Chronic Otitis Media — MCQs
Positive Rinne test is seen in -
Mainstay of treatment of glue ear -
A patient with a history of chronic ear infection now presents with manifestations, including headache and vomiting. A CT brain image is shown. What is the most probable diagnosis?
Tuberculous otitis media of the middle ear has all of the following except:-
Prior history of ear surgery and scanty, foul-smelling, painless discharge from the ear are characteristic features of which of the following lesions?
What is the treatment of choice for atticoantral type of chronic suppurative otitis media?
The treatment of choice for atticoantral variety of chronic suppurative otitis media is:
What is the treatment of choice for atticoantral type of chronic suppurative otitis media (CSOM)?
Treatment of choice for CSOM with vertigo and facial nerve palsy is:
In which condition is light reflex distortion typically observed?
Chronic Otitis Media Indian Medical PG Practice Questions and MCQs
Question 1: Positive Rinne test is seen in -
- A. Wax impacted ear
- B. Presbycusis (Correct Answer)
- C. CSOM
- D. Otosclerosis
Explanation: ***Presbycusis*** - A **positive Rinne test** indicates that **air conduction is better than bone conduction (AC > BC)**, which is normal. - In presbycusis, which is a **sensorineural hearing loss**, the inner ear is affected. While hearing is impaired, the *relationship between air and bone conduction remains normal*, thus a positive Rinne test is maintained. *Wax impacted ear* - This causes a **conductive hearing loss** by obstructing the ear canal. - In conductive hearing loss, **bone conduction is better than air conduction (BC > AC)**, resulting in a **negative Rinne test**. *CSOM* - **Chronic Suppurative Otitis Media (CSOM)** involves infection and perforation of the tympanic membrane and/or damage to ossicles. - This leads to **conductive hearing loss**, where **bone conduction is better than air conduction**, resulting in a **negative Rinne test**. *Otosclerosis* - This condition involves **abnormal bone growth** in the middle ear, particularly around the stapes footplate, leading to fixation. - It causes a **conductive hearing loss**, characterized by **bone conduction being better than air conduction**, meaning a **negative Rinne test**.
Question 2: Mainstay of treatment of glue ear -
- A. Temporal bone resection
- B. Tonsillectomy & adenoidectomy
- C. Radical Mastoidectomy
- D. Myringotomy + aeration to middle ear (Correct Answer)
Explanation: ***Myringotomy + aeration to middle ear*** - **Myringotomy** involves creating a small incision in the eardrum to drain fluid, and inserting a **grommet (ventilation tube)** to aerate the middle ear, which is the primary treatment for persistent glue ear (otitis media with effusion). - This procedure aims to restore ventilation to the middle ear, allowing trapped fluid to drain and preventing recurrent fluid accumulation, which improves hearing. *Temporal bone resection* - This is a major surgical procedure involving the removal of part of the temporal bone, typically reserved for extensive **malignant tumors** or severe infections, and is not indicated for glue ear. - It carries significant risks and is disproportionate to the treatment of a benign condition like glue ear. *Tonsillectomy & adenoidectomy* - While **adenoidectomy** can sometimes be performed in conjunction with grommet insertion if enlarged adenoids contribute to eustachian tube dysfunction, it is not the **primary treatment** for glue ear itself. - **Tonsillectomy** is generally performed for recurrent tonsillitis and has no direct role in treating glue ear. *Radical Mastoidectomy* - This is a highly invasive surgical procedure involving the removal of the mastoid air cells and part of the external auditory canal, typically performed for severe **cholesteatoma** or chronic mastoiditis. - It is an extensive and risky operation that is not appropriate for the management of glue ear, which is a much milder condition.
Question 3: A patient with a history of chronic ear infection now presents with manifestations, including headache and vomiting. A CT brain image is shown. What is the most probable diagnosis?
- A. Meningitis
- B. Extradural Abscess
- C. Cerebral Abscess
- D. Temporal lobe Abscess (Correct Answer)
Explanation: ***Temporal lobe Abscess*** - The CT scan shows a **ring-enhancing lesion** with significant surrounding edema, which is characteristic of a **brain abscess**. - Given the history of a **chronic ear infection**, the temporal lobe is a common site for bacterial spread from the mastoid air cells or middle ear. *Meningitis* - Meningitis involves inflammation of the **meninges** and typically presents with diffuse changes on imaging, such as sulcal effacement or leptomeningeal enhancement, rather than a focal, encapsulated lesion. - While it can cause headache and vomiting, the CT image does not show findings typical of meningitis. *Extradural Abscess* - An extradural (or epidural) abscess is located **between the dura mater and the skull bone**. - It would typically appear as a collection outside the brain parenchyma, potentially causing mass effect but distinct from an intraparenchymal lesion seen in the image. *Cerebral Abscess* - The image does show a **cerebral abscess**, but this option is less specific than "Temporal lobe abscess." - The question asks for the **most probable diagnosis**, and combining the imaging findings with the patient's history of ear infection points to a specific location within the cerebrum.
Question 4: Tuberculous otitis media of the middle ear has all of the following except:-
- A. Multiple perforations are seen
- B. Pale granulomas are seen
- C. Painful otorrhea is seen (Correct Answer)
- D. ATT should be started
Explanation: ***Painful otorrhea is seen*** - **Tuberculous otitis media** is often characterized by **painless otorrhea**, making painful otorrhea an unlikely finding. - The absence of pain is attributed to the **insidious** and slow-growing nature of the infection, which often delays diagnosis. *Multiple perforations are seen* - **Multiple tympanic membrane perforations** are a classic sign of tuberculous otitis media, differentiating it from other chronic otitis media forms. - These perforations are often **small and non-healing**, contributing to persistent discharge. *Pale granulomas are seen* - The presence of **pale granulomas** in the middle ear is a histological hallmark of tuberculosis, reflecting the characteristic **caseating granulomatous inflammation**. - These granulomas can lead to **ossicular erosion** and subsequent conductive hearing loss. *ATT should be started* - **Anti-tubercular treatment (ATT)** is the definitive therapy for tuberculous otitis media, targeting the underlying Mycobacterium tuberculosis infection. - Early initiation of ATT is crucial to prevent further **destruction** of middle ear structures and hearing loss.
Question 5: Prior history of ear surgery and scanty, foul-smelling, painless discharge from the ear are characteristic features of which of the following lesions?
- A. ASOM
- B. Cholesteatoma (Correct Answer)
- C. Central perforation
- D. Otitis externa
Explanation: ***Cholesteatoma*** - The **combination of all three features** (prior ear surgery + scanty, foul-smelling, painless discharge) is highly characteristic of cholesteatoma. - A prior history of ear surgery, particularly for **chronic otitis media**, can predispose to or be related to an **acquired cholesteatoma**. - **Scanty, foul-smelling, painless discharge** (otorrhea) is a hallmark symptom of cholesteatoma, with the **foul smell** being particularly distinctive due to breakdown of keratin debris and secondary infection. - The **painless** nature helps differentiate it from acute infections. *ASOM (Acute Suppurative Otitis Media)* - ASOM typically presents with **acute otalgia** (ear pain) and a **profuse purulent, non-foul-smelling discharge** following tympanic membrane perforation. - It is an acute infection and usually does not have a prior history of ear surgery as a direct cause of the current discharge. - The presence of **pain** and absence of foul smell distinguish it from cholesteatoma. *Central perforation* - A central perforation of the tympanic membrane often results in **intermittent, mucoid discharge** during upper respiratory tract infections, which is usually not foul-smelling. - While it can be associated with discharge, the characteristic **foul smell** and **prior surgery history** point away from simple central perforation as the primary diagnosis. - The discharge is typically more profuse during active infection. *Otitis externa* - **Otitis externa** primarily affects the ear canal, causing **pain, tenderness, and sometimes a watery or purulent discharge**, but it does not typically present with a foul-smelling discharge associated with a prior ear surgery history. - It is usually due to infection of the external auditory canal skin and not related to middle ear pathology or prior surgery in the way a cholesteatoma is. - The **painful** nature is a key distinguishing feature.
Question 6: What is the treatment of choice for atticoantral type of chronic suppurative otitis media?
- A. Tympanoplasty
- B. Modified radical mastoidectomy (Correct Answer)
- C. Antibiotics
- D. None of the options
Explanation: ***Modified radical mastoidectomy*** - This procedure is the treatment of choice for **atticoantral type of chronic suppurative otitis media (CSOM)** due to the presence of **cholesteatoma**, which requires complete surgical removal. - It involves removing the posterior and superior canal wall, exenterating the mastoid air cells, and exteriorizing the **aditus and antrum** into the external auditory canal to create a common cavity. - Unlike radical mastoidectomy, it **attempts to preserve the tympanic membrane and ossicular chain when disease extent permits**, thereby maintaining the middle ear transformer mechanism and optimizing hearing outcomes. *Antibiotics* - While antibiotics may be used to manage acute exacerbations or infections, they cannot eradicate the inherent **cholesteatoma** found in atticoantral CSOM. - They primarily target bacteria and have no effect on the **pathological skin growth** that characterizes cholesteatoma. *Tympanoplasty* - **Tympanoplasty** is a reconstructive procedure primarily used for repairing a **perforated tympanic membrane** or ossicular chain defects, typically in the tubotympanic type of CSOM. - It does not address the fundamental problem of **cholesteatoma** and its destructive potential in atticoantral disease. *None of the options* - This is incorrect because **modified radical mastoidectomy** is a well-established and effective treatment for atticoantral CSOM. - Omitting treatment would lead to progressive destruction of middle ear structures and potentially life-threatening complications.
Question 7: The treatment of choice for atticoantral variety of chronic suppurative otitis media is:
- A. Mastoidectomy (Correct Answer)
- B. Medical management
- C. Underlay myringoplasty
- D. Insertion of ventilation tube
Explanation: **Correct: Mastoidectomy** - The **atticoantral** variety of chronic suppurative otitis media (CSOM) is typically associated with **cholesteatoma**, which necessitates surgical eradication to prevent complications such as intracranial infection, facial nerve palsy, and labyrinthine destruction. - **Mastoidectomy** is the treatment of choice to remove the cholesteatoma and achieve a safe, dry ear by clearing disease from the mastoid air cells and attic. *Incorrect: Medical management* - This approach is typically used for the **tubotympanic** (mucosal/safe) type of CSOM, which involves a central perforation without cholesteatoma. - It is **ineffective in the presence of cholesteatoma**, as antibiotics cannot penetrate the keratinized debris matrix and do not eradicate the underlying pathology. *Incorrect: Underlay myringoplasty* - This procedure repairs a **tympanic membrane perforation** but does not address the underlying cholesteatoma or disease within the mastoid and attic. - It is used for **safe, dry perforations**, usually associated with the tubotympanic type of CSOM after the ear has been rendered inactive. *Incorrect: Insertion of ventilation tube* - Ventilation tubes (grommets) are primarily used for **recurrent acute otitis media** or **otitis media with effusion (glue ear)** to equalize middle ear pressure and facilitate drainage. - They are **not indicated for CSOM**, especially the atticoantral type with cholesteatoma, as they do not resolve the chronic infection or remove the pathological tissue.
Question 8: What is the treatment of choice for atticoantral type of chronic suppurative otitis media (CSOM)?
- A. Tympanoplasty
- B. Modified radical mastoidectomy (Correct Answer)
- C. None of the options
- D. Antibiotics
Explanation: ***Modified radical mastoidectomy*** - The **atticoantral type of CSOM** is characterized by active **cholesteatoma**, which requires surgical removal to prevent further bone erosion and complications. - A **modified radical mastoidectomy** is the treatment of choice as it removes the cholesteatoma and diseased mastoid air cells while aiming to preserve residual hearing. *Antibiotics* - While topical or systemic antibiotics may be used to control acute infections or discharge in CSOM, they do not eradicate **cholesteatoma**. - **Cholesteatoma** is an epidermoid cyst that requires surgical excision, as antibiotics alone cannot resolve it. *Tympanoplasty* - **Tympanoplasty** is primarily performed to reconstruct the tympanic membrane (eardrum) and/or the ossicular chain to restore hearing. - It is typically indicated for the **tubotympanic type of CSOM** (safe type) without cholesteatoma, not for the atticoantral type which involves cholesteatoma. *None of the options* - This option is incorrect because **modified radical mastoidectomy** is a well-established and necessary treatment for the atticoantral type of CSOM involving cholesteatoma.
Question 9: Treatment of choice for CSOM with vertigo and facial nerve palsy is:
- A. Myringoplasty
- B. Antibiotics and labyrinthine sedative
- C. Immediate mastoid exploration (Correct Answer)
- D. Labyrinthectomy
Explanation: ***Immediate mastoid exploration*** - Vertigo and facial nerve palsy in the context of CSOM (Chronic Suppurative Otitis Media) indicate **intracranial complications** or significant **bone erosion** by the cholesteatoma, necessitating urgent surgical intervention. - **Mastoid exploration** allows for removal of the cholesteatoma, drainage of infection, and decompression of the facial nerve, preventing irreversible damage and life-threatening complications. *Myringoplasty* - This procedure involves **repairing the tympanic membrane** (eardrum) and is primarily performed for simple perforations without labyrinthine involvement or facial nerve complications. - It would not address the underlying pathology of **cholesteatoma erosion** or the serious symptoms of vertigo and facial nerve palsy. *Antibiotics and labyrinthine sedative* - While antibiotics may be part of the management for active infection, they alone cannot resolve an extensive **cholesteatoma** causing bone destruction and nerve compression. - **Labyrinthine sedatives** might temporarily relieve vertigo but do not treat the causative disease process, which requires surgical intervention. *Labyrinthectomy* - This procedure involves **destroying the labyrinth** to alleviate intractable vertigo, typically reserved for severe, unilateral Meniere's disease or non-functioning labyrinths. - It is a **destructive procedure** that would result in complete hearing loss and would not address the underlying **cholesteatoma** or the facial nerve palsy.
Question 10: In which condition is light reflex distortion typically observed?
- A. ASOM (Correct Answer)
- B. Glomus
- C. OME
- D. CSOM
Explanation: ***ASOM*** - In **Acute Suppurative Otitis Media (ASOM)**, there is inflammation and fluid accumulation in the middle ear, causing the **tympanic membrane to bulge and distort**. - This **distortion** of the tympanic membrane directly leads to an **abnormal or absent light reflex** when examined with an otoscope. *Glomus* - A **glomus tumor** is a rare, benign, highly vascular tumor typically found in the middle ear. - While it may cause conductive hearing loss and pulsatile tinnitus, it does not primarily involve changes to the **light reflex** as a direct result of tympanic membrane distortion. *OME* - **Otitis Media with Effusion (OME)**, or "glue ear," involves thick fluid behind the tympanic membrane but without acute inflammation. - The tympanic membrane may appear dull or retracted, and the light reflex can be diffuse or absent, but it's typically not described as "distorted" in the same way as with acute bulging. *CSOM* - **Chronic Suppurative Otitis Media (CSOM)** involves a persistent perforation of the tympanic membrane and chronic discharge. - The key feature is the **perforation**, which would mean the light reflex itself (reflection off an intact drum) would be absent or severely altered, rather than simply distorted.
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