Diseases of the Ear Practice Questions

Q: Surfer's ear differs from osteoma in that it is:

Sessile. ### Explanation The question asks to differentiate **Exostoses (Surfer’s Ear)** from **Osteomas** of the external auditory canal. The correct answer is **Sessile**. #### 1. Why "Sessile" is Correct **Exostoses (Surfer’s Ear)** are benign bony overgrowths of the external auditory canal caused by chronic exposure to cold water or wind. Pathologically, they are characterized by broad-based, **sessile** elevations of lamellar bone. In contrast, an **Osteoma** is a true benign neoplasm that typically presents as a **pedunculated** (stalked) mass. #### 2. Analysis of Incorrect Options * **A & B (Unilateral/Single):** These are features of **Osteomas**. Osteomas are typically solitary and unilateral. Exostoses (Surfer’s Ear) are almost always **bilateral and multiple**, appearing as 3 to 4 smooth mounds in the deep canal. * **D (Seen in cartilaginous canal):** Both exostoses and osteomas occur in the **bony part** of the external auditory canal, not the cartilaginous part. Exostoses specifically arise from the periosteum of the tympanic bone. #### 3. Clinical Pearls for NEET-PG | Feature | Exostoses (Surfer's Ear) | Osteoma | | :--- | :--- | :--- | | **Etiology** | Reactive (Cold water/wind) | Neoplastic (Spontaneous) | | **Number** | Multiple | Solitary | | **Laterality** | Bilateral | Unilateral | | **Shape** | Sessile (Broad-based) | Pedunculated (Stalked) | | **Location** | Deep bony canal | Bony-cartilaginous junction | * **High-Yield Fact:** Exostoses are often asymptomatic but can lead to conductive hearing loss or otitis externa if they obstruct the canal or trap debris (the "wax trap" effect). Surgery (canalplasty) is indicated only if symptomatic.

Q: In otosclerosis, tinnitus is due to which of the following?

Cochlear involvement. **Explanation:** In **Otosclerosis**, tinnitus is a common symptom, often described as a low-pitched, continuous sound. The correct answer is **Cochlear involvement** because tinnitus in this condition is primarily a sensory phenomenon. 1. **Why Cochlear Involvement is Correct:** Otosclerosis is not just limited to the stapes footplate (stapedial otosclerosis); it can also involve the bony labyrinth (cochlear otosclerosis). The release of toxic enzymes (like hyaluronidase) into the inner ear fluids or the direct extension of the otosclerotic focus into the cochlea causes irritation of the hair cells. This sensorineural irritation is the primary driver of tinnitus. 2. **Why Other Options are Incorrect:** * **Increased vascularity (Schwartze Sign):** While active lesions (Otospongiosis) are highly vascular, this typically causes a reddish hue behind the tympanic membrane, not the subjective tinnitus experienced by the patient. * **Conductive deafness:** Conductive loss makes the patient more aware of internal body sounds (autophony) because it eliminates the "masking effect" of environmental noise, but it is not the *pathological cause* of the tinnitus itself. **High-Yield Clinical Pearls for NEET-PG:** * **Schwartze Sign (Flamingo Flush):** Indicates an active stage of otosclerosis (increased vascularity). * **Carhart’s Notch:** A characteristic dip in the bone conduction threshold at **2000 Hz**. * **Gelle’s Test:** Negative in otosclerosis (indicates stapes fixation). * **Treatment of Choice:** Stapedotomy (most common) or Stapedectomy. * **Medical Management:** Sodium Fluoride (used to mature active foci and reduce tinnitus/vertigo).

Q: In Meniere's disease, all of the following are typically seen, EXCEPT:

Tinnitus and hearing loss decrease during an attack. **Explanation:** Meniere’s disease (Endolymphatic Hydrops) is characterized by an increase in the volume and pressure of the endolymph within the inner ear. **Why Option D is the Correct Answer (The "Except"):** In Meniere’s disease, an acute attack is triggered by a sudden increase in endolymphatic pressure. Consequently, **tinnitus and hearing loss significantly worsen (increase)** during an attack, rather than decrease. The classic triad includes episodic vertigo, fluctuating sensorineural hearing loss (SNHL), and roaring tinnitus, all of which peak during the symptomatic phase. **Analysis of Other Options:** * **Option A:** **Ballooning of Reissner’s membrane** is the hallmark histopathological finding. The increased endolymphatic pressure causes the membrane to bulge into the scala vestibuli. It may eventually rupture, leading to the mixing of endolymph and perilymph. * **Option B:** **Fluctuating hearing loss** is a defining clinical feature. Initially, the hearing loss involves low frequencies and improves between attacks, though it eventually becomes permanent and involves all frequencies (flat curve). * **Option C:** **Salt-restricted diet** is a primary conservative management strategy. Reducing sodium intake helps decrease endolymphatic pressure by reducing fluid retention. **High-Yield Clinical Pearls for NEET-PG:** * **Lermoyez Syndrome:** A variant where hearing actually *improves* during a vertigo attack (the "reverse" Meniere's). * **Audiometry:** Characteristically shows **Low-frequency SNHL** in early stages. * **Recruitment Phenomenon:** Present (indicates cochlear pathology). * **Glycerol Test:** Used for diagnosis; glycerol acts as an osmotic diuretic, temporarily improving hearing thresholds. * **Drug of Choice:** **Betahistine** is used for maintenance; Vestibular sedatives (e.g., Prochlorperazine) are used for acute attacks.

Q: Which of the following is NOT true about otosclerosis?

Leads to unilateral deafness. ### Explanation **Otosclerosis** is a primary metabolic bone disease of the otic capsule characterized by the replacement of normal bone with vascular spongy bone, eventually leading to stapes fixation. **Why Option B is the Correct Answer (The False Statement):** Otosclerosis is typically a **bilateral** condition (seen in approximately 70-85% of cases). While it may start in one ear, it almost always progresses to involve both ears, resulting in bilateral conductive hearing loss. Therefore, stating that it leads to unilateral deafness is incorrect. **Analysis of Incorrect Options (True Statements):** * **A. More common in females:** The female-to-male ratio is approximately **2:1**. Clinical symptoms often worsen during physiological stress such as pregnancy or menopause. * **C. Tympanic membrane is normal:** Since otosclerosis is a disease of the ossicles and otic capsule, the tympanic membrane remains mobile and healthy. A specific clinical sign, **Schwartz sign** (a flamingo-pink flush), may be seen through a normal TM due to increased vascularity over the promontory. * **D. Occurs at the oval window:** The most common site of involvement is the **fissula ante fenestram**, located just anterior to the oval window. This leads to stapedial fixation. **High-Yield Clinical Pearls for NEET-PG:** * **Hearing Loss:** Characterized by progressive Conductive Hearing Loss (CHL). * **Paracusis Willisii:** Patients hear better in noisy surroundings (a classic symptom). * **Audiometry:** Shows **Cahart’s Notch** (a dip in bone conduction at 2000 Hz). * **Tympanometry:** Usually shows an **As type** (stiffened) curve. * **Treatment of Choice:** Stapedotomy or Stapedectomy.

Q: Vesicle in the ear with ipsilateral facial nerve palsy is typically caused by which infection?

Varicella-zoster virus (VZV). ### Explanation The clinical presentation of **vesicles in the ear** (specifically the pinna, concha, or external auditory canal) associated with **ipsilateral facial nerve palsy** is the hallmark of **Ramsay Hunt Syndrome** (Herpes Zoster Oticus). **1. Why Varicella-zoster virus (VZV) is correct:** Ramsay Hunt Syndrome is caused by the **reactivation of latent VZV** in the **geniculate ganglion** of the facial nerve (CN VII). The virus travels down the nerve fibers, leading to inflammation and compression of the facial nerve (causing lower motor neuron palsy) and cutaneous eruption of vesicles in the distribution of the sensory branches (the "Zoster Zone" of the ear). Patients may also experience vestibulocochlear symptoms (tinnitus, vertigo, or hearing loss) if CN VIII is involved. **2. Why other options are incorrect:** * **Cytomegalovirus (CMV):** Primarily associated with congenital sensorineural hearing loss (SNHL) or retinitis in immunocompromised patients; it does not typically cause acute vesicular eruptions and facial palsy. * **Epstein-Barr virus (EBV):** Commonly causes Infectious Mononucleosis and is linked to Nasopharyngeal Carcinoma; it is not a standard cause of Ramsay Hunt Syndrome. * **Herpes simplex virus (HSV):** While HSV-1 is the most common cause of **Bell’s Palsy** (idiopathic facial paralysis), Bell’s Palsy is characterized by the **absence** of vesicles. **Clinical Pearls for NEET-PG:** * **Triad of Ramsay Hunt Syndrome:** Facial paralysis, ear pain (otalgia), and vesicles. * **Prognosis:** The recovery rate for facial nerve function in Ramsay Hunt Syndrome is significantly **poorer** than in Bell’s Palsy. * **Treatment:** Combination of oral **Acyclovir/Valacyclovir** and **Corticosteroids**. * **Hitler’s Sign:** Vesicles on the posterior-superior wall of the external auditory canal (high-yield clinical sign).

Question 1

Surfer's ear differs from osteoma in that it is:

Accepted Answer

Sessile

Answer

Unilateral

Answer

Single

Answer

Seen in cartilaginous canal

Question 2

What is the nerve supply of the pinna?

Accepted Answer

Greater superficial petrosal nerve

Answer

Great auricular nerve

Answer

Auriculotemporal nerve

Answer

Lesser occipital nerve

Question 3

In otosclerosis, tinnitus is due to which of the following?

Accepted Answer

Cochlear involvement

Answer

Increased vascularity in the lesion

Answer

Conductive deafness

Answer

All of the above

Question 4

Which of the following is true about cholesteatoma (atticoantral)?

Accepted Answer

Scanty, malodorous discharge

Answer

Otaliga

Answer

Central perforation

Answer

Ossicular involvement

Question 5

Malignant otitis externa is most commonly caused by?

Accepted Answer

Pseudomonas aeruginosa

Answer

Staphylococcus aureus

Answer

Streptococcus pneumoniae

Answer

Staphylococcus epidermidis

Question 6

A 38-year-old male presented with a suspected diagnosis of suppurative labyrinthitis. An initial examination revealed a positive Rinne's test and a positive fistula test. The patient refused treatment and returned to the emergency department after 2 weeks complaining of deafness in the affected ear. On re-examination, the fistula test was observed to be negative. What is the likely expected finding on repeating the Rinne's test?

Accepted Answer

False Negative Rinne's Test

Answer

True Positive Rinne's Test

Answer

False Positive Rinne's Test

Answer

True Negative Rinne's Test

Question 7

In Meniere's disease, all of the following are typically seen, EXCEPT:

Accepted Answer

Tinnitus and hearing loss decrease during an attack

Answer

Ballooning of the Reissner's membrane

Answer

Hearing loss is fluctuating in nature

Answer

Salt-restricted diet is advised

Question 8

In malignant otitis externa, which nerve is commonly affected?

Accepted Answer

Facial nerve

Answer

Abducent nerve

Answer

Auditory nerve

Answer

Vagus nerve

Question 9

Which of the following is NOT true about otosclerosis?

Accepted Answer

Leads to unilateral deafness

Answer

More common in females than males

Answer

Tympanic membrane is normal

Answer

Occurs at the oval window

Question 10

Vesicle in the ear with ipsilateral facial nerve palsy is typically caused by which infection?

Accepted Answer

Varicella-zoster virus (VZV)

Answer

Cytomegalovirus (CMV)

Answer

Epstein-Barr virus (EBV)

Answer

Herpes simplex virus (HSV)

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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