A young boy came to OPD with complaints of difficulty in breathing. On examination, bilateral polyps were found. On aspiration, bleeding was seen. What will be the initial management?
All the following are true about Meniere's disease except?
What is the most common cause of deafness in a patient with Nasopharyngeal Carcinoma:
FMGE 2019 - ENT FMGE Practice Questions and MCQs
Question 1: A young boy came to OPD with complaints of difficulty in breathing. On examination, bilateral polyps were found. On aspiration, bleeding was seen. What will be the initial management?
- A. Septoplasty
- B. I and D
- C. Topical corticosteroids (Correct Answer)
- D. Antihistaminic
Explanation: ***Topical corticosteroids*** - **Topical corticosteroids** are the **first-line medical management** for **nasal polyps**, helping to reduce inflammation and shrink polyp size. - They work by reducing local inflammation and edema, improving nasal airway patency and breathing. - **Important note**: The presence of **bleeding on aspiration** suggests a **vascular lesion** (such as juvenile nasopharyngeal angiofibroma in young males), which would require **imaging (CT/MRI) before any intervention** and **no biopsy** due to hemorrhage risk. However, if these are inflammatory polyps, topical steroids remain the initial medical management. *Antihistaminic* - **Antihistamines** are not first-line treatment for nasal polyps, as polyps are primarily an **eosinophilic inflammatory condition** rather than a simple IgE-mediated allergic reaction. - While antihistamines may help with associated allergic rhinitis symptoms, they do **not shrink polyps** or address the underlying inflammatory pathology. *Septoplasty* - **Septoplasty** is a surgical procedure to correct a **deviated nasal septum**, not for treating nasal polyps. - This would not address the bilateral polyps causing difficulty in breathing. *I and D* - **Incision and drainage (I&D)** is performed for abscesses or pus collections, which is not the presentation here. - Nasal polyps are benign inflammatory masses, not infectious collections requiring drainage.
Question 2: All the following are true about Meniere's disease except?
- A. Low frequency hearing loss
- B. Increase in endolymph
- C. Idiopathic
- D. Destroying the cochlea is mandatory (Correct Answer)
Explanation: ***Destroying the cochlea is mandatory*** - While various interventions, including **destructive procedures**, exist for Meniere's disease in severe cases refractory to medical therapy (e.g., labyrinthectomy, vestibular neurectomy), it is **not mandatory** for diagnosis or initial management. - Initial management typically involves **conservative medical treatment** to control symptoms, such as **diuretics**, low-salt diet, and symptomatic relief during attacks. *Low frequency hearing loss* - Meniere's disease typically presents with **fluctuating sensorineural hearing loss**, predominantly affecting **low frequencies** in the early stages. - This characteristic hearing loss is often associated with aural fullness and tinnitus. *Increase in endolymph* - The underlying pathology of Meniere's disease is believed to be **endolymphatic hydrops**, which is an **excessive accumulation of endolymph** in the inner ear. - This increased pressure within the endolymphatic system distorts the membranous labyrinth, leading to the classic symptoms. *Idiopathic* - Meniere's disease is generally considered **idiopathic**, meaning its specific cause is unknown. - While various theories exist regarding its etiology (e.g., viral infections, autoimmune disorders, vascular compromise), a definitive cause has not been identified.
Question 3: What is the most common cause of deafness in a patient with Nasopharyngeal Carcinoma:
- A. Fluid accumulation in the middle ear due to eustachian tube obstruction (Correct Answer)
- B. Middle ear Infection
- C. Metastasis to Temporal Bone
- D. Infiltration of Tumour into middle ear
Explanation: ***Fluid accumulation in the middle ear due to eustachian tube obstruction*** - **Nasopharyngeal carcinoma** often grows in close proximity to the opening of the **eustachian tube**, leading to its obstruction. - Obstruction of the eustachian tube prevents proper ventilation of the middle ear, leading to a build-up of fluid (**serous otitis media**), which causes a **conductive hearing loss**. *Middle ear Infection* - While middle ear infections can cause deafness, they are not the most common cause of hearing loss directly attributable to **nasopharyngeal carcinoma**. - **Fluid accumulation due to Eustachian tube dysfunction** precedes infection and is the primary mechanism linked to the tumor. *Metastasis to Temporal Bone* - **Metastasis to the temporal bone** can occur in advanced stages of nasopharyngeal carcinoma, causing hearing loss. - However, direct **eustachian tube obstruction and serous otitis media** are significantly more common initial presentations of hearing impairment. *Infiltration of Tumour into middle ear* - While direct tumor infiltration into the middle ear can lead to deafness, it is less common than the effect of **eustachian tube obstruction**. - **Tumor infiltration** typically indicates more advanced local disease, whereas **eustachian tube dysfunction** can be an early symptom.