UPSC-CMS 2012 — ENT
2 Previous Year Questions with Answers & Explanations
The treatment of choice for a mastoid fracture with immediate complete facial nerve paralysis is
Which one of the following conditions produces sensorineural deafness ?
UPSC-CMS 2012 - ENT UPSC-CMS Practice Questions and MCQs
Question 1: The treatment of choice for a mastoid fracture with immediate complete facial nerve paralysis is
- A. Sling operation
- B. Steroid therapy
- C. Mastoidectomy with nerve grafting
- D. Nerve decompression (Correct Answer)
Explanation: ***Nerve decompression*** - For a mastoid (temporal bone) fracture causing **facial nerve paralysis**, surgical **nerve decompression** is the treatment of choice when surgery is indicated. - Most cases of facial nerve paralysis from temporal bone fractures result from **nerve compression or edema** within the fallopian canal, not complete transection. - **Decompression** relieves pressure on the nerve, allowing recovery of function, and is performed via **mastoidectomy** to access the facial nerve in its intratemporal course. - Indications for surgical decompression include **immediate complete paralysis** with evidence of nerve degeneration on electrodiagnostic testing, or failed conservative management. *Mastoidectomy with nerve grafting* - **Nerve grafting** is reserved for cases where the facial nerve is **completely transected or severed**, which is rare in temporal bone fractures. - Most temporal bone trauma causes nerve injury from compression or hematoma, not complete anatomical discontinuity requiring grafting. - Grafting would only be considered after direct visualization confirms irreparable nerve transection. *Steroid therapy* - High-dose **corticosteroids** are actually the **first-line treatment** for facial nerve paralysis following temporal bone fractures, especially in cases of **delayed or incomplete paralysis**. - Steroids reduce **inflammation and edema** around the injured nerve and are often effective for **delayed-onset paralysis**. - However, they are typically used as conservative management rather than the definitive "treatment of choice" when immediate complete paralysis occurs. *Sling operation* - A **sling operation** (facial reanimation surgery) is used for **long-standing, irreversible facial paralysis** when nerve recovery is no longer possible. - It provides **static facial support** but does not restore nerve function. - This is not appropriate for acute management of traumatic facial nerve injury.
Question 2: Which one of the following conditions produces sensorineural deafness ?
- A. Atelectatic middle ear
- B. Eustachian tube blockage
- C. Tympanic membrane rupture
- D. Mixed otosclerosis (Correct Answer)
Explanation: ***Mixed otosclerosis*** - **Otosclerosis** is a bone remodeling disease primarily affecting the **ossicles** and **otic capsule**. - **Mixed otosclerosis** involves both **stapes fixation (conductive component)** and **cochlear involvement (sensorineural component)**. - Among the given options, this is the **only condition that produces sensorineural hearing loss**, although it presents as a mixed hearing loss with both conductive and sensorineural components. - The **cochlear otosclerosis** component causes the sensorineural deafness through involvement of the **otic capsule** and **cochlear structures**. *Atelectatic middle ear* - This condition involves the collapse of the **tympanic membrane** onto the ossicles due to **negative middle ear pressure**. - It causes **pure conductive hearing loss** by impairing sound transmission through the middle ear, with no sensorineural component. *Eustachian tube blockage* - Blockage of the **Eustachian tube** leads to **negative pressure** in the middle ear space. - This results in **pure conductive hearing loss** due to impaired movement of the tympanic membrane and ossicles, with no sensorineural component. *Tympanic membrane rupture* - A rupture in the **tympanic membrane** creates a direct opening between the external ear canal and the middle ear. - This condition causes **pure conductive hearing loss** by disrupting the normal sound conduction mechanism, with no sensorineural component.