Diseases of the Ear Practice Questions

Q: Griesinger sign is otalgia along with pain and edema over mastoid. It is typically seen in?

Lateral sinus thrombosis. **Explanation:** **Griesinger’s Sign** is a classic clinical indicator of **Lateral (Sigmoid) Sinus Thrombosis (LST)**, a serious extracranial complication of chronic suppurative otitis media. 1. **Why Lateral Sinus Thrombosis is correct:** The sign refers to edema and tenderness over the posterior part of the mastoid process. It occurs due to **thrombosis of the mastoid emissary vein**, which normally drains into the sigmoid sinus. When the sigmoid sinus is obstructed by a thrombus, retrograde congestion leads to localized inflammation and swelling over the mastoid bone. 2. **Why other options are incorrect:** * **Acoustic Neuroma:** This is a benign tumor of the 8th cranial nerve. It typically presents with progressive sensorineural hearing loss, tinnitus, and equilibrium issues, not acute inflammatory signs like mastoid edema. * **Otosclerosis:** A metabolic bone disease of the otic capsule causing conductive hearing loss (stapedial fixation). It presents with a normal-looking tympanic membrane and no external swelling or pain. * **CSOM:** While LST is a *complication* of CSOM, CSOM itself refers to chronic ear discharge and perforation. Griesinger’s sign specifically indicates that the infection has progressed to involve the venous sinuses. **High-Yield Clinical Pearls for NEET-PG:** * **Delta Sign:** Seen on contrast-enhanced CT, representing a thrombus in the sigmoid sinus (empty triangle). * **Tobey-Ayer Test:** A clinical test where compression of the internal jugular vein on the diseased side fails to raise CSF pressure (measured via lumbar puncture). * **Crowe-Beck Test:** Engorgement of retinal veins upon compression of the jugular vein on the healthy side. * **Picket-fence Fever:** The characteristic hectic temperature spikes seen in LST due to septicemia.

Q: Which of the following conditions is associated with congenital anomalies of the middle ear?

Down syndrome. **Explanation:** **Down Syndrome (Trisomy 21)** is frequently associated with a wide spectrum of ear anomalies. The most common middle ear findings include **ossicular malformations** (particularly involving the stapes and incus), narrow or stenotic middle ear clefts, and Eustachian tube dysfunction. These structural issues, combined with a high incidence of chronic serous otitis media, often lead to significant conductive hearing loss in these patients. **Analysis of Incorrect Options:** * **Turner Syndrome (45, XO):** While associated with otological issues, the most characteristic findings are **Sensory Neural Hearing Loss (SNHL)** and a high incidence of acute/chronic otitis media. Middle ear structural anomalies are less common than in Down syndrome. * **Klinefelter Syndrome (47, XXY):** This condition primarily affects the endocrine and reproductive systems. It is not classically associated with congenital middle ear anomalies. * **Alport Syndrome:** This is a genetic disorder of Type IV collagen. It typically presents with a triad of **progressive SNHL**, glomerulonephritis, and ocular defects (lenticonus). It does not involve structural malformations of the middle ear. **High-Yield Clinical Pearls for NEET-PG:** * **Down Syndrome Ear Triad:** Small pinna (low-set), narrow External Auditory Canal (EAC), and ossicular anomalies. * **Most common ossicular anomaly in Down syndrome:** Stapes suprastructure malformation. * **Goldenhar Syndrome & Treacher Collins:** These are other high-yield syndromes frequently associated with **Microtia** and **Atresia** of the middle ear. * **Mnemonic for Alport:** "Can't see (lenticonus), can't pee (nephritis), can't hear high-frequency (SNHL)."

Q: Chalky white tympanic membrane is seen in:

Tympanosclerosis. **Explanation:** **Tympanosclerosis** is the correct answer because it is characterized by the hyalinization and subsequent calcification of the subepithelial connective tissue of the tympanic membrane (TM) and middle ear mucosa. Clinically, this manifests as dense, **chalky white patches** or plaques on the tympanic membrane, often described as "horseshoe-shaped" when they surround the handle of the malleus. It is typically a sequela of chronic inflammation or previous ventilation tube insertion. **Analysis of Incorrect Options:** * **ASOM (Acute Suppurative Otitis Media):** In the early stages, the TM appears **congested and red** (cartwheel appearance). In the suppurative stage, it may bulge and appear yellow or grey due to pus behind it, but not chalky white. * **Otosclerosis:** The tympanic membrane is usually **normal and mobile**. In about 10% of active cases, a reddish hue called **Schwartze sign** (Flamingo pink blush) may be seen over the promontory due to increased vascularity. * **Cholesteatoma:** This appears as a **pearly white, greasy mass** typically seen in the attic (pars flaccida) or posterosuperior quadrant of the TM, often associated with a retraction pocket or marginal perforation. It is a keratinizing squamous epithelium collection, not a calcification of the membrane itself. **High-Yield Clinical Pearls for NEET-PG:** * **Myringosclerosis:** When the calcification is limited strictly to the tympanic membrane (as seen in this question). * **Chalky white TM =** Tympanosclerosis. * **Flamingo pink TM =** Otosclerosis (Schwartze sign). * **Blue TM =** Hemotympanum or Glomus tumor. * **Dull/Amber TM =** Otitis Media with Effusion (Serous Otitis Media).

Q: Chorda tympani is a part of which anatomical structure?

Middle ear. **Explanation:** The **chorda tympani** is a branch of the **Facial Nerve (CN VII)** that carries taste sensations from the anterior two-thirds of the tongue and provides parasympathetic innervation to the submandibular and sublingual glands. **Why Middle Ear is correct:** Anatomically, the chorda tympani enters the middle ear through the **posterior canaliculus** (iter chordae posterius). It then runs across the lateral wall of the middle ear, passing between the **incus** and the **handle of the malleus**. It exits the middle ear via the **petrotympanic fissure** (Glaserian fissure) to join the lingual nerve. Because its significant course lies within the tympanic cavity, it is considered an anatomical part of the middle ear. **Why other options are incorrect:** * **Inner Ear:** The inner ear contains the cochlea and vestibular apparatus. While the facial nerve passes through the internal auditory canal and the bony fallopian canal nearby, the chorda tympani branch specifically traverses the air-filled middle ear space. * **External Auditory Canal:** This is the lateral-most part of the ear, separated from the middle ear by the tympanic membrane. The chorda tympani runs medial to the tympanic membrane. **Clinical Pearls for NEET-PG:** * **Taste Disturbance:** Iatrogenic injury to the chorda tympani during **Stapedectomy** or **Mastoidectomy** can lead to a metallic taste or loss of taste on the ipsilateral side of the tongue. * **Relation to Eardrum:** It runs across the upper part of the tympanic membrane (pars flaccida area). * **Nerve Origin:** It arises from the facial nerve in the vertical (mastoid) segment, just above the stylomastoid foramen.

Q: Where is the scutum located?

Lateral wall. The **scutum** (also known as Leidy’s column) is a sharp bony spur formed by the superior margin of the bony external auditory canal. It serves as the transition point between the roof of the external auditory canal and the lateral wall of the attic (epitympanum). ### Why the Correct Answer is Right: * **Option B (Lateral Wall):** The middle ear is divided into the hypotympanum, mesotympanum, and epitympanum. The lateral wall of the **epitympanum (attic)** is formed primarily by the scutum. It is the bony plate to which the pars flaccida of the tympanic membrane attaches superiorly. ### Why the Incorrect Options are Wrong: * **Option A (Roof):** The roof of the middle ear is formed by the **tegmen tympani**, a thin plate of bone separating the middle ear from the middle cranial fossa. * **Option C (Anterior Wall):** This wall is characterized by the opening of the **Eustachian tube** and the canal for the tensor tympani muscle; it separates the ear from the internal carotid artery. * **Option D (Posterior Wall):** This wall contains the **aditus ad antrum**, the pyramid (housing the stapedius muscle), and the facial nerve canal. ### Clinical Pearls for NEET-PG: * **Cholesteatoma:** The scutum is the first bony structure to be eroded in an **attic cholesteatoma**. On a CT scan of the temporal bone (coronal view), "blunting of the scutum" is an early radiological sign of cholesteatoma. * **Prussak’s Space:** This space lies medial to the scutum and lateral to the neck of the malleus; it is the most common site for primary acquired cholesteatoma.

Q: What is the most common cause of otomycosis?

Aspergillus. **Explanation:** **Otomycosis** (Otitis Externa Mycotica) is a fungal infection of the external auditory canal, typically occurring in humid climates or in patients with predisposing factors like prolonged use of antibiotic ear drops, immunocompromised states, or chronic moisture. **Why Aspergillus is correct:** * **Aspergillus niger** is the most common causative organism identified in otomycosis cases worldwide. It is characterized clinically by the presence of a black, "wet newspaper" or "sooty" appearance due to its black conidiophores. * **Aspergillus fumigatus** is the second most common species, often presenting with pale blue or green spores. **Why other options are incorrect:** * **Candida:** While *Candida albicans* is a significant cause of otomycosis (presenting as a creamy white, curd-like discharge), it is statistically less frequent than Aspergillus. It is more commonly seen in patients with underlying dermatological conditions or diabetes. * **Histoplasma & Cryptococcus:** These are systemic fungal pathogens. While they can cause disseminated disease in immunocompromised individuals, they are not primary or common causes of localized external ear infections. **Clinical Pearls for NEET-PG:** 1. **Symptoms:** Intense itching (pruritus), ear blockage, and a musty odor. 2. **Otoscopy:** Look for the "Wet Newspaper" appearance (A. niger) or "Cotton wool" appearance (Candida). 3. **Treatment:** The mainstay is meticulous **aural toilet** (cleaning) followed by topical antifungal agents like **Clotrimazole** (most common) or Nystatin. 4. **Avoidance:** Patients must be advised to keep the ear dry and stop using steroid/antibiotic drops, which promote fungal overgrowth.

Q: Hennebert's sign is seen in which of the following conditions?

Congenital Syphilis. **Explanation:** **Hennebert's Sign** is a clinical finding where nystagmus or vertigo is elicited by applying pressure to the external auditory canal (using a Siegle’s speculum or tragal pressure), despite an **intact tympanic membrane**. **Why Congenital Syphilis is Correct:** In late congenital syphilis, the underlying pathology is often **osteitis of the otic capsule**. This leads to a "fistula effect" without an actual bony defect, caused by either an abnormally mobile stapes footplate or fibrous bands connecting the stapes to the membranous labyrinth. This is frequently associated with **Tullio’s phenomenon** (vertigo induced by loud sounds). **Analysis of Incorrect Options:** * **Acoustic Neuroma:** This is a retrocochlear lesion (CN VIII tumor). It typically presents with unilateral sensorineural hearing loss and tinnitus, but does not involve fistula-like symptoms. * **Glomus Tumor:** These vascular tumors present with pulsatile tinnitus and a "Rising Sun" appearance behind the drum. While Brown’s sign (blanching of the tumor on positive pressure) is seen, Hennebert’s sign is not. * **Otosclerosis:** This involves fixation of the stapes footplate. While a variant called "Superior Semicircular Canal Dehiscence" can mimic these signs, classic otosclerosis does not present with Hennebert's sign. **High-Yield Clinical Pearls for NEET-PG:** * **Hennebert’s Sign** is also seen in **Meniere’s disease** (due to adhesions between the saccule and stapes footplate). * **Hutchinson’s Triad (Congenital Syphilis):** 1. Interstitial keratitis, 2. Hutchinson’s teeth (notched incisors), and 3. Sensorineural hearing loss. * **Fistula Test vs. Hennebert's Sign:** The Fistula test is positive when there is a bony defect (e.g., Cholesteatoma eroding the lateral canal). Hennebert’s sign is essentially a "fistula sign" in the presence of an intact drum.

Question 1

Griesinger sign is otalgia along with pain and edema over mastoid. It is typically seen in?

Accepted Answer

Lateral sinus thrombosis

Answer

Acoustic neuroma

Answer

Otosclerosis

Answer

Chronic suppurative otitis media (CSOM)

Question 2

Which of the following conditions is associated with congenital anomalies of the middle ear?

Accepted Answer

Down syndrome

Answer

Turner syndrome

Answer

Klinefelter syndrome

Answer

Alport syndrome

Question 3

Chalky white tympanic membrane is seen in:

Accepted Answer

Tympanosclerosis

Answer

Acute suppurative otitis media (ASOM)

Answer

Otosclerosis

Answer

Cholesteatoma

Question 4

Chorda tympani is a part of which anatomical structure?

Accepted Answer

Middle ear

Answer

Inner ear

Answer

External auditory canal

Answer

None of the above

Question 5

What is the treatment for traumatic rupture of the tympanic membrane?

Accepted Answer

No active treatment

Answer

Aural packing

Answer

Chloromycetin ear drops

Answer

Tympanoplasty

Question 6

Where is the scutum located?

Accepted Answer

Lateral wall

Answer

Roof

Answer

Anterior wall

Answer

Posterior wall

Question 7

In a case of acute suppurative otitis media, which quadrant is typically selected for a myringotomy?

Accepted Answer

Posteroinferior

Answer

Anterosuperior

Answer

Anteroinferior

Answer

Posterosuperior

Question 8

What is the most common cause of otomycosis?

Accepted Answer

Aspergillus

Answer

Candida

Answer

Histoplasma

Answer

Cryptococcus

Question 9

Hennebert's sign is seen in which of the following conditions?

Accepted Answer

Congenital Syphilis

Answer

Acoustic Neuroma

Answer

Glomus Tumor

Answer

Otosclerosis

Question 10

Malignant otitis externa is characterized by which of the following?

Accepted Answer

Granulation tissue is seen in the floor of the external auditory canal

Answer

Caused by Pseudomonas aeruginosa

Answer

Malignancy of the external auditory canal

Answer

Radiotherapy can be given

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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