choice because it is a **negative characteristic** (an exception). Classically, TOM is defined by **painless otorrhea** that is out of proportion to the degree of bone destruction. If a patient presents with significant ear discharge but reports no pain, suspicion for TB increases. Therefore, "Painful otorrhea" is the feature that does *not* belong to the classic clinical triad of TOM. **Analysis of other options (Characteristic features):** * **Multiple tympanic perforations:** This is a classic, high-yield sign. Multiple small "sieve-like" perforations occur due to the coalescence of multiple tubercles on the drum. These later merge into a single large central perforation. * **Pale granulation:** The middle ear mucosa typically shows pale, flabby granulations. * **Facial palsy:** TOM is notorious for early onset of complications. Facial nerve paralysis occurs in approximately 15-40% of cases due to the bone-eroding nature of the granulomas. **NEET-PG High-Yield Pearls:** * **Classic Triad:** Painless otorrhea, multiple perforations, and profound hearing loss. * **Hearing Loss:** Usually profound and sensorineural or mixed, occurring earlier than in pyogenic otitis media. * **Diagnosis:** Confirmed by identifying *Mycobacterium tuberculosis* in ear discharge (AFB staining) or via culture/PCR of middle ear granulations. * **Treatment:** Standard Anti-Tubercular Therapy (ATT). Surgery is reserved for complications like mastoiditis or sequestra.

Q: Otitic barotrauma occurs during which of the following activities?

Underwater diving. **Explanation:** Otitic barotrauma (Aerotitis media) occurs due to a failure of the **Eustachian tube (ET)** to equalize a rapid pressure difference between the middle ear and the external environment. **Why "Underwater Diving" is the correct answer:** Otitic barotrauma occurs when there is a **rapid increase in ambient pressure** (relative negative pressure in the middle ear). During **underwater diving** (descent) or **aircraft descent**, the external atmospheric pressure rises quickly. If the ET fails to open, the relative negative pressure in the middle ear causes the tympanic membrane to retract, followed by mucosal edema and transudation of fluid or blood (hemotympanum). **Why other options are incorrect:** * **Ascending in an aircraft / Decreasing ambient pressure:** During ascent, the ambient pressure decreases. This creates a relative **positive pressure** in the middle ear. The ET acts as a passive one-way valve, allowing air to escape easily from the middle ear to the nasopharynx. Therefore, barotrauma is rare during ascent; it is almost exclusively a disease of **descent**. **High-Yield Clinical Pearls for NEET-PG:** * **Teed Classification:** Used to grade the severity of tympanic membrane findings in barotrauma (Grade 0 to Grade 5). * **The "Locking" Phenomenon:** If the pressure differential exceeds **80-90 mmHg**, the nasopharyngeal opening of the ET is sucked shut, making it impossible for the tensor veli palatini muscle to open it. * **Prevention:** Instruct patients to perform the **Valsalva maneuver** or chew gum during descent. * **Contraindication:** Patients with Upper Respiratory Tract Infections (URTI) or nasal allergy should avoid flying/diving due to ET mucosal edema.

Q: Cauliflower ear is typically seen in which condition?

Hematoma of the auricle. **Explanation:** **Cauliflower ear** is an acquired deformity of the external ear resulting from an untreated or inadequately treated **Auricular Hematoma**. 1. **Why Option A is correct:** The auricle's cartilage depends on the overlying perichondrium for its blood supply. Trauma (common in wrestlers and boxers) causes blood to accumulate in the subperichondrial space. This **hematoma** separates the cartilage from its nutrient source, leading to ischemic necrosis. During the healing process, asymmetrical fibrosis and neocartilage formation occur, resulting in a shriveled, lumpy appearance resembling a cauliflower. 2. **Why other options are incorrect:** * **Option B (Carcinoma):** Squamous cell carcinoma usually presents as a non-healing ulcer or an exophytic growth, not a diffuse shriveled deformity. * **Option C (Fungal infection):** Fungal infections (Otomycosis) typically affect the external auditory canal, causing itching and debris, but do not structuraly deform the auricle into a "cauliflower" shape. * **Option D (Congenital deformity):** Conditions like Microtia or Anotia are developmental failures of the branchial arches, presenting at birth, unlike the acquired nature of cauliflower ear. **NEET-PG High-Yield Pearls:** * **Management:** The gold standard treatment for an acute auricular hematoma is **incision and drainage** followed by a **pressure dressing** to prevent re-accumulation of blood. * **Complication:** If the hematoma becomes infected, it leads to **Perichondritis**, which can further accelerate cartilage destruction. * **Commonly tested associations:** Often referred to as "Wrestler’s Ear" or "Boxer’s Ear."

Q: Which of the following is NOT true about Malignant otitis externa?

Completely monitored with TC99 scan till recovery. **Explanation:** Malignant Otitis Externa (MOE), also known as **Necrotizing Otitis Externa**, is a life-threatening progressive infection of the external auditory canal that spreads to the skull base (osteomyelitis). **Why Option B is the correct (False) statement:** Technetium-99m (Tc99) bone scans are highly sensitive for detecting early bone involvement because they pick up increased osteoblastic activity. However, Tc99 scans **remain positive for several months** even after the infection has resolved (due to ongoing bone remodeling). Therefore, they cannot be used to monitor treatment response or confirm recovery. The investigation of choice for monitoring resolution and "cooling down" of the disease is the **Gallium-67 scan**, which tracks active inflammation/leukocyte activity. **Analysis of other options:** * **Option A:** **Pseudomonas aeruginosa** is the causative organism in more than 95% of cases. It is typically seen in elderly diabetic patients or immunocompromised individuals. * **Option C:** It is synonymous with **Necrotizing Otitis Externa** because the infection causes extensive necrosis of soft tissue, cartilage, and bone. * **Option D:** As the disease spreads to the skull base, it can involve cranial nerves. The **Facial nerve (CN VII)** is the most commonly affected nerve (at the stylomastoid foramen), leading to facial muscle paralysis. **High-Yield Clinical Pearls for NEET-PG:** * **Pathognomonic sign:** Presence of **granulation tissue** at the junction of the cartilaginous and bony part of the external auditory canal. * **Diagnosis:** CT scan is best for assessing the extent of bone erosion; MRI is superior for soft tissue/dural involvement. * **Treatment:** Long-term systemic IV antipseudomonal antibiotics (e.g., Ciprofloxacin, Ceftazidime) and strict glycemic control.

Q: The fistula test stimulates which structure?

Lateral semicircular canal. ### Explanation **1. Why the Lateral Semicircular Canal (LSCC) is Correct:** The fistula test is performed by applying positive or negative pressure to the external auditory canal (using a Siegel’s speculum or tragal pressure). In the presence of a **labyrinthine fistula**—most commonly caused by a cholesteatoma eroding the bony labyrinth—this pressure is transmitted directly to the endolymph. Because the **Lateral Semicircular Canal** is the most lateral and superficial part of the vestibular system, it is the most frequent site of erosion (85–90% of cases). The pressure change induces endolymph movement, stimulating the crista ampullaris, which results in vertigo and nystagmus (Hennebert’s sign). **2. Why the Other Options are Incorrect:** * **Posterior and Anterior Semicircular Canals:** While these are part of the vestibular system, they are located deeper within the petrous temporal bone and are rarely the primary site of erosion in chronic suppurative otitis media (CSOM). * **Cochlea:** The cochlea is responsible for hearing (auditory function). While a fistula can rarely involve the promontory, the fistula test specifically looks for a vestibular response (nystagmus/vertigo), which is a function of the semicircular canals. **3. Clinical Pearls for NEET-PG:** * **Hennebert’s Sign:** A "false positive" fistula test (nystagmus without a bony fistula). It is classically seen in **Meniere’s disease** (due to adhesions between the stapes footplate and saccule) and **Congenital Syphilis**. * **False Negative Test:** May occur if the fistula is plugged by cholesteatoma or granulation tissue, or if the labyrinth is "dead" (non-functional). * **Management:** A positive fistula test in the context of CSOM is an absolute indication for surgery (Mastoidectomy) to prevent labyrinthitis or intracranial complications.

Q: A patient with a history of right ear discharge undergoes mastoidectomy. Postoperatively, the patient presents with vertigo and deafness. What is the most likely diagnosis?

Labyrinthitis. **Explanation:** The clinical presentation of **vertigo** and **deafness** following mastoid surgery in a patient with chronic ear discharge is a classic indicator of **Labyrinthitis**. **1. Why Labyrinthitis is correct:** The inner ear (labyrinth) is in close anatomical proximity to the middle ear and mastoid. During surgery for chronic otitis media (especially if a cholesteatoma is present), the protective bony covering of the labyrinth (most commonly the lateral semicircular canal) may be breached or eroded. This allows inflammatory mediators or infection to enter the inner ear, leading to **suppurative labyrinthitis**. This results in the "dead ear" phenomenon—characterized by a combination of **vestibular symptoms (vertigo)** and **cochlear symptoms (sensorineural hearing loss/deafness)**. **2. Why other options are incorrect:** * **Thrombophlebitis (Sigmoid Sinus):** Presents with "picket-fence" fever, headache, and signs of increased intracranial pressure, but not typically sudden deafness. * **Temporal Lobe Abscess:** An intracranial complication presenting with headache, vomiting, seizures, and focal neurological deficits (like nominal aphasia), rather than primary inner ear symptoms. * **Mastoiditis:** This is an infection of the mastoid air cells themselves. While it is the reason for the surgery, it does not explain the acute onset of postoperative vertigo and deafness unless it progresses to labyrinthitis. **NEET-PG High-Yield Pearls:** * **Most common site of fistula:** Lateral Semicircular Canal (LSCC). * **Fistula Test:** Positive when pressure changes in the canal induce vertigo/nystagmus; it becomes negative once the ear is "dead" (Labyrinthitis). * **Management:** Labyrinthitis is a surgical emergency if caused by acute infection; it requires high-dose antibiotics and sometimes surgical drainage.

Question 1

What surgery is the treatment of choice in otosclerosis?

Accepted Answer

Stapedectomy

Answer

Stapes mobilization

Answer

Fenestration

Answer

Chemical labyrinthectomy

Question 2

An elderly patient with chronic otitis media might have all the following complications, EXCEPT:

Accepted Answer

Inability to chew food due to injury to the mandibular division of the trigeminal nerve (CN V)

Answer

Loss of taste in the anterior part of the tongue due to injury to the chorda tympani nerve

Answer

Mastoiditis

Answer

Paralysis of facial muscles due to an injury to the facial nerve (CN VII)

Question 3

What are the characteristic features of tuberculous otitis media?

Accepted Answer

Painful otorrhea

Answer

Multiple tympanic perforations

Answer

Pale granulation

Answer

Facial palsy

Question 4

What is the operation of choice for coalescent mastoiditis?

Accepted Answer

Cortical mastoidectomy

Answer

Modified radical mastoidectomy

Answer

Radical mastoidectomy

Answer

Fenestration operation

Question 5

Otitic barotrauma occurs during which of the following activities?

Accepted Answer

Underwater diving

Answer

Ascending in an aircraft

Answer

When ambient pressure is decreasing

Answer

All of the above

Question 6

Cauliflower ear is typically seen in which condition?

Accepted Answer

Hematoma of the auricle

Answer

Carcinoma of the auricle

Answer

Fungal infection of the auricle

Answer

Congenital deformity of the auricle

Question 7

Which of the following statements is FALSE regarding malignant otitis externa?

Accepted Answer

Sensorineural hearing loss is a common presentation.

Answer

ESR is useful in monitoring the response to antibiotics.

Answer

It is common in diabetics.

Answer

Granulation tissue is present in the external ear canal.

Question 8

Which of the following is NOT true about Malignant otitis externa?

Accepted Answer

Completely monitored with TC99 scan till recovery

Answer

Caused by Pseudomonas Aeruginosa

Answer

Also known as Necrotising Otitis Externa

Answer

Can lead to paralysis of facial muscles

Question 9

The fistula test stimulates which structure?

Accepted Answer

Lateral semicircular canal

Answer

Posterior semicircular canal

Answer

Anterior semicircular canal

Answer

Cochlea

Question 10

A patient with a history of right ear discharge undergoes mastoidectomy. Postoperatively, the patient presents with vertigo and deafness. What is the most likely diagnosis?

Accepted Answer

Labyrinthitis

Answer

Thrombophlebitis

Answer

Temporal lobe abscess

Answer

Mastoiditis

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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