Diseases of the Ear Practice Questions

Q: What is true about Acute Necrotizing Otitis Media (ANOM)?

The most common organism is β-Hemolytic streptococci.. **Explanation:** **Acute Necrotizing Otitis Media (ANOM)** is a virulent form of acute otitis media characterized by rapid destruction of the tympanic membrane and middle ear structures. 1. **Why Option B is Correct:** The classic causative organism for ANOM is **$\beta$-Hemolytic streptococci**. While other organisms like *Staphylococcus aureus* or *Streptococcus pneumoniae* can be involved, $\beta$-Hemolytic streptococci are historically and clinically recognized as the most common and aggressive pathogens in this specific necrotizing variant. 2. **Why Other Options are Incorrect:** * **Option A:** *Pseudomonas aeruginosa* is the primary pathogen in **Malignant Otitis Externa** (seen in elderly diabetics) and Chronic Suppurative Otitis Media (CSOM), but not typically in ANOM. * **Option C:** While it can occur in debilitated patients, ANOM is classically associated with **children suffering from exanthematous fevers** (e.g., Measles, Scarlet fever, or Influenza). It is the severity of the specific infection rather than generalized "low immunity" that defines its presentation. * **Option D:** ANOM typically results in a **large central perforation** (often described as a "total" or "subtotal" perforation) due to the sloughing of the tympanic membrane. Marginal perforations are more characteristic of Attico-antral (unsafe) CSOM. **High-Yield Clinical Pearls for NEET-PG:** * **Pathology:** Rapid necrosis leads to the formation of a large central perforation and can result in permanent hearing loss due to ossicular destruction (especially the incus). * **Healing:** The perforation rarely heals spontaneously; it often heals by secondary intention, leading to a thin, atrophic membrane or permanent defect. * **Key Association:** Always link ANOM with **Measles** in exam questions.

Q: Painless discharge from the ear and multiple tympanic membrane perforations are characteristic of which condition?

Tuberculous otitis media. **Explanation:** **Tuberculous Otitis Media (TOM)** is the correct answer because it presents with a classic clinical triad: **painless ear discharge**, **multiple tympanic membrane (TM) perforations**, and profound hearing loss disproportionate to the symptoms. The infection usually reaches the middle ear via the Eustachian tube (secondary to pulmonary TB) or hematogenous spread. The multiple perforations occur due to the coalescence of multiple small tubercles on the TM; these eventually merge into a single large central perforation. **Analysis of Incorrect Options:** * **Fungal Otitis Media (Otomycosis):** Characteristically presents with intense itching, pain, and a "wet newspaper" or "cotton wool" appearance (Aspergillus/Candida). It does not typically cause multiple TM perforations. * **Serous Otitis Media (Otitis Media with Effusion):** Characterized by a retracted, dull TM with air-fluid levels or bubbles. The TM remains **intact**, and there is no discharge. * **Viral Otitis Media:** Often presents as Myringitis Bullosa, characterized by severe pain and hemorrhagic blebs on the TM. It does not cause chronic painless discharge or multiple perforations. **High-Yield Clinical Pearls for NEET-PG:** * **Pathognomonic sign:** Multiple "sieve-like" perforations (though these often coalesce into one large perforation later). * **Discharge:** Characteristically thin, odorless, and watery (flocculent). * **Facial Nerve Paralysis:** A known complication of TOM due to bone necrosis. * **Diagnosis:** Confirmed by identifying *Mycobacterium tuberculosis* in the discharge (AFB staining) or via middle ear mucosa biopsy showing granulomas.

Q: What is the most common cause of conductive hearing loss with an intact tympanic membrane?

Otitis media with effusion (Glue ear). **Explanation:** The correct answer is **Otitis media with effusion (OME)**, also known as "Glue ear." **1. Why it is the correct answer:** Conductive hearing loss (CHL) occurs when sound cannot be efficiently conducted through the outer or middle ear. In OME, the middle ear space is filled with non-purulent fluid instead of air. This fluid increases the impedance of the ossicular chain, leading to CHL. Crucially, in OME, the **tympanic membrane remains intact**, though it may appear dull, retracted, or show an air-fluid level/bubbles. It is the most common cause of CHL in children and a frequent cause in adults following upper respiratory infections. **2. Why the other options are incorrect:** * **Presbycusis (A):** This is age-related hearing loss. It is a **Sensorineural Hearing Loss (SNHL)**, not conductive, caused by the degeneration of hair cells in the cochlea. * **Meniere's disease (B):** This is an inner ear disorder characterized by endolymphatic hydrops. It presents with a triad of vertigo, tinnitus, and fluctuating **SNHL** (typically low-frequency). * **Acoustic neuroma (D):** Also known as vestibular schwannoma, this is a benign tumor of the 8th cranial nerve. It causes retrocochlear **SNHL**, not conductive loss. **3. Clinical Pearls for NEET-PG:** * **Otosclerosis:** Another common cause of CHL with an intact TM (especially in young adults). It is characterized by a "flamingo flush" (Schwartz sign) and **Carhart’s notch** at 2000 Hz on audiometry. * **Tympanometry:** In OME, the tympanogram shows a **Type B (flat) curve**, whereas Otosclerosis shows a **Type As (shallow)** curve. * **Management of OME:** Most cases resolve spontaneously; if persistent, myringotomy with grommet insertion is the treatment of choice.

Q: A patient hears better in noise. What is the diagnosis?

Paracusis. **Explanation:** The phenomenon where a patient hears better in a noisy environment is known as **Paracusis Willisii**. This is a classic clinical feature of **Otosclerosis**. **Why Paracusis is the correct answer:** In patients with conductive hearing loss (specifically Otosclerosis), the background noise masks low-frequency sounds for people with normal hearing. Consequently, people around the patient tend to speak louder to be heard over the noise. Since the patient has a conductive barrier that filters out the ambient low-frequency background noise, they perceive the increased volume of the speaker's voice more clearly than they would in a quiet room. **Analysis of Incorrect Options:** * **Hyperacusis:** This is an abnormal sensitivity to ordinary environmental sounds, often perceived as painfully loud. It is commonly seen in Bell’s palsy (due to stapedius muscle paralysis). * **Hypoacusis:** A general term for reduced hearing acuity or hearing loss of any type. * **Presbyacusis:** This is age-related sensorineural hearing loss. Patients with presbyacusis typically hear **worse** in noise because they lose the ability to discriminate speech frequencies against background interference (the "cocktail party effect"). **High-Yield Clinical Pearls for NEET-PG:** * **Paracusis Willisii** is a pathognomonic sign of **Otosclerosis**. * **Schwartz Sign:** A flamingo-pink flush seen on the promontory through the tympanic membrane, indicating active otosclerosis. * **Carhart’s Notch:** A characteristic dip in the bone conduction threshold at **2000 Hz** seen on an Audiogram in Otosclerosis. * **Gelle’s Test:** Used to differentiate ossicular fixation from a mobile chain; it is negative in Otosclerosis.

Q: What is not true about auricular hematoma?

Resolves spontaneously.. **Explanation:** **Auricular Hematoma** (also known as Othematoma) is a collection of blood between the perichondrium and the auricular cartilage, typically resulting from blunt trauma. **Why Option C is the correct answer (What is NOT true):** Auricular hematomas **do not resolve spontaneously**. Because the cartilage depends on the overlying perichondrium for its blood supply, an untreated hematoma creates a barrier that leads to ischemic necrosis of the cartilage. If left alone, the hematoma undergoes organization and fibrosis, resulting in the permanent deformity known as **"Cauliflower Ear."** Therefore, active surgical intervention (aspiration or incision and drainage) is mandatory. **Analysis of other options:** * **Option A (True):** Antibiotics are routinely prescribed to prevent **Perichondritis**, a serious complication that can lead to further cartilage destruction. * **Option B (True):** It is an occupational hazard for athletes involved in contact sports like **rugby, wrestling, and boxing** due to repeated shearing trauma to the pinna. **High-Yield Clinical Pearls for NEET-PG:** 1. **Management:** Small hematomas can be aspirated with a wide-bore needle; large or recurrent ones require **Incision and Drainage (I&D)** followed by a pressure dressing (to prevent re-accumulation). 2. **Complication:** The most common late complication of an untreated hematoma is **Cauliflower Ear** (Boxer’s ear). 3. **Site:** It most commonly occurs on the anterior (lateral) surface of the pinna where the skin is tightly bound to the perichondrium.

Q: A 2-year-old child undergoes tympanostomy tube placement for treatment of chronic bilateral serous otitis media. Which of the following complications is least likely to occur subsequent to surgery?

Scarring of the external auditory canal. **Explanation:** Tympanostomy tube (Grommet) placement is the most common surgical procedure in children for chronic otitis media with effusion. To identify the "least likely" complication, one must distinguish between complications affecting the **tympanic membrane (TM)** versus the **external auditory canal (EAC)**. **Why Option D is Correct:** **Scarring of the external auditory canal** is not a recognized complication of tympanostomy. The procedure involves a radial or curvilinear incision (myringotomy) specifically in the TM (usually the anteroinferior quadrant). Since the EAC skin is not incised or traumatized during standard tube placement, scarring or stenosis of the canal does not occur. **Analysis of Incorrect Options:** * **A. Chronic Perforation:** Occurs in about 1–2% of cases after the tube extrudes. The risk increases with long-term tubes (e.g., T-tubes). * **B. Cholesteatoma:** A rare but serious complication (approx. 0.5%). It can occur if squamous epithelium from the TM surface is accidentally implanted into the middle ear during insertion or if the TM invaginates through a persistent perforation. * **C. Tympanosclerosis:** The **most common** post-operative finding (up to 30–50%). It appears as chalky white patches on the TM due to hyaline and calcium deposits; it rarely affects hearing significantly. **NEET-PG High-Yield Pearls:** * **Most common complication:** Tympanosclerosis (Myringosclerosis). * **Most common "nuisance" complication:** Post-operative otorrhea (discharge). * **Ideal site for Myringotomy:** Anteroinferior quadrant (safest, as it is away from the ossicles and the chorda tympani nerve). * **Indication:** Bilateral effusion for >3 months with associated hearing loss (>20–30 dB).

Q: A patient presents with hearing loss and a sensation of fullness in the left ear. What is the most likely diagnosis?

Fracture of the temporal bone. **Explanation:** The correct answer is **Fracture of the temporal bone**. Temporal bone fractures are a common cause of sudden hearing loss and ear fullness following head trauma. The hearing loss can be **conductive** (due to hemotympanum, tympanic membrane rupture, or ossicular disruption) or **sensorineural** (due to cochlear concussion or involvement of the otic capsule). The sensation of "fullness" is typically attributed to the accumulation of blood in the middle ear cleft (**hemotympanum**). **Analysis of Incorrect Options:** * **A. Cholesteatoma:** While it causes hearing loss, it is a chronic condition characterized by keratinizing squamous epithelium in the middle ear. It typically presents with foul-smelling ear discharge (otorrhea) rather than sudden fullness. * **C. Ochronosis:** This is a systemic manifestation of Alkaptonuria. While it can cause bluish-black pigmentation of the pinna and late-stage hearing loss due to ossicular stiffening, it is an extremely rare cause of acute ear fullness. * **D. Otomycosis:** This fungal infection of the external auditory canal presents with intense itching, pain, and debris. While it causes fullness, the hallmark is the presence of fungal hyphae (e.g., "wet newspaper" appearance for *Aspergillus niger*). **NEET-PG High-Yield Pearls:** * **Longitudinal Fractures (80%):** Most common; usually result in conductive hearing loss and bleeding from the ear. The facial nerve is involved in only 20% of cases. * **Transverse Fractures (20%):** More severe; often result in sensorineural hearing loss and vertigo due to otic capsule involvement. The facial nerve is involved in 50% of cases. * **Battle’s Sign:** Post-auricular ecchymosis indicating a posterior cranial fossa/temporal bone fracture. * **Hemotympanum:** A classic sign of temporal bone fracture where the tympanic membrane appears bright blue or dark red.

Q: Which of the following statements about Pendred syndrome is FALSE?

Thyroidectomy is the treatment.. **Explanation:** **Pendred Syndrome** is an autosomal recessive disorder characterized by the triad of **sensorineural hearing loss (SNHL)**, **goiter**, and an abnormal perchlorate discharge test. 1. **Why Option A is the Correct (False) Statement:** Thyroidectomy is **not** the treatment for Pendred syndrome. Most patients are clinically euthyroid or mildly hypothyroid. The goiter is managed with **Thyroxine (T4) supplementation**, which suppresses TSH levels and reduces the size of the goiter. Surgery is only indicated in rare cases of severe compression symptoms or malignancy. 2. **Analysis of Other Options:** * **Option B:** It is caused by mutations in the **SLC26A4 gene** (located on chromosome 7q31), which encodes the protein **Pendrin**. Pendrin acts as an ion exchanger (chloride/iodide/bicarbonate) in the inner ear and thyroid. * **Option C:** SNHL is a hallmark feature. It is typically congenital, bilateral, and severe. It is classically associated with inner ear malformations, most commonly an **Enlarged Vestibular Aqueduct (EVA)** or Mondini dysplasia. * **Option D:** Goiter usually develops in late childhood or early puberty due to a defect in iodine organification. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic:** "P" for **P**endred, **P**endrin gene, **P**erchlorate discharge test (Positive), and **P**artial organification defect. * **Radiology:** The most common radiological finding is **Enlarged Vestibular Aqueduct (EVA)**. * **Diagnosis:** A **Perchlorate Discharge Test** is used to demonstrate the iodine organification defect (though genetic testing is now the gold standard). * Pendred syndrome is one of the most common causes of syndromic genetic hearing loss.

Question 1

What is true about Acute Necrotizing Otitis Media (ANOM)?

Accepted Answer

The most common organism is β-Hemolytic streptococci.

Answer

The most common organism is Pseudomonas Aeruginosa.

Answer

It occurs in patients with low immunity.

Answer

It causes marginal perforation.

Question 2

Painless discharge from the ear and multiple tympanic membrane perforations are characteristic of which condition?

Accepted Answer

Tuberculous otitis media

Answer

Fungal otitis media

Answer

Serous otitis media

Answer

Viral otitis media

Question 3

What is the most common cause of conductive hearing loss with an intact tympanic membrane?

Accepted Answer

Otitis media with effusion (Glue ear)

Answer

Presbycusis

Answer

Meniere's disease

Answer

Acoustic neuroma

Question 4

Which of the following statement regarding Eustachian tube dysfunction is wrong?

Accepted Answer

Undistorted light image on the anterior quadrant of tympanic membrane

Answer

No movement of the tympanic membrane on siegel's method

Answer

Malleus is easily visible

Answer

Lusterless tympanic membrane

Question 5

A 65-year-old person with bilateral sensorineural hearing loss and proportionate speech discrimination is suffering from:

Accepted Answer

Presbycusis

Answer

Noise induced hearing loss

Answer

Ototoxic drug-induced hearing loss

Answer

Acoustic neuroma

Question 6

A patient hears better in noise. What is the diagnosis?

Accepted Answer

Paracusis

Answer

Hyperacusis

Answer

Hypoacusis

Answer

Presbyacusis

Question 7

What is not true about auricular hematoma?

Accepted Answer

Resolves spontaneously.

Answer

All cases should receive antibiotics.

Answer

Commonly seen in rugby players.

Answer

All of the above.

Question 8

A 2-year-old child undergoes tympanostomy tube placement for treatment of chronic bilateral serous otitis media. Which of the following complications is least likely to occur subsequent to surgery?

Accepted Answer

Scarring of the external auditory canal

Answer

Chronic perforation

Answer

Cholesteatoma

Answer

Tympanosclerosis

Question 9

A patient presents with hearing loss and a sensation of fullness in the left ear. What is the most likely diagnosis?

Accepted Answer

Fracture of the temporal bone

Answer

Cholesteatoma

Answer

Ochronosis

Answer

Otomycosis

Question 10

Which of the following statements about Pendred syndrome is FALSE?

Accepted Answer

Thyroidectomy is the treatment.

Answer

It is caused by mutation of the PENDRIN gene.

Answer

It is associated with sensorineural deafness.

Answer

Goitre is a common feature.

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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