Otology Practice Questions

Q: Which one does not cause VII Nerve palsy :

Pertussis. ***Pertussis*** - **Pertussis**, or whooping cough, is a respiratory infection caused by **Bordetella pertussis** that does not directly cause facial nerve palsy. - While prolonged, severe coughing fits can cause complications like subconjunctival hemorrhage or rib fractures, **cranial nerve palsies** are not a typical manifestation. *Parotid tumor* - Malignant **parotid tumors** commonly infiltrate and compress the **facial nerve (cranial nerve VII)** as it passes through the parotid gland. - This can lead to **unilateral facial nerve palsy**, often presenting as facial weakness or paralysis on the affected side. *ASOM* - **Acute suppurative otitis media (ASOM)**, or acute middle ear infection, can lead to **facial nerve palsy** due to inflammation or direct extension of infection to the facial nerve. - The facial nerve runs in close proximity to the middle ear, making it vulnerable to complications from severe or untreated infections. *Herpes zoster* - **Herpes zoster oticus** (Ramsay Hunt syndrome) is caused by reactivation of the **varicella-zoster virus** in the geniculate ganglion of the facial nerve. [1] - This condition is a well-known cause of acute **facial nerve palsy**, often accompanied by painful vesicular rash in the ear canal and hearing loss. [1]

Q: Schwartze's operation is also called as:

Cortical mastoidectomy. ***Cortical mastoidectomy*** - **Schwartze's operation** is synonymous with **cortical mastoidectomy**, which involves removing diseased mastoid air cells while preserving the ear canal and ossicular chain. - This procedure is typically performed for acute **coalescent mastoiditis**. *Modified radical mastoidectomy* - This involves removing the mastoid air cells and the posterior wall of the external auditory canal while preserving the **tympanic membrane** and ossicles (or a portion of them). - It is often performed for **cholesteatoma** with good hearing. *Radical mastoidectomy* - This is the most extensive mastoidectomy procedure, involving complete removal of mastoid air cells, middle ear structures, and the posterior canal wall to create a common cavity. - It is performed for extensive **cholesteatoma** or chronic ear disease when hearing preservation is not possible. *Fenestration operation* - This is a surgical procedure to create a new opening (fenestra) in the **horizontal semicircular canal** to improve hearing in cases of otosclerosis. - This procedure is not a mastoidectomy and addresses a different etiology of hearing loss.

Q: Earliest symptom of glomus tumor is?

Pulsatile tinnitus. ***Pulsatile tinnitus*** - **Pulsatile tinnitus** is often the earliest and most characteristic symptom of a glomus tumor due to its highly vascular nature and close proximity to vascular structures. - Patients typically report hearing a **heartbeat-like sound** in their ear that corresponds to their pulse. *Pulsatile otorrhoea* - **Pulsatile otorrhoea** would indicate active discharge from the ear, often associated with a perforating membrane or advanced infection, which is not an early sign of an internal vascular tumor. - This symptom suggests a more advanced or complicated ear pathology rather than the primary presentation of a glomus tumor. *Facial nerve palsy* - **Facial nerve palsy** occurs when the glomus tumor has grown to a significant size and begins to compress or invade the facial nerve, indicating a more advanced stage of the disease. - Isolated facial nerve weakness is not typically the first symptom but rather a complication of tumor extension. *Hearing Loss* - While **hearing loss** can be a symptom of a glomus tumor, it is often not the earliest and is usually **conductive** due to obstruction of the middle ear rather than sensorineural. - Many other middle ear pathologies like otitis media or otosclerosis cause hearing loss earlier and more commonly.

Q: A patient with cholesteatoma has lateral semicircular canal fistula. The most specific sign is:

Fistula test. ***Fistula test*** - The **fistula test** (Positive pressure test or Hennebert's test) directly assesses for a communication between the middle ear and the labyrinth by applying positive or negative pressure to the external auditory canal. - A positive result, indicated by **nystagmus** or **vertigo** induced by pressure changes, is the **most specific sign** for a **labyrinthine fistula** in the context of **cholesteatoma**. - The lateral semicircular canal is the most commonly affected site in cholesteatoma-related fistulae. *Hennebert's sign* - **Hennebert's sign** refers to **nystagmus** or **vertigo** induced by pressure changes in the external auditory canal **in the absence of an actual fistula**. - It represents a **false positive fistula test** and is classically associated with **congenital syphilis**, **Meniere's disease**, or other conditions causing increased labyrinthine membrane mobility. - In this case with a **confirmed fistula**, the positive pressure test would be called a **positive fistula test**, not Hennebert's sign. *Head thrust test* - The **head thrust test** evaluates the function of the **vestibulo-ocular reflex (VOR)** and is used to detect **peripheral vestibular hypofunction**. - While cholesteatoma can affect vestibular function, this test is **not specific** for identifying a **labyrinthine fistula**. *Dix-Hallpike test* - The **Dix-Hallpike test** is used to diagnose **Benign Paroxysmal Positional Vertigo (BPPV)** by identifying nystagmus and vertigo triggered by specific head positions. - This test detects **otoconia displacement** in the semicircular canals and is **not relevant** for identifying a **labyrinthine fistula**.

Q: A factory worker develops hearing loss. Most likely affected frequency range (Hz)?

3000-6000 Hz. ***3000-6000*** - **Noise-induced hearing loss (NIHL)**, common in factory workers, typically affects the **higher frequencies** first, particularly the 3000-6000 Hz range. - This specific range includes a characteristic "notch" at **4000 Hz** often seen in audiograms of individuals with NIHL. *8000-10000* - While high frequencies can be affected, the **initial and most pronounced damage** in NIHL often occurs at slightly lower frequencies (3000-6000 Hz). - Hearing loss at over **8000 Hz** is usually associated with presbycusis (age-related hearing loss) or ototoxic medications rather than primarily NIHL. *500-1000* - Hearing loss in the **lower frequencies** (500-1000 Hz) is less common for early manifestations of noise-induced hearing loss. - Loss in this range is more indicative of **conductive hearing loss** or other types of sensorineural hearing loss, but not typically NIHL. *1000-2000* - While important for speech comprehension, this range is generally affected **later** in the progression of noise-induced hearing loss. - Initial pure tone audiogram changes due to NIHL are rarely seen initially at these frequencies, with the **4000 Hz notch** being a hallmark.

Q: Which of the following is the most common cause of sensorineural hearing loss in adults?

Presbycusis. ***Presbycusis*** - **Presbycusis**, or age-related hearing loss, is the **most common cause of sensorineural hearing loss** in adults, typically affecting both ears symmetrically. - It results from gradual changes in the **inner ear**, particularly the hair cells of the cochlea, due to the aging process. *Meniere's disease* - Characterized by a classic triad of **vertigo**, fluctuating **sensorineural hearing loss**, and **tinnitus** with aural fullness. - While it causes sensorineural hearing loss, it is **less common** than presbycusis and often presents with additional vestibular symptoms. *Acoustic neuroma* - This is a rare, benign tumor on the **vestibulocochlear nerve** (cranial nerve VIII) that can cause unilateral or asymmetric sensorineural hearing loss, **tinnitus**, and balance issues. - It is a **specific and localized cause** of hearing loss, not a widespread or common cause in the general adult population. *Chronic otitis media* - Chronic otitis media typically causes **conductive hearing loss** due to damage to the middle ear structures like the tympanic membrane or ossicles. - While prolonged inflammation can sometimes lead to secondary sensorineural involvement, its **primary effect is on middle ear sound conduction**, not directly on the inner ear.

Q: A 35-year-old male presents with pulsatile tinnitus and a reddish mass behind the tympanic membrane. What is the most likely diagnosis?

Glomus tumor. ***Glomus tumor*** - A **glomus tumor** (paraganglioma) typically presents with **pulsatile tinnitus** due to its vascular nature and appears as a **reddish mass behind the tympanic membrane**. - Its presence can lead to **conductive hearing loss** and, in some cases, cranial nerve palsies due to local invasion. *Cholesteatoma* - A **cholesteatoma** is a benign growth of **squamous epithelium** that causes a white, pearly mass, not a reddish one, and often leads to foul-smelling discharge and bone erosion. - While it can cause hearing loss and tinnitus, the tinnitus is usually not pulsatile, and the visual appearance behind the tympanic membrane is distinct. *Otosclerosis* - **Otosclerosis** is characterized by abnormal bone remodeling in the middle ear, leading to **progressive conductive hearing loss**, typically without a visible mass behind the tympanic membrane. - It does not cause pulsatile tinnitus or a reddish mass; rather, the tympanic membrane often appears normal or may show a "Schwartze sign" (reddish hue over the promontory) in active disease, which is different from a distinct mass. *Acoustic neuroma* - An **acoustic neuroma** (vestibular schwannoma) is a benign tumor of the **vestibulocochlear nerve** that typically causes **unilateral sensorineural hearing loss**, tinnitus (often non-pulsatile), and balance issues. - It does not present as a visible mass behind the tympanic membrane, as it is located internally within the cerebellopontine angle.

Q: Pink reflex through intact tympanic membrane in active otosclerosis is known as

Schwartz sign. ***Schwartz sign*** - The **Schwartz sign** (also known as the **flaming or pink tympanum sign**) is a reddish hue visible through the tympanic membrane. - It is caused by **hyperemia** (increased blood flow) to the promontory's mucosa, indicating active, vascularized otosclerotic foci. *Schwabach's test* - This is a **tuning fork test** that compares the patient's bone conduction with the examiner's. - It assesses **sensorineural hearing loss** but does not involve direct visualization of the tympanic membrane. *Lyre's phenomenon* - This term is **not typically associated** with otosclerosis or ear examination findings. - It appears to be a **distractor** and does not describe any known clinical sign in otology. *Chvostek's reflex* - This is a **clinical sign of hypocalcemia**, characterized by twitching of the facial muscles when tapping the facial nerve. - It is **neurological in nature** and unrelated to ear pathology or otosclerosis.

Question 1

Which one does not cause VII Nerve palsy :

Accepted Answer

Pertussis

Answer

Parotid tumor

Answer

ASOM

Answer

Herpes zoster

Question 2

Schwartze's operation is also called as:

Accepted Answer

Cortical mastoidectomy

Answer

Modified radical mastoidectomy

Answer

Radical mastoidectomy

Answer

Fenestration operation

Question 3

Earliest symptom of glomus tumor is?

Accepted Answer

Pulsatile tinnitus

Answer

Pulsatile otorrhoea

Answer

Facial nerve palsy

Answer

Hearing Loss

Question 4

A patient with cholesteatoma has lateral semicircular canal fistula. The most specific sign is:

Accepted Answer

Fistula test

Answer

Head thrust test

Answer

Hennebert's sign

Answer

Dix-Hallpike test

Question 5

A factory worker develops hearing loss. Most likely affected frequency range (Hz)?

Accepted Answer

3000-6000 Hz

Answer

8000-10000 Hz

Answer

500-1000 Hz

Answer

1000-2000 Hz

Question 6

Assertion: Otosclerosis results in sensorineural hearing loss in the late stages. Reason: In otosclerosis, abnormal bone growth occurs at the stapes footplate, leading to fixation of the stapes and conductive hearing loss.

Accepted Answer

Both Assertion and Reason are true, but Reason is not the correct explanation for Assertion.

Answer

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion.

Answer

Both Assertion and Reason are false.

Answer

Assertion is true, but Reason is false.

Question 7

Best treatment for traumatic facial nerve injury with no improvement after 3 months?

Accepted Answer

Facial nerve decompression

Answer

Conservative management

Answer

Steroids

Answer

Facial sling

Question 8

Which of the following is the most common cause of sensorineural hearing loss in adults?

Accepted Answer

Presbycusis

Answer

Meniere's disease

Answer

Acoustic neuroma

Answer

Chronic otitis media

Question 9

A 35-year-old male presents with pulsatile tinnitus and a reddish mass behind the tympanic membrane. What is the most likely diagnosis?

Accepted Answer

Glomus tumor

Answer

Cholesteatoma

Answer

Otosclerosis

Answer

Acoustic neuroma

Question 10

Pink reflex through intact tympanic membrane in active otosclerosis is known as

Accepted Answer

Schwartz sign

Answer

Schwabach's test

Answer

Lyre's phenomenon

Answer

Chvostek's reflex

Otology — MCQs

Otology — MCQs

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