Diseases of the Ear — MCQs

Diseases of the Ear Indian Medical PG Practice Questions and MCQs

Question 101: Griesinger sign is otalgia along with pain and edema over mastoid. It is typically seen in?

A. Lateral sinus thrombosis (Correct Answer)
B. Acoustic neuroma
C. Otosclerosis
D. Chronic suppurative otitis media (CSOM)

Explanation: **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.

Question 102: Which of the following conditions is associated with congenital anomalies of the middle ear?

A. Turner syndrome
B. Down syndrome (Correct Answer)
C. Klinefelter syndrome
D. Alport syndrome

Explanation: **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)."

Question 103: Chalky white tympanic membrane is seen in:

A. Acute suppurative otitis media (ASOM)
B. Otosclerosis
C. Tympanosclerosis (Correct Answer)
D. Cholesteatoma

Explanation: **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).

Question 104: Chorda tympani is a part of which anatomical structure?

A. Middle ear (Correct Answer)
B. Inner ear
C. External auditory canal
D. None of the above

Explanation: **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.

Question 105: What is the treatment for traumatic rupture of the tympanic membrane?

A. Aural packing
B. Chloromycetin ear drops
C. Tympanoplasty
D. No active treatment (Correct Answer)

Explanation: **Explanation:** The management of traumatic rupture of the tympanic membrane (TM) is primarily conservative because the majority of these perforations (over 80-90%) heal spontaneously within 3 to 6 weeks. **Why "No active treatment" is correct:** The underlying medical principle is to **"keep the ear dry and leave it alone."** The TM has an excellent blood supply and regenerative capacity. Active intervention often introduces infection or interferes with the natural migration of epithelium across the perforation. Patients are advised to avoid blowing their nose forcefully and to prevent water entry into the ear canal. **Why other options are incorrect:** * **Aural packing (A):** Packing the ear canal is contraindicated as it acts as a foreign body, increases the risk of secondary infection (otitis externa/media), and can displace the edges of the perforation inwards. * **Chloromycetin ear drops (B):** Topical ear drops are generally avoided in dry traumatic perforations. They can be ototoxic if they reach the middle ear and may macerate the edges of the wound, delaying spontaneous closure. * **Tympanoplasty (C):** Surgical repair is not the first-line treatment. It is only considered if the perforation fails to heal spontaneously after a period of observation (usually 3–6 months) or if there is associated ossicular disruption. **Clinical Pearls for NEET-PG:** * **Most common site:** The pars tensa (anteroinferior quadrant) is most frequently involved. * **Sign of healing:** The appearance of a "monomere" (a thin, transparent layer lacking the fibrous middle layer) is common after spontaneous healing. * **Prognosis:** Perforations caused by "clean" trauma (e.g., a slap) have a better prognosis than those caused by "dirty" trauma (e.g., water sports or welding sparks). * **Sudden hearing loss:** If a traumatic rupture is accompanied by vertigo or profound sensorineural hearing loss, suspect a **perilymph fistula** or ossicular dislocation.

Question 106: Where is the scutum located?

A. Roof
B. Lateral wall (Correct Answer)
C. Anterior wall
D. Posterior wall

Explanation: 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.

Question 107: In a case of acute suppurative otitis media, which quadrant is typically selected for a myringotomy?

A. Anterosuperior
B. Anteroinferior
C. Posteroinferior (Correct Answer)
D. Posterosuperior

Explanation: ### **Explanation** In Acute Suppurative Otitis Media (ASOM), **myringotomy** is indicated when there is severe pain, bulging of the tympanic membrane, or incomplete resolution despite antibiotics. The procedure involves making a small incision in the tympanic membrane to drain pus from the middle ear. #### **Why Posteroinferior (PI) is the Correct Choice:** The **Posteroinferior quadrant** is the safest and most preferred site for myringotomy because: 1. **Safety:** It is the most distant from vital middle ear structures. 2. **Avoidance of Ossicles:** The incudostapedial joint and the stapes lie in the posterosuperior quadrant; choosing the inferior part avoids accidental injury to the ossicular chain. 3. **Avoidance of Nerves:** It avoids the chorda tympani nerve. 4. **Drainage:** Being a dependent area in the upright position, it facilitates better drainage of inflammatory exudate. #### **Analysis of Incorrect Options:** * **Posterosuperior (PS):** This is the **most dangerous** quadrant. An incision here risks damaging the long process of the incus, the stapes, and the chorda tympani nerve. * **Anterosuperior (AS):** This area is close to the Eustachian tube orifice and is technically more difficult to access due to the curvature of the external auditory canal. * **Anteroinferior (AI):** While safer than the superior quadrants, it is primarily used for **Grommet insertion** (in Serous Otitis Media) rather than simple drainage, as it provides better ventilation and is less likely to be displaced by the ossicles. #### **High-Yield Clinical Pearls for NEET-PG:** * **Incision Type:** In ASOM, a **curvilinear (circumferential)** incision is made. In Serous Otitis Media (OME), a **radial** incision is preferred to minimize scarring and facilitate grommet placement. * **Indication:** The most common indication for myringotomy in ASOM is a "bulging drum" with severe earache. * **Anesthesia:** In adults, it can be done under local anesthesia (phenol application); in children, general anesthesia is required.

Question 108: What is the most common cause of otomycosis?

A. Candida
B. Aspergillus (Correct Answer)
C. Histoplasma
D. Cryptococcus

Explanation: **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.

Question 109: Hennebert's sign is seen in which of the following conditions?

A. Congenital Syphilis (Correct Answer)
B. Acoustic Neuroma
C. Glomus Tumor
D. Otosclerosis

Explanation: **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 110: Malignant otitis externa is characterized by which of the following?

A. Caused by Pseudomonas aeruginosa
B. Malignancy of the external auditory canal
C. Granulation tissue is seen in the floor of the external auditory canal (Correct Answer)
D. Radiotherapy can be given

Explanation: **Explanation:** **Malignant Otitis Externa (MOE)**, also known as Necrotizing Otitis Externa, is a life-threatening progressive infection of the external auditory canal (EAC) and skull base. Despite its name, it is **not a neoplastic process** but an invasive bacterial infection. 1. **Why Option C is Correct:** The hallmark clinical finding of MOE is the presence of **active granulation tissue** at the junction of the bony and cartilaginous portions of the EAC (specifically the **floor**). This occurs as the infection spreads through the **Fissures of Santorini** into the infratemporal fossa and skull base. 2. **Why Option A is Incorrect:** While *Pseudomonas aeruginosa* is indeed the most common causative organism (95% of cases), the question asks for a "characteristic" feature. In the context of NEET-PG, if a clinical sign (granulation tissue) is pitted against an etiology, the pathognomonic clinical finding is prioritized. (Note: In some versions of this question, A and C are both true, but C is the most specific clinical marker). 3. **Why Option B is Incorrect:** MOE is an **infectious/inflammatory** condition, not a true malignancy. The term "malignant" refers to its aggressive, destructive nature and high mortality rate if untreated. 4. **Why Option D is Incorrect:** Since it is an infection, the mainstay of treatment is **long-term systemic antibiotics** (e.g., Ciprofloxacin) and diabetic control. Radiotherapy has no role and would worsen the condition by causing tissue ischemia. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Elderly diabetics (most common) and immunocompromised states. * **Pathognomonic Sign:** Granulation tissue at the floor of the EAC. * **Complication:** Cranial nerve palsies (CN VII is most common). * **Diagnosis:** **Technetium-99m scan** (best for initial diagnosis/bone involvement); **Gallium-67 scan** (best for monitoring treatment response/resolution). * **Treatment:** Intravenous Ciprofloxacin is the drug of choice.

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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