Otology Practice Questions

Q: Mastoid reservoir phenomenon is positive in which of the following conditions?

Coalescent mastoiditis. **Explanation:** **Mastoid Reservoir Phenomenon** is a classic clinical sign of **Coalescent Mastoiditis**. It occurs when the mastoid air cells break down (coalescence) and form a large, pus-filled cavity. When the ear is mopped dry, the external auditory canal rapidly refills with pus from the mastoid reservoir through a perforation in the tympanic membrane. This happens because the volume of pus in the mastoid cavity is significantly larger than what the middle ear can hold. **Analysis of Options:** * **Coalescent Mastoiditis (Correct):** The destruction of bony septa creates a large "reservoir" of pus. The rapid re-accumulation of discharge after cleaning is pathognomonic for this condition. * **CSOM (Incorrect):** While CSOM presents with ear discharge, the discharge is usually persistent or intermittent but does not typically exhibit the rapid "refilling" characteristic of a large bony reservoir unless complicated by mastoiditis. * **Petrositis (Incorrect):** This involves the petrous apex. While it presents with Gradenigo’s triad (otorrhea, retro-orbital pain, and 6th nerve palsy), it does not specifically produce the reservoir sign. * **Coalescent Otitis Media (Incorrect):** This is a distractor term. "Coalescence" specifically refers to the breakdown of bony trabeculae in the mastoid, not the middle ear itself. **High-Yield Clinical Pearls for NEET-PG:** * **Sagging of the posterosuperior meatal wall:** Another hallmark sign of coalescent mastoiditis due to periostitis. * **Ironed-out appearance:** Loss of the retroauricular sulcus due to edema over the mastoid. * **Radiology:** X-ray Schuller’s view or CT Temporal bone shows "clouding" of air cells and loss of bony septa (coalescence). * **Treatment:** Intravenous antibiotics; if failing, **Cortical Mastoidectomy** (Schwartze operation) is the surgery of choice.

Q: Which of the following is true about Glomus-jugulare tumors?

Lymph node metastasis is seen. **Explanation:** Glomus jugulare (Paraganglioma) is a benign but locally aggressive tumor arising from the paraganglia located in the adventitia of the jugular bulb. **1. Why Option C is Correct:** While Glomus tumors are generally considered benign, they are "locally invasive." Approximately **2–5% of cases** can exhibit malignancy. The hallmark of malignancy in paragangliomas is not cellular atypia, but rather the presence of **lymph node metastasis** or distant spread (most commonly to the lungs or liver). **2. Analysis of Incorrect Options:** * **Option A:** Glomus tumors are significantly **more common in females** (ratio approx. 4:1 to 6:1), typically presenting in the 4th–6th decades of life. * **Option B:** They arise from **non-chromaffin cells** (paraganglion cells) derived from the neural crest. These cells do not stain with chromium salts, unlike the chromaffin cells of the adrenal medulla. * **Option D:** While **multicentricity** can occur (especially in familial cases associated with SDH mutations), it is seen in only about **10% of sporadic cases**. In contrast, lymph node metastasis is a definitive pathological characteristic used to define malignancy in these tumors. **High-Yield Clinical Pearls for NEET-PG:** * **Pulsatile Tinnitus:** The most common presenting symptom (bruit heard by the patient). * **Brown’s Sign:** Pulsation seen on otoscopy that ceases with positive pressure using a Siegle’s speculum. * **Aquino’s Sign:** Blanching of the mass on carotid artery compression. * **Phelps’ Sign:** Loss of the bony crest between the carotid canal and jugular foramen on CT. * **Salt and Pepper Appearance:** Classic MRI finding (T2 sequence) due to high vascularity (flow voids). * **Treatment of Choice:** Surgical excision; preoperative embolization is often used to reduce vascularity.

Q: What is the most common congenital dysplasia of the ear?

Scheibe's dysplasia. **Explanation:** The correct answer is **Scheibe’s dysplasia** (Cochleosaccular dysplasia). It is the **most common** congenital inner ear anomaly, accounting for approximately 70% of cases. **1. Why Scheibe’s Dysplasia is Correct:** In this condition, the bony labyrinth is normal, but there is malformation of the membranous labyrinth. Specifically, it involves the **cochlea and the saccule** (the phylogenetically younger parts of the inner ear). The utricle and semicircular canals (older parts) remain functional. It is frequently associated with syndromes like Usher’s and Waardenburg syndrome. **2. Analysis of Incorrect Options:** * **Michel Aplasia:** This is the most severe but **rarest** form. It involves complete absence of both the bony and membranous inner ear structures due to developmental arrest at the 3rd week of gestation. * **Mondini’s Dysplasia:** This involves a bony abnormality where the cochlea has only **1.5 turns** instead of the normal 2.5 to 2.75 turns. While high-yield, it is less common than Scheibe’s. * **Alexander’s Dysplasia:** This involves a malformation of the **basal turn of the cochlea**, resulting in high-frequency sensorineural hearing loss. **Clinical Pearls for NEET-PG:** * **Scheibe’s Dysplasia:** Most common; affects membranous labyrinth only; Saccule + Cochlea involved. * **Mondini’s Dysplasia:** Associated with a risk of spontaneous CSF otorrhoea/rhinorrhoea and recurrent meningitis. * **Imaging:** Michel and Mondini dysplasias are visible on CT scans (bony defects), whereas Scheibe’s dysplasia is **not visible on CT** because the bony labyrinth is intact. * **Management:** Cochlear implants are the treatment of choice for profound bilateral cases in all the above, except Michel aplasia (where an Auditory Brainstem Implant is required).

Q: Identify the treatment option with the image given below:

Type 3 tympanoplasty. ***Type 3 tympanoplasty*** - This procedure, also known as **myringostapediopexy**, involves placing a graft directly onto the head of the stapes, as depicted in the image. - It is indicated when both the **malleus** and **incus** are eroded or absent, but the stapes is intact and mobile, allowing for sound transmission directly to the stapes. *Type 1 Tympanoplasty* - This is a simple repair of a tympanic membrane perforation, also called **myringoplasty**, where the graft is placed to close the hole. - This procedure is only suitable when the **ossicular chain** is completely intact and mobile, which is not the case shown. *Type 2 tympanoplasty* - This is performed when the **malleus** is eroded, and the graft is placed onto the **incus** or the remaining part of the malleus. - The image shows that the incus is also absent, as the graft is placed directly on the stapes, making this option incorrect. *Type 4 tympanoplasty* - This procedure is indicated when only the **stapes footplate** remains and is mobile; the graft is placed directly on the footplate. - This creates a very shallow middle ear space, essentially shielding only the round window and Eustachian tube opening, a more extensive reconstruction than shown.

Q: A 35-year-old woman presented to the clinic with the symptoms of hearing loss and pulsatile tinnitus. Further examination reveals conductive hearing loss with the Rinne test negative. A reddish mass is seen behind the tympanic membrane. What is the most likely diagnosis for this patient?

Glomus tumour. ***Glomus tumour (Correct Answer)*** - **Pulsatile tinnitus** combined with **conductive hearing loss** and a **reddish retrotympanic mass** forms the classic diagnostic triad for glomus tympanicum (a paraganglioma arising from glomus bodies). - The **reddish vascular mass** behind the tympanic membrane is pathognomonic, sometimes called the **'rising sun sign'** or demonstrating **Brown's sign** (blanching with pneumatic otoscopy). - This slow-growing, highly vascular tumor characteristically presents with these features in middle-aged adults. *Acute otitis media (Incorrect)* - This acute bacterial infection presents with rapid onset of **otalgia** (ear pain), **fever**, and a bulging, intensely red tympanic membrane. - While it causes temporary conductive hearing loss due to **purulent fluid** accumulation, it lacks the chronic presentation and **pulsatile tinnitus** characteristic of vascular masses. - The clinical course is acute (days), not chronic like glomus tumors. *Chronic otitis media (Incorrect)* - Defined by chronic inflammation typically resulting in **tympanic membrane perforation**, recurrent **otorrhea** (ear discharge), and possible **cholesteatoma** formation. - While it causes conductive hearing loss, it does **not** produce **pulsatile tinnitus** or a **reddish, vascular retrotympanic mass**. - The tympanic membrane shows perforation or scarring, not an intact membrane with a vascular mass behind it. *Serous otitis media (Incorrect)* - Also known as **otitis media with effusion**, involves sterile, non-purulent fluid in the middle ear from **eustachian tube dysfunction**. - The tympanic membrane appears dull, retracted, or shows **air-fluid levels** and bubbles, but does not show a vascular mass. - This condition does **not** cause **pulsatile tinnitus** and the fluid is serous, not vascular tissue.

Q: A patient presents to the clinic with a history of chronic ear drainage and hearing loss for several months. Otoscopic examination reveals a central perforation of the tympanic membrane. Pure tone audiometry confirms a conductive hearing loss. Based on these findings, what is the most appropriate next step in the definitive management of this patient's condition?

Myringoplasty. ***Myringoplasty*** - This procedure involves the surgical repair of the **tympanic membrane (TM)** perforation (a central perforation in this case) and is the definitive treatment for chronic otitis media, tubotympanic type (safe CSOM). - Repairing the TM perforation eliminates the source of chronic drainage and optimally helps in resolving the **conductive hearing loss** by restoring the vibrating surface. *Modified radical mastoidectomy* - This procedure is primarily reserved for **unsafe chronic otitis media** (Atticoantral disease), typically involving **cholesteatoma** or extensive irreversible mucosal disease in the mastoid. - Since the patient has a **central perforation** (safe type) without mention of retraction pockets or cholesteatoma, this extensive surgery is overmanagement and not indicated. *Exploratory tympanostomy* - This term generally refers to making an incision in the TM (myringotomy) or placing a **ventilation tube (grommet)**, typically done for otitis media with effusion (serous otitis media). - It does not address the underlying **chronic irreversible perforation** of the TM causing the current symptoms; surgical repair is required. *Immediate commencement of broad-spectrum oral antibiotics* - Antibiotics are useful for managing acute exacerbations of CSOM (controlling active discharge or infection) but are not the **definitive treatment** for the underlying structural pathology (chronic perforation). - They cannot **repair the tympanic membrane** or permanently restore hearing; the structural defect requires surgical intervention (myringoplasty).

Q: Identify the structure marked in the given image:

Lateral SCC. ***Lateral SCC*** - The image provided clearly labels the "Lateral semicircular canal" with a line pointing to the structure in question, confirming its identity. - The **semicircular canals** are part of the bony labyrinth of the inner ear, crucial for maintaining **balance**. *Facial nerve* - The **facial nerve** is also labeled in the diagram but points to a thin, yellow structure separate from the blue curved structure. - The facial nerve's primary role is controlling **facial expressions** and taste sensation. *Sino-dural angle* - The **sino-dural angle** refers to the junction of the sigmoid sinus and the posterior fossa dura, which is not specifically highlighted or pointed to as the structure in question. - This anatomical landmark is important in **otologic surgery** as a reference point. *Sigmoid sinus* - The **sigmoid sinus** is a venous channel labeled on the right side of the diagram, appearing as a larger blue structure. - It collects blood from the brain and drains into the **internal jugular vein**.

Q: A 25-year-old male complains of difficulty in hearing which has been worsening over last 6 months with occasional tinnitus. Otoscopy shows normal tympanic membrane. Pure tone audiometry shows following recording. What is the diagnosis?

Otosclerosis. ***Otosclerosis*** - The audiogram shows a **conductive hearing loss** with an air-bone gap, especially prominent at 2000 Hz (Carhart's notch), which is a classic finding in otosclerosis. - The patient's age (25-year-old male) and symptoms of progressive hearing loss and tinnitus with a **normal tympanic membrane** are consistent with otosclerosis. *Meniere's disease* - Meniere's disease typically presents with **fluctuating sensorineural hearing loss**, vertigo, tinnitus, and aural fullness, not conductive hearing loss. - The audiogram for Meniere's would primarily show **low-frequency sensorineural hearing loss**, without an air-bone gap like the one seen here. *Serous otitis media* - Serous otitis media causes **conductive hearing loss** due to fluid in the middle ear, but it is typically associated with a **dull or retracted tympanic membrane** and often occurs in children or after an upper respiratory infection. - While it causes conductive hearing loss, the specific pattern (Carhart's notch) and a normal tympanic membrane make otosclerosis a more likely diagnosis in this young adult. *Ear wax* - An **ear wax impaction** would also cause a conductive hearing loss, but it would be clearly visible on otoscopy, which is noted as normal in this case. - The audiogram would likely show a more generalized conductive loss rather than the specific pattern observed with Carhart's notch.

Q: Which of the following is a contraindication to the procedure shown below?

Glomus tumor. ***Glomus tumor*** - A **glomus tumor** as a contraindication because it is a highly vascular tumor in the middle ear, and performing a myringotomy (as depicted by the incisions 'C' and 'R' on the tympanic membrane) could lead to **severe hemorrhage**. - Identification of this tumor, often presenting as a **pulsatile red mass** behind the tympanic membrane, mandates further evaluation and planned surgical excision rather than a simple myringotomy. *Osteosclerosis* - **Osteosclerosis** refers to increased bone density and is not directly related to the tympanic membrane itself. - It would not typically contraindicate a myringotomy, which is a procedure involving an incision in the eardrum. *Myringosclerosis* - **Myringosclerosis** involves **calcified plaques** on the tympanic membrane, which indicates a thickened, scarred, and often less mobile eardrum. - While it may make the membrane slightly more rigid, it does not contraindicate a myringotomy when indicated for conditions like otitis media with effusion. *Thick tympanic membrane* - A **thick tympanic membrane** is often a result of chronic inflammation or past infections. - While it might require a sharper or stronger incision, it is not a direct contraindication to myringotomy, as the procedure is still feasible and can be necessary for drainage or ventilation.

Question 1

Mastoid reservoir phenomenon is positive in which of the following conditions?

Accepted Answer

Coalescent mastoiditis

Answer

Chronic suppurative otitis media (CSOM)

Answer

Petrositis

Answer

Coalescent otitis media

Question 2

Which of the following is true about Glomus-jugulare tumors?

Accepted Answer

Lymph node metastasis is seen

Answer

Most common in males

Answer

Arises from non-chromaffin cells

Answer

Multicentric origin

Question 3

What is the most common congenital dysplasia of the ear?

Accepted Answer

Scheibe's dysplasia

Answer

Michel aplasia

Answer

Mondini's dysplasia

Answer

Alexander's dysplasia

Question 4

Identify the treatment option with the image given below:

Accepted Answer

Type 3 tympanoplasty

Answer

Type 2 tympanoplasty

Answer

Type 4 tympanoplasty

Answer

Type 1 tympanoplasty

Question 5

A 35-year-old woman presented to the clinic with the symptoms of hearing loss and pulsatile tinnitus. Further examination reveals conductive hearing loss with the Rinne test negative. A reddish mass is seen behind the tympanic membrane. What is the most likely diagnosis for this patient?

Accepted Answer

Glomus tumour

Answer

Chronic otitis media

Answer

Serous otitis media

Answer

Acute otitis media

Question 6

A patient presents to the clinic with a history of chronic ear drainage and hearing loss for several months. Otoscopic examination reveals a central perforation of the tympanic membrane. Pure tone audiometry confirms a conductive hearing loss. Based on these findings, what is the most appropriate next step in the definitive management of this patient's condition?

Accepted Answer

Myringoplasty

Answer

Immediate commencement of broad-spectrum oral antibiotics

Answer

Modified radical mastoidectomy

Answer

Exploratory tympanostomy

Question 7

Identify the structure marked in the given image:

Accepted Answer

Lateral SCC

Answer

Facial nerve

Answer

Sino-dural angle

Answer

Sigmoid sinus

Question 8

All of the following statements regarding this instrument are true except: (Recent NEET Pattern 2016-17)

Accepted Answer

This device is used to administer antibiotics in the middle ear cavity

Answer

Speculum that is used here has a concave lens with a magnification of 2.5 times

Answer

This device is used to assess tympanic membrane mobility

Answer

This device is used to suck out middle ear secretions

Question 9

A 25-year-old male complains of difficulty in hearing which has been worsening over last 6 months with occasional tinnitus. Otoscopy shows normal tympanic membrane. Pure tone audiometry shows following recording. What is the diagnosis?

Accepted Answer

Otosclerosis

Answer

Meniere's disease

Answer

Serous otitis media

Answer

Ear wax

Question 10

Which of the following is a contraindication to the procedure shown below?

Accepted Answer

Glomus tumor

Answer

Osteosclerosis

Answer

Myringosclerosis

Answer

Thick tympanic membrane

Otology — MCQs

Otology — MCQs

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