All of the following are features of Tubotympanic CSOM except which of the following?
All of the following are causes of perforation of the cartilaginous part of the nasal septum except?
Which of the following statements about malignant otitis externa is true?
Hennebert's sign is a false positive fistula test when there is no evidence of middle ear disease causing a fistula of the horizontal semicircular canal. It is seen in?
NEET-PG 2015 - ENT NEET-PG Practice Questions and MCQs
Question 21: All of the following are features of Tubotympanic CSOM except which of the following?
- A. Profuse discharge
- B. Hearing loss
- C. Extreme pain (Correct Answer)
- D. Facial nerve paralysis
Explanation: ***Extreme pain*** - **Extreme pain** is NOT a characteristic feature of **tubotympanic CSOM**. This type is typically associated with a history of **painless otorrhea**. - Tubotympanic CSOM is considered the "safe" type with inflammation limited to the mucosa without bone erosion. - The presence of severe pain should raise suspicion for complications or the **atticoantral (unsafe) type** of CSOM. *Profuse discharge* - **Profuse, mucoid** or **mucopurulent discharge** is a hallmark feature of tubotympanic CSOM. - This discharge results from chronic inflammation of the **middle ear mucoperiosteum** through a central perforation in the **pars tensa**. - The discharge is typically non-foul smelling (unlike atticoantral CSOM). *Hearing loss* - **Conductive hearing loss** is a universal feature of tubotympanic CSOM. - Results from **tympanic membrane perforation**, middle ear effusion, and potential ossicular discontinuity. - The degree of hearing loss correlates with the size and location of the perforation. *Facial nerve paralysis* - Facial nerve paralysis is **NOT a typical feature** of tubotympanic (safe) CSOM. - This complication is characteristically associated with **atticoantral (unsafe) CSOM** with cholesteatoma causing bone erosion. - While theoretically possible in very advanced neglected tubotympanic disease, it would indicate transformation to unsafe disease or secondary complications. - **Note:** Some sources may list this as a rare complication, but it is not a characteristic feature distinguishing tubotympanic CSOM, making this option potentially ambiguous in an "EXCEPT" question format.
Question 22: All of the following are causes of perforation of the cartilaginous part of the nasal septum except?
- A. Tuberculosis
- B. Leprosy
- C. Trauma
- D. Syphilis (Correct Answer)
Explanation: ***Syphilis*** - **Syphilis** typically causes perforation of the **bony part** of the nasal septum, particularly the vomer and perpendicular plate of the ethmoid bone, due to chronic granulomatous inflammation. - The cartilaginous septum is generally less affected by syphilis in terms of perforation, although early mucosal involvement can occur. *Trauma* - **Trauma** (e.g., nose picking, septal surgery, foreign body insertion) is a common cause of **perforation of the cartilaginous nasal septum**. - Such injuries can lead to localized necrosis and subsequent perforation due to disruption of the blood supply to the septal cartilage. *Tuberculosis* - **Tuberculosis** can cause **granulomatous inflammation** and necrosis, leading to perforation of the **cartilaginous nasal septum**. - This is part of extrapulmonary tuberculosis and can present with chronic nasal obstruction and discharge. *Leprosy* - **Leprosy** (Hansen's disease) is known to cause severe destruction of nasal structures due to chronic inflammation, including perforation of the **cartilaginous nasal septum**. - The specific bacteria cause granulomatous lesions that erode the cartilage over time.
Question 23: Which of the following statements about malignant otitis externa is true?
- A. Not painful
- B. Common in diabetics and old age (Correct Answer)
- C. Caused by streptococcus
- D. Responds to topical antibiotics alone
Explanation: ***Common in diabetics and old age*** - **Malignant otitis externa** is an aggressive infection primarily affecting the external auditory canal and surrounding structures. - It most commonly occurs in **immunocompromised individuals**, especially **elderly diabetics**, due to impaired immune response and microvascular complications. *Not painful* - Malignant otitis externa is characterized by **severe, unrelenting otalgia (ear pain)** that often worsens at night and is disproportionate to the clinical findings. - The pain is due to the **inflammatory and destructive process** involving cartilage, bone, and nerves. *Caused by streptococcus* - The most common causative organism for malignant otitis externa is **Pseudomonas aeruginosa** (>90% of cases), not Streptococcus. - **Streptococcus species** are more commonly associated with acute otitis media or common skin infections. *Responds to topical antibiotics alone* - Malignant otitis externa requires **prolonged systemic antibiotic therapy** (typically 4-6 weeks of intravenous or oral fluoroquinolones like ciprofloxacin). - Topical antibiotics alone are **insufficient** due to the invasive nature of the infection, which extends beyond the external canal to involve bone and soft tissues.
Question 24: Hennebert's sign is a false positive fistula test when there is no evidence of middle ear disease causing a fistula of the horizontal semicircular canal. It is seen in?
- A. Congenital syphilis
- B. Cholesteatoma
- C. Stapedectomy
- D. Meniere’s disease (Correct Answer)
Explanation: ***Meniere's disease*** - **Hennebert's sign** is a *false-positive fistula test* resulting from a hypermobile footplate or saccule, or a fibrous band between the stapes footplate and the utricle due to otolithic *hydrops*. - It indicates that changes in external ear canal pressure cause **nystagmus** and **vertigo** due to inner ear fluid displacement, even without a true fistula. - This is the **most common** cause of Hennebert's sign in clinical practice. *Congenital syphilis* - Congenital syphilis can also present with Hennebert's sign as a false-positive fistula test due to inner ear involvement. - However, the question context specifies Hennebert's sign in the absence of middle ear disease, making Meniere's disease the more typical answer. - Other features include **sensorineural hearing loss**, **vestibular dysfunction**, **interstitial keratitis**, and **Hutchinson's teeth**. *Cholesteatoma* - A cholesteatoma often erodes bone, leading to a **true fistula** in the horizontal semicircular canal, especially its lateral aspect. - This would result in a *true positive fistula test* rather than a false positive associated with Hennebert's sign. *Stapedectomy* - A stapedectomy is a surgical procedure to treat otosclerosis, involving the removal of the stapes and insertion of a prosthesis. - While it can lead to complications such as perilymph fistula, it is not directly associated with Hennebert's sign as a *pre-existing condition* causing a false-positive fistula test in the absence of middle ear disease.