Otology Practice Questions

Q: Greisinger's sign is suggestive of:

Acute mastoiditis with lateral sinus thrombosis. ### Explanation **Greisinger’s sign** is a classic clinical finding in **Lateral Sinus Thrombosis (LST)**, which is a serious extracranial complication of chronic or acute coalescent mastoiditis. #### 1. Why Option A is Correct The sign refers to **pitting edema and tenderness over the mastoid process**, specifically over the area of the mastoid emissary vein. * **Pathophysiology:** When the lateral (sigmoid) sinus becomes thrombosed, the retrograde pressure causes thrombosis or congestion of the **mastoid emissary vein**. This leads to localized edema and inflammatory changes in the soft tissues behind the mastoid. * In the context of the NEET-PG, this is a high-yield association with "Hectic Pick-fence" fever and the Griesinger sign. #### 2. Why Other Options are Incorrect * **Option B:** Maxillary cancer spreading to the nasal cavity presents with cheek swelling, epistaxis, or infraorbital anesthesia, but does not involve mastoid edema. * **Option C:** Rhinosporidiosis is a granulomatous fungal-like infection (caused by *Rhinosporidium seeberi*) characterized by leafy, strawberry-like nasal masses; it has no relation to venous thrombosis. * **Option D:** While LST can lead to internal jugular vein (IJV) thrombosis, the specific sign for IJV involvement is a palpable "cord-like" swelling in the neck, not mastoid edema. #### 3. Clinical Pearls for NEET-PG * **Tobey-Ayer Test / Queckenstedt’s Test:** Used during lumbar puncture to diagnose LST. Compression of the IJV on the affected side fails to show a rise in CSF pressure. * **Crowe-Beck Test:** Engorgement of retinal veins and conjunctiva upon compressing the IJV on the healthy side. * **Delta Sign (Empty Triangle Sign):** Seen on contrast-enhanced CT, representing a clot in the sigmoid sinus surrounded by dural enhancement. * **Treatment:** High-dose antibiotics, mastoidectomy, and potentially anticoagulants.

Q: A 30-year-old woman with a family history of hearing loss from her mother's side developed a hearing problem during pregnancy. The hearing loss is bilateral and slowly progressive. Pure tone audiometry shows an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

Otosclerosis. ### Explanation **1. Why Otosclerosis is the Correct Answer:** The clinical presentation is classic for **Otosclerosis**, a primary metabolic bone disease of the otic capsule. * **Epidemiology:** It typically affects young adults (20–30 years) and has a strong **autosomal dominant** inheritance with incomplete penetrance (family history). * **Pregnancy:** Hormonal changes during pregnancy are known to accelerate the progression of the disease. * **Audiometry:** The "apparent bone conduction loss at 2000 Hz" is the pathognomonic **Carhart’s Notch**. This is not a true sensorineural loss but a mechanical artifact caused by the loss of the stapes' resonance frequency (normally 2000 Hz) due to stapedial fixation. **2. Why Other Options are Incorrect:** * **Acoustic Neuroma:** This presents with unilateral sensorineural hearing loss and tinnitus, not bilateral conductive loss triggered by pregnancy. * **Otitis Media with Effusion (OME):** While it causes conductive hearing loss, it is usually associated with Eustachian tube dysfunction or URTI and would show a "B" type tympanogram, not Carhart’s notch. * **Sigmoid Sinus Thrombosis:** This is a complication of chronic suppurative otitis media (CSOM) presenting with "picket-fence" fever and headache, not progressive hearing loss. **3. High-Yield Clinical Pearls for NEET-PG:** * **Schwartz Sign:** A flamingo-pink flush seen on the promontory through the TM (indicates active disease/otospongiosis). * **Gelle’s Test:** Negative (indicates stapes fixation). * **Tympanometry:** Typically shows an **As type** curve (stiffened ossicular chain). * **Treatment of Choice:** **Stapedotomy** (with Teflon piston insertion). Sodium fluoride can be used to medically manage the active phase.

Q: McEwan's triangle is formed by all the following except:

Floor of bony canal wall. **Explanation:** **MacEwen’s Triangle** (also known as the **Suprameatal Triangle**) is a vital surgical landmark on the outer surface of the mastoid bone. It serves as a guide for the surgeon to locate the **Mastoid Antrum**, which lies approximately 12–15 mm deep to this area. **Why Option C is the correct answer:** The **floor of the bony canal wall** does not contribute to the boundaries of MacEwen’s triangle. The triangle is located superior and posterior to the external auditory canal (EAC), whereas the floor is the most inferior part of the canal. **Analysis of the boundaries (Incorrect Options):** * **Superior Boundary:** Formed by the **Supramastoid crest** (the continuation of the **Temporal line**). (Option B) * **Anterior Boundary:** Formed by the **Posterosuperior margin/wall of the bony external auditory canal**. (Option A) * **Posterior Boundary:** Formed by a **tangent drawn to the posterior wall of the EAC**, perpendicular to the temporal line. (Option D) **Clinical Pearls for NEET-PG:** 1. **Surgical Significance:** MacEwen’s triangle is the primary landmark used during **Mastoidectomy** to safely enter the mastoid antrum. 2. **Henle’s Spine (Suprameatal Spine):** A small bony projection often found at the anteroinferior margin of the triangle; it is a key surgical landmark for the antrum. 3. **Depth:** In adults, the antrum is roughly 15 mm deep to the triangle. In infants, it is much more superficial (only about 2 mm deep). 4. **Content:** The mastoid antrum is the largest air cell and communicates with the middle ear via the *aditus ad antrum*.

Q: Cortical mastoidectomy is indicated in which of the following conditions?

Coalescent mastoiditis. **Explanation:** **Cortical Mastoidectomy** (also known as Schwartze operation) is a **conservative** surgical procedure where all accessible mastoid air cells are exenterated, converting them into a single cavity without disturbing the posterior meatal wall or the contents of the middle ear. **Why Coalescent Mastoiditis is the Correct Answer:** Coalescent mastoiditis is a complication of Acute Otitis Media (AOM) where the bony septa between mastoid air cells break down due to pressure from pus, forming a single empyema cavity. The primary goal of treatment is to **drain the pus** and remove the infected air cells while preserving hearing. Since the ossicles and middle ear structures are usually intact, a cortical mastoidectomy is the procedure of choice. **Analysis of Incorrect Options:** * **A & D (Cholesteatoma / Pars Flaccida Perforation):** These represent "unsafe" Chronic Suppurative Otitis Media (CSOM). Cholesteatoma is bone-eroding and requires a **Modified Radical Mastoidectomy (MRM)** or Radical Mastoidectomy to ensure complete removal and exteriorization of the disease. * **C (CSOM with Brain Abscess):** This is a life-threatening complication of chronic disease. It requires a **Modified Radical Mastoidectomy** (to address the primary source) along with neurosurgical drainage of the abscess. **High-Yield Clinical Pearls for NEET-PG:** * **Indications for Cortical Mastoidectomy:** Coalescent mastoiditis, masked mastoiditis, as a preliminary step in Endolymphatic sac surgery or Cochlear Implantation, and persistent ASOM. * **Boundaries of MacEwen’s Triangle (Surgical Landmark):** Superiorly (Supramastoid crest), Anteriorly (Postero-superior margin of external auditory canal), Posteriorly (Tangent to the EAC). * **Key Concept:** Cortical mastoidectomy **preserves** the posterior canal wall; Radical mastoidectomy **removes** it.

Q: What condition is characterized by a pulsatile tumor in the external auditory meatus that bleeds on touch?

Glomus tumor. **Explanation:** The correct answer is **Glomus tumor** (specifically Glomus Jugulare or Glomus Tympanicum). These are highly vascular, slow-growing, benign but locally invasive neuroendocrine tumors arising from the paraganglia. **Why Glomus Tumor is correct:** The hallmark of a glomus tumor is its **extreme vascularity**. When the tumor grows from the middle ear and erodes through the tympanic membrane into the external auditory meatus, it appears as a reddish-pink, fleshy mass. Because it arises from vascular tissue, it exhibits **pulsatility** (synchronous with the pulse) and **profuse bleeding** upon even minor manipulation or touch. **Why other options are incorrect:** * **Cholesteatoma:** This is a keratinizing squamous epithelium collection. It typically appears as a pearly white, non-vascular mass and does not bleed on touch or pulsate. * **Polyp:** While an inflammatory aural polyp can bleed, it is usually associated with chronic suppurative otitis media (CSOM) and lacks the characteristic rhythmic pulsation of a glomus tumor. * **Malignancy of the middle ear:** Squamous cell carcinoma can present as a friable mass that bleeds, but it is characterized by deep-seated pain, blood-stained discharge, and early facial nerve palsy rather than a distinct pulsatile nature. **High-Yield Clinical Pearls for NEET-PG:** * **Pulsatile Tinnitus:** The most common early symptom of a glomus tumor. * **Brown’s Sign:** Pulsation of the tumor seen on otoscopy, which ceases when ear canal pressure is raised above systolic pressure using a Siegel’s speculum. * **Aqueduct Sign (Phelps' Sign):** Loss of bony septum between the jugular bulb and the carotid canal (seen on CT). * **Rising Sun Appearance:** A red flush seen behind an intact tympanic membrane in early stages.

Q: Otospongiosis is inherited as?

Autosomal dominant. **Explanation:** **Otospongiosis (Otosclerosis)** is a primary metabolic bone disease of the otic capsule characterized by the replacement of normal dense bone with vascular irregular spongy bone. **1. Why Autosomal Dominant is Correct:** Otosclerosis is inherited as an **Autosomal Dominant** trait with **incomplete penetrance** (approximately 40%) and **variable expressivity**. This means that while the gene is dominant, not everyone who inherits it will manifest the clinical disease. About 50% of cases have a positive family history. The condition is most commonly seen in young adults (20–30 years), with a female-to-male ratio of 2:1, and it often progresses during pregnancy. **2. Why Other Options are Incorrect:** * **Autosomal Recessive:** While some sporadic cases occur, the classic familial pattern follows a dominant inheritance. Recessive patterns are more typical of congenital non-syndromic deafness (e.g., GJB2 mutations). * **X-linked Inheritance (Dominant/Recessive):** Otosclerosis shows no sex-linked linkage. Although it is more common in females, this is due to hormonal influences rather than X-chromosome inheritance. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Fissula ante fenestram (leads to stapedial fixation). * **Clinical Sign:** **Schwartze sign** (Flamingo flush) – reddish hue seen through the TM due to increased vascularity of the promontory. * **Audiometry:** **Carhart’s Notch** (dip in bone conduction at 2000 Hz). * **Tympanometry:** **As type** (Stiffened system) curve. * **Treatment of choice:** Stapedotomy (preferred over stapedectomy). * **Medical management:** Sodium fluoride (to mature active foci).

Q: A steel worker presented with noise-induced hearing loss. Which part of the inner ear is most likely affected?

Outer hair cell. **Explanation:** Noise-Induced Hearing Loss (NIHL) is a sensorineural hearing loss resulting from exposure to high-intensity sound. The primary site of pathology in the inner ear is the **Organ of Corti** within the cochlea. **1. Why Outer Hair Cells (OHCs) are the correct answer:** The **Outer Hair Cells** are the most metabolically active and mechanically fragile structures in the cochlea. They function as "cochlear amplifiers." Exposure to excessive noise leads to overstimulation, causing oxidative stress, mitochondrial dysfunction, and eventually structural damage or apoptosis of the OHCs. Damage typically begins at the basal turn of the cochlea, corresponding to high-frequency sounds (classically **4000 Hz**). **2. Why other options are incorrect:** * **Inner Hair Cells (IHCs):** While IHCs can be damaged in severe or chronic cases, they are more resilient than OHCs. OHC damage always precedes IHC damage in NIHL. * **Macula:** This is the sensory epithelium of the vestibule (utricle and saccule) responsible for linear acceleration and static equilibrium. It is not involved in hearing. * **Cupula:** This is a gelatinous structure in the ampulla of the semicircular canals responsible for angular acceleration. It is part of the vestibular system, not the auditory system. **Clinical Pearls for NEET-PG:** * **Acoustic Dip:** NIHL characteristically shows a V-shaped notch at **4 kHz** (Boiler-maker's notch) on an audiogram. * **Temporary Threshold Shift (TTS):** Reversible hearing loss (auditory fatigue) following noise exposure. * **Permanent Threshold Shift (PTS):** Irreversible damage due to prolonged exposure or high-intensity impulse noise. * **Presbycusis vs. NIHL:** Both affect high frequencies, but NIHL specifically targets 4 kHz initially, whereas presbycusis is a sloping loss starting at the highest frequencies.

Question 1

Greisinger's sign is suggestive of:

Accepted Answer

Acute mastoiditis with lateral sinus thrombosis

Answer

Maxillary cancer with spread to nasal cavity

Answer

Rhinosporidiosis

Answer

Jugular vein thrombosis

Question 2

A 30-year-old woman with a family history of hearing loss from her mother's side developed a hearing problem during pregnancy. The hearing loss is bilateral and slowly progressive. Pure tone audiometry shows an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

Accepted Answer

Otosclerosis

Answer

Acoustic neuroma

Answer

Otitis media with effusion

Answer

Sigmoid sinus thrombosis

Question 3

Which of the following statements regarding the facial nerve and its relations is FALSE?

Accepted Answer

The tympanic segment of the facial nerve is located below the round window and above the horizontal semicircular canal.

Answer

The processus cochleariformis serves as a landmark for the geniculate ganglion of the facial nerve.

Answer

The mastoid segment of the facial nerve is consistently situated posterior to the tympanomastoid suture.

Answer

A patient with a lesion between the geniculate ganglion and the nerve to the stapedius will experience phonophobia, loss of the stapedial reflex, and impaired taste sensation.

Question 4

McEwan's triangle is formed by all the following except:

Accepted Answer

Floor of bony canal wall

Answer

Posterosuperior bony canal wall

Answer

Temporal line

Answer

Tangential line drawn to the external auditory canal

Question 5

Cortical mastoidectomy is indicated in which of the following conditions?

Accepted Answer

Coalescent mastoiditis

Answer

Cholesteatoma without complication

Answer

Chronic suppurative otitis media with brain abscess

Answer

Perforation in the pars flaccida

Question 6

What condition is characterized by a pulsatile tumor in the external auditory meatus that bleeds on touch?

Accepted Answer

Glomus tumor

Answer

Cholesteatoma

Answer

Polyp

Answer

Malignancy of the middle ear

Question 7

Over the past 10 years, a 50-year-old male has had progressive difficulty hearing, particularly on the left side. Audiometry testing reveals that he has a bone conduction type of deafness. Which of the following conditions is he most likely to have?

Accepted Answer

Otosclerosis

Answer

Cholesteatoma

Answer

Schwannoma

Answer

Otitis media

Question 8

Otospongiosis is inherited as?

Accepted Answer

Autosomal dominant

Answer

Autosomal recessive

Answer

X-linked dominant

Answer

X-linked recessive

Question 9

Which of the following conditions will result in the maximum conductive hearing loss?

Accepted Answer

Intact tympanic membrane with ossicular discontinuity

Answer

Partial stapes fixation

Answer

Tympanic membrane perforation with an intact ossicular chain

Answer

Tympanic membrane perforation with ossicular discontinuity

Question 10

A steel worker presented with noise-induced hearing loss. Which part of the inner ear is most likely affected?

Accepted Answer

Outer hair cell

Answer

Inner hair cell

Answer

Macula

Answer

Cupula

Otology — MCQs

Otology — MCQs

On this page

Practice by Chapter

Want unlimited practice?