Diseases of the Ear — MCQs

Diseases of the Ear Indian Medical PG Practice Questions and MCQs

Question 91: The 'Light House sign' is characteristically seen in which of the following conditions?

A. Acute Suppurative Otitis Media (Correct Answer)
B. Otosclerosis
C. Acute Mastoiditis
D. Meniere’s Disease

Explanation: ### Explanation **Correct Option: A. Acute Suppurative Otitis Media (ASOM)** The **'Light House sign'** is a classic clinical finding observed during the **Stage of Suppuration** in Acute Suppurative Otitis Media. * **Mechanism:** During this stage, pus under high pressure in the middle ear leads to a small pinpoint perforation in the pars tensa of the tympanic membrane. As the middle ear mucosa is highly vascular and inflamed, the pus is discharged in a pulsatile manner. * **Appearance:** When viewed through an otoscope, the reflection of light off the pulsating drop of pus at the perforation site creates a rhythmic "flickering" or "flashing" effect, resembling a lighthouse beacon. --- ### Why Other Options are Incorrect: * **B. Otosclerosis:** Characterized by a **Schwartz sign** (Flamingo pink flush) due to increased vascularity over the promontory. It typically presents with conductive hearing loss and a normal, intact tympanic membrane. * **C. Acute Mastoiditis:** While a complication of ASOM, its hallmark signs include **"sagging" of the posterosuperior meatal wall** and retroauricular swelling/tenderness (Mastoid tenderness). * **D. Meniere’s Disease:** This is an inner ear disorder (endolymphatic hydrops). The tympanic membrane appears **completely normal** on examination. --- ### NEET-PG High-Yield Clinical Pearls: 1. **Stages of ASOM:** * *Stage of Tubal Occlusion:* Retracted TM, Cartwheel appearance of vessels. * *Stage of Pre-suppuration:* Cartwheel injection, bulging TM. * *Stage of Suppuration:* **Lighthouse sign**, pinpoint perforation. * *Stage of Resolution:* Healing of TM. 2. **Pulsatile Otorrhoea:** Always think of ASOM or a **Glomus Tumor** (though in Glomus, the pulsation is seen behind an *intact* TM, known as the **Brown’s sign**). 3. **Treatment of Choice for ASOM:** Antibiotics (Amoxicillin is first-line); Myringotomy is indicated if the TM is severely bulging or if there is persistent pain.

Question 92: Pulsatile otorrhoea is seen in which of the following conditions?

A. Glomus tumour
B. CSF otorrhea
C. Acute suppurative otitis media (ASOM) (Correct Answer)
D. Fistula

Explanation: **Explanation:** **Pulsatile otorrhoea** (also known as the **"Lighthouse effect"**) is a classic clinical sign of **Acute Suppurative Otitis Media (ASOM)** in the stage of suppuration. 1. **Why ASOM is correct:** During the stage of suppuration, the middle ear is filled with pus under pressure. The middle ear mucosa becomes intensely congested and hyperemic. When the tympanic membrane perforates, the pus is discharged. Because the underlying mucosa is so vascular, the pulsations of the dilated capillaries are transmitted to the fluid, causing it to pulsate as it escapes through the small perforation. This rhythmic pulsation of discharge is a hallmark of ASOM. 2. **Why other options are incorrect:** * **Glomus Tumour:** While this condition is famous for **pulsatile tinnitus** (the patient hears their own heartbeat) and a "rising sun" appearance behind the drum, it does not typically cause otorrhoea unless there is a secondary infection or the tumour has eroded through the drum. * **CSF Otorrhoea:** This presents as a clear, watery discharge (halo sign) following head trauma or surgery. It may be synchronous with respiration or straining, but it is not typically described as "pulsatile otorrhoea." * **Fistula:** A labyrinthine fistula usually presents with vertigo and nystagmus (Fistula test positive) rather than pulsatile discharge. **High-Yield Clinical Pearls for NEET-PG:** * **Lighthouse Sign:** Specifically refers to the visual pulsation of a bead of pus in ASOM. * **Pulsatile Tinnitus:** Think Glomus Jugulare, Carotid Body Tumour, or Benign Intracranial Hypertension. * **ASOM Stages:** Remember the sequence: Hyperemia → Exudation → Suppuration (Pulsatile Otorrhoea) → Resolution. * **Treatment of choice for ASOM:** Systemic antibiotics (Amoxicillin is first-line). Myringotomy is indicated if the drum is bulging and causing severe pain.

Question 93: Ramsay Hunt syndrome is caused by which pathogen?

A. Herpes zoster virus (Correct Answer)
B. Herpes simplex virus
C. Varicella zoster virus
D. Pseudomonas

Explanation: **Explanation:** **Ramsay Hunt Syndrome (Herpes Zoster Oticus)** is caused by the reactivation of the **Varicella Zoster Virus (VZV)** latent in the **geniculate ganglion** of the facial nerve (CN VII). While VZV causes chickenpox (primary infection), its reactivation in this specific neural distribution is clinically termed **Herpes Zoster Virus (HZV)** infection. * **Why Option A is correct:** Ramsay Hunt Syndrome is the clinical manifestation of Herpes Zoster affecting the facial nerve. It is characterized by a classic triad: facial nerve palsy, otalgia (ear pain), and herpetic vesicles on the auricle or external auditory canal. * **Why Option B is incorrect:** Herpes Simplex Virus (HSV-1) is the most common cause of **Bell’s Palsy**, which presents with isolated facial paralysis *without* the characteristic herpetic vesicles or severe otalgia seen in Ramsay Hunt. * **Why Option C is incorrect:** While Varicella Zoster Virus is the underlying agent, "Herpes Zoster" is the specific term for the reactivated disease state. In many exams, "Herpes Zoster" is the preferred clinical answer for the syndrome itself. * **Why Option D is incorrect:** *Pseudomonas aeruginosa* is the most common causative organism for **Malignant Otitis Externa**, not viral syndromes. **High-Yield Clinical Pearls for NEET-PG:** 1. **Clinical Triad:** Ipsilateral facial palsy + Otalgia + Vesicles in the "Hunt's zone" (concha, EAC, or retroauricular area). 2. **Nerves Involved:** Primarily CN VII; however, CN VIII is often involved, leading to sensorineural hearing loss and vertigo. 3. **Prognosis:** Ramsay Hunt Syndrome has a **poorer prognosis** for facial nerve recovery compared to Bell’s Palsy. 4. **Treatment:** Combination of oral **Acyclovir** (or Valacyclovir) and **Corticosteroids**.

Question 94: Which of the following is NOT true about Glomus jugulare tumors?

A. The 'rising sun' sign is seen on imaging.
B. It involves the 9th and 10th cranial nerves.
C. Pulsatile tinnitus is a common symptom.
D. It invades the epitympanum. (Correct Answer)

Explanation: **Explanation:** Glomus jugulare (Paraganglioma) is a highly vascular, slow-growing tumor arising from the glomus bodies in the adventitia of the jugular bulb. **Why Option D is the Correct Answer (The False Statement):** Glomus jugulare tumors primarily involve the **hypotympanum** (the floor of the middle ear) as they erode upward from the jugular bulb. While they can fill the entire middle ear space in advanced stages, they do not specifically target or characteristically invade the **epitympanum** (attic) first; this area is more commonly associated with cholesteatomas. **Analysis of Other Options:** * **Option A (Rising Sun Sign):** This is a classic otoscopic finding where a red/pink vascular mass is seen behind the intact tympanic membrane, appearing to "rise" from the floor (hypotympanum). * **Option B (9th and 10th Cranial Nerves):** Due to its location at the jugular foramen, these tumors frequently compress or invade the lower cranial nerves (IX, X, XI, and sometimes XII), leading to Vernet’s syndrome or Collet-Sicard syndrome. * **Option C (Pulsatile Tinnitus):** This is the most common presenting symptom. The tumor’s extreme vascularity causes the patient to hear their own heartbeat (bruit). **High-Yield Clinical Pearls for NEET-PG:** * **Brown’s Sign:** Pulsation of the tumor mass seen on otoscopy, which ceases when ear canal pressure is increased with a Siegle’s speculum. * **Aquino’s Sign:** Blanching of the mass upon carotid artery compression. * **Phelps’ Sign:** Loss of the bony septum between the carotid canal and the jugular foramen (seen on CT). * **Salt and Pepper Appearance:** Classic MRI finding (T2 weighted) due to high-flow void vessels. * **Treatment:** Surgery (Fisch approach) or Radiotherapy (Gamma Knife) for elderly/unresectable cases.

Question 95: Picket fence fever is typically seen in which of the following conditions?

A. Petrositis
B. Lateral sinus thrombosis (Correct Answer)
C. Meningitis
D. Temporal lobe abscess

Explanation: **Explanation:** **Lateral Sinus Thrombosis (LST)**, also known as Sigmoid Sinus Thrombosis, is a known complication of chronic suppurative otitis media (CSOM). The characteristic **"Picket Fence" fever** (also called Hectic Tremor) occurs due to the periodic release of septic emboli from the infected thrombus into the systemic circulation. This results in sudden, high-grade fever spikes with chills and rigors, followed by rapid defervescence (profuse sweating), mimicking the sharp peaks of a picket fence on a temperature chart. **Analysis of Options:** * **Petrositis (Option A):** Characterized by **Gradenigo’s Syndrome**, which consists of a clinical triad: persistent otorrhea, retro-orbital pain (trigeminal nerve involvement), and diplopia due to 6th cranial nerve palsy. It does not typically present with picket fence fever. * **Meningitis (Option B):** Presents with high-grade continuous fever, neck rigidity, and positive Kernig’s/Brudzinski’s signs. The fever pattern is usually sustained rather than intermittent spikes. * **Temporal Lobe Abscess (Option D):** Often presents with features of raised intracranial pressure (headache, vomiting, papilledema) and focal neurological deficits (e.g., nominal aphasia). The fever is often low-grade or even subnormal in the manifest stage. **Clinical Pearls for NEET-PG:** * **Griesinger’s Sign:** Edema over the mastoid process due to thrombosis of the mastoid emissary vein (Pathognomonic for LST). * **Tobey-Ayer Test:** Used during manometry to detect lateral sinus obstruction (compression of the internal jugular vein). * **Crowe-Beck Test:** Engorgement of retinal veins upon compression of the healthy internal jugular vein. * **Investigation of Choice:** Contrast-enhanced MRI/MRV (shows the "Empty Delta Sign").

Question 96: Mastoid infection in a 10-year-old boy eroding through the outer table of the bone results in which of the following conditions?

A. Acute coalescent mastoiditis
B. Subperiosteal abscess (Correct Answer)
C. Brain abscess
D. Lateral sinus thrombophlebitis

Explanation: ### Explanation **Correct Option: B. Subperiosteal abscess** The mastoid bone consists of a honeycomb-like arrangement of air cells. In acute mastoiditis, pus accumulates under pressure. When this infection erodes through the **outer cortex (outer table)** of the mastoid bone, the pus collects between the bone and the overlying periosteum, resulting in a **subperiosteal abscess**. In children, the most common site is the post-aural region (von Bezold’s abscess and Luc’s abscess are other site-specific variations). **Analysis of Incorrect Options:** * **A. Acute coalescent mastoiditis:** This is the *precursor* stage. It refers to the breakdown of the internal bony septa (trabeculae) separating the mastoid air cells, turning them into a single large cavity filled with pus. It becomes a subperiosteal abscess only after it breaches the outer cortex. * **C. Brain abscess:** This occurs if the infection erodes through the **inner table** (tegmen antri or tegmen tympani) into the middle or posterior cranial fossa. * **D. Lateral sinus thrombophlebitis:** This is an intracranial complication caused by the erosion of the **sinus plate** (posterior wall of the mastoid), leading to inflammation and thrombus formation within the sigmoid sinus. **High-Yield Clinical Pearls for NEET-PG:** * **Reservoir Sign:** Re-accumulation of pus in the ear canal immediately after mopping it dry; pathognomonic for mastoiditis. * **Ironing out of Mastoid:** Loss of the normal contour of the mastoid process due to periosteal thickening. * **Sagging of Posterosuperior Meatal Wall:** Occurs due to periostitis adjacent to the antrum. * **Most common organism:** *Streptococcus pneumoniae* (followed by *H. influenzae* and *S. pyogenes*). * **Imaging:** Contrast-enhanced CT (CECT) of the temporal bone is the gold standard for diagnosing complications.

Question 97: A 30-year-old male has attic cholesteatoma of the left ear with lateral sinus thrombophlebitis. Which of the following will be the operation of choice?

A. Intact canal wall mastoidectomy
B. Simple mastoidectomy with tympanoplasty
C. Canal wall down mastoidectomy (Correct Answer)
D. Mastoidectomy with cavity obliteration

Explanation: **Explanation:** The patient presents with **attic cholesteatoma** (unsafe/squamosal type Chronic Suppurative Otitis Media) complicated by **lateral sinus thrombophlebitis**. 1. **Why Canal Wall Down (CWD) Mastoidectomy is correct:** In cases of attic cholesteatoma, the primary goal is the complete removal of the disease to create a "safe" ear. When a **life-threatening complication** like lateral sinus thrombophlebitis is present, the priority shifts to maximum exposure and exteriorization. A CWD mastoidectomy (e.g., Modified Radical Mastoidectomy) involves removing the posterior canal wall, converting the mastoid antrum and external auditory canal into a single cavity. This provides the best surgical access to clear the cholesteatoma and manage the infected sinus plate or thrombus, while also allowing for easy post-operative monitoring. 2. **Why other options are incorrect:** * **A & B (Intact Canal Wall/Simple Mastoidectomy):** These procedures preserve the posterior canal wall. They are contraindicated in the presence of complications because they offer limited visibility and carry a higher risk of residual or recurrent cholesteatoma. Simple mastoidectomy is typically reserved for ASOM complications like mastoiditis, not cholesteatoma. * **D (Cavity Obliteration):** While obliteration can be done after a CWD procedure, it is generally avoided in the presence of active intracranial or vascular complications (like thrombophlebitis) to prevent masking a persistent or recurrent infection. **High-Yield Clinical Pearls for NEET-PG:** * **Surgery of Choice for Cholesteatoma with Complications:** Always Canal Wall Down Mastoidectomy. * **Griesinger’s Sign:** Edema over the mastoid process due to thrombosis of the mastoid emissary vein (pathognomonic for lateral sinus thrombophlebitis). * **Greisinger’s Test:** Used to evaluate lateral sinus patency during surgery. * **Tobey-Ayer Test:** A manometric test during lumbar puncture to diagnose lateral sinus thrombosis (compression of the jugular vein on the affected side shows no rise in CSF pressure).

Question 98: What is the commonest cause of deafness?

A. Trauma
B. Wax (Correct Answer)
C. Acute mastoiditis
D. Meniere's disease

Explanation: **Explanation:** The correct answer is **Wax (Cerumen)**. **Why Wax is the correct answer:** Impacted cerumen is globally recognized as the **most common cause of reversible conductive hearing loss**. It is a physiological accumulation of secretions from the ceruminous and sebaceous glands mixed with desquamated epithelium. Because it is a universal phenomenon affecting all age groups and demographics, it statistically outweighs pathological diseases like Meniere’s or infections in terms of prevalence. **Analysis of Incorrect Options:** * **Trauma:** While trauma (e.g., temporal bone fractures or longitudinal membrane tears) can cause significant hearing loss, its incidence is much lower compared to the routine accumulation of wax. * **Acute Mastoiditis:** This is a complication of Acute Otitis Media (AOM). While it causes conductive deafness due to middle ear effusion and suppuration, it is a localized infectious pathology and not a "common" cause in the general population. * **Meniere’s Disease:** This is a specific inner ear disorder characterized by endolymphatic hydrops. It causes sensorineural hearing loss (SNHL), but it is relatively rare compared to conductive causes like wax. **High-Yield Clinical Pearls for NEET-PG:** * **Commonest cause of hearing loss in children:** Otitis Media with Effusion (Serous Otitis Media). * **Commonest cause of SNHL in adults:** Presbycusis (age-related hearing loss). * **Keratosis Obturans:** A specific condition where a dense plug of desquamated keratin (not just wax) obstructs the canal, often associated with bronchiectasis and sinusitis. * **Management:** The preferred method for wax removal is syringing (using water at body temperature, 37°C, to avoid the caloric reflex) or manual removal under microscopic guidance. Syringing is contraindicated if there is a history of tympanic membrane perforation.

Question 99: Cholesteatoma is seen in which of the following conditions?

A. Acute Suppurative Otitis Media (ASOM)
B. Chronic Suppurative Otitis Media (CSOM) (Correct Answer)
C. Secretory Otitis Media
D. Otosclerosis

Explanation: **Explanation:** **Cholesteatoma** is a hallmark feature of **Chronic Suppurative Otitis Media (CSOM)**, specifically the **Attico-antral (unsafe)** type. Pathologically, it is not a tumor or a cholesterol deposit, but a "skin in the wrong place"—a cystic structure lined by keratinizing stratified squamous epithelium that trapped keratin debris within the middle ear or mastoid. It possesses proteolytic enzymes (like collagenases) that cause bone destruction, leading to complications like ossicular necrosis or intracranial abscesses. **Why the other options are incorrect:** * **ASOM:** This is an acute bacterial infection of the middle ear characterized by rapid onset, fever, and earache. It does not involve the chronic epithelial migration or retraction pockets necessary for cholesteatoma formation. * **Secretory Otitis Media (Otitis Media with Effusion):** This involves sterile fluid accumulation in the middle ear due to Eustachian tube dysfunction. While chronic retraction pockets from SOM can *lead* to secondary cholesteatoma, the condition itself is defined by fluid, not keratinizing epithelium. * **Otosclerosis:** This is a primary metabolic bone disease of the otic capsule characterized by bony ankylosis of the stapes footplate, leading to conductive hearing loss with a healthy tympanic membrane. **High-Yield Clinical Pearls for NEET-PG:** * **Genesis:** The most accepted theory for primary acquired cholesteatoma is the **Invagination Theory (Wittmaack’s)**, involving retraction pockets in the Pars Flaccida. * **Microscopic Finding:** Presence of **keratin flakes** is diagnostic. * **Radiology:** HRCT of the temporal bone is the investigation of choice to visualize bone erosion (e.g., erosion of the **scutum**). * **Treatment:** Always surgical (**Mastoidectomy**) because of its bone-eroding nature.

Question 100: What is the approximate length of the external auditory canal?

A. 12 mm
B. 24 mm (Correct Answer)
C. 36 mm
D. 48 mm

Explanation: **Explanation:** The external auditory canal (EAC) is an S-shaped passage extending from the concha of the auricle to the tympanic membrane. In adults, its average length is **24 mm**. **Why Option B is Correct:** The EAC is anatomically divided into two distinct parts: 1. **Cartilaginous part (Outer 1/3rd):** Approximately **8 mm** long. It contains hair follicles, sebaceous glands, and ceruminous glands. 2. **Bony part (Inner 2/3rd):** Approximately **16 mm** long. It is lined by thin skin and lacks adnexal structures. Adding these segments (8 mm + 16 mm) gives the total length of **24 mm**. **Why Other Options are Incorrect:** * **Option A (12 mm):** This is too short for the entire canal; it is closer to the length of just the bony portion in some pediatric populations. * **Option C (36 mm):** This exceeds the standard adult length. However, 36 mm is the approximate length of the **Eustachian tube**, a common point of confusion for students. * **Option D (48 mm):** This is double the actual length of the EAC. **High-Yield Clinical Pearls for NEET-PG:** * **Shape:** The canal is not straight; it follows an "S" shape. To visualize the tympanic membrane, the pinna must be pulled **upwards, backwards, and laterally** in adults. * **Narrowest Point:** The **isthmus** is the narrowest part of the EAC, located in the bony portion about 6 mm lateral to the tympanic membrane. Foreign bodies lodged medial to the isthmus are difficult to remove. * **Foramina of Huschke:** A deficiency in the anteroinferior part of the bony canal wall, seen in children (sometimes persisting in adults), which can allow infections to spread between the EAC and the parotid gland. * **Fissures of Santorini:** Deficiencies in the cartilaginous canal wall that allow infections (like malignant otitis externa) to spread to the parotid or parapharyngeal space.

Practice by Chapter

Otitis Externa

Practice Questions

Acute Otitis Media

Practice Questions

Chronic Otitis Media

Practice Questions

Complications of Otitis Media

Practice Questions

Otosclerosis

Practice Questions

Presbycusis

Practice Questions

Sudden Sensorineural Hearing Loss

Practice Questions

Noise-Induced Hearing Loss

Practice Questions

Ménière's Disease

Practice Questions

Benign Paroxysmal Positional Vertigo

Practice Questions

Vestibular Neuritis

Practice Questions

Tumors of the Ear and Temporal Bone

Practice Questions

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