Diseases of the Ear Practice Questions

Q: Which cranial nerve is responsible for referred pain to the ear?

Glossopharyngeal nerve (IX). **Explanation:** The ear has a complex sensory nerve supply, making it a common site for **referred otalgia** (ear pain originating from a distant site). **1. Why Glossopharyngeal nerve (IX) is correct:** The Glossopharyngeal nerve provides sensory innervation to the oropharynx, tonsils, and the posterior third of the tongue. It also gives off the **Jacobson’s nerve (tympanic branch)**, which forms the tympanic plexus and provides sensation to the middle ear and the medial surface of the tympanic membrane. Due to this shared pathway, pathologies in the oropharynx (e.g., post-tonsillectomy pain, peritonsillar abscess, or base of tongue tumors) are perceived as pain in the ear. **2. Why the other options are incorrect:** * **Oculomotor nerve (III):** A motor nerve responsible for most extraocular muscle movements and pupillary constriction. It has no sensory distribution to the ear or pharynx. * **Accessory nerve (XI):** A purely motor nerve supplying the sternocleidomastoid and trapezius muscles. * **Hypoglossal nerve (XII):** A motor nerve supplying the intrinsic and extrinsic muscles of the tongue (except palatoglossus). It does not carry sensory fibers related to referred pain. **Clinical Pearls for NEET-PG:** * **Nerves causing referred otalgia:** Remember the "Big Five": **V** (Trigeminal - via auriculotemporal), **VII** (Facial), **IX** (Glossopharyngeal - via Jacobson's), **X** (Vagus - via Arnold’s nerve), and **C2/C3** (Greater auricular/Lesser occipital). * **Eagle’s Syndrome:** Elongated styloid process irritating the CN IX, leading to throat pain and referred otalgia. * **Trotter’s Triad:** Associated with Nasopharyngeal Carcinoma; includes conductive hearing loss, palatal palsy, and trigeminal neuralgia (referred pain).

Q: All are causes of sensorineural deafness except?

Rupture of tympanic membrane. **Explanation** Hearing loss is broadly categorized into **Conductive Hearing Loss (CHL)**, caused by pathology in the external or middle ear, and **Sensorineural Hearing Loss (SNHL)**, caused by pathology in the cochlea (sensory) or the VIIIth cranial nerve (neural). **Why Option D is the Correct Answer:** **Rupture of the tympanic membrane** is a classic cause of **Conductive Hearing Loss**. The tympanic membrane is part of the middle ear's sound-conducting apparatus. A perforation disrupts the mechanical transmission of sound vibrations to the ossicles, preventing sound from efficiently reaching the inner ear. Since the inner ear (cochlea) and nerve remain intact, it is not a sensorineural cause. **Analysis of Incorrect Options (Causes of SNHL):** * **A. Old Age (Presbycusis):** This is the most common cause of SNHL. It involves age-related degeneration of the hair cells in the Organ of Corti and the stria vascularis. * **B. Acoustic Neuroma (Vestibular Schwannoma):** This is a benign tumor of the VIIIth cranial nerve. It causes **retrocochlear SNHL** by compressing the cochlear nerve fibers. * **C. Ototoxic Drugs:** Drugs like aminoglycosides (e.g., Gentamicin), loop diuretics, and Cisplatin cause SNHL by damaging the sensory hair cells within the cochlea. **High-Yield Clinical Pearls for NEET-PG:** * **Rinne Test:** In SNHL, Rinne is Positive (AC > BC). In CHL, Rinne is Negative (BC > AC). * **Weber Test:** Lateralizes to the **better** ear in SNHL and to the **affected** (poorer) ear in CHL. * **Audiometry:** SNHL shows no "Air-Bone Gap," whereas CHL shows a significant gap (>15 dB) between air and bone conduction thresholds. * **Carhart’s Notch:** A specific dip at 2000 Hz in bone conduction, characteristic of Otosclerosis (a CHL condition).

Q: Which cells of the Organ of Corti are vulnerable to noise-induced damage?

Outer hair cells. **Explanation:** **1. Why Outer Hair Cells (OHCs) are the correct answer:** Noise-induced hearing loss (NIHL) primarily targets the **Outer Hair Cells** of the Organ of Corti. OHCs are the "amplifiers" of the cochlea; they are more metabolically active and structurally delicate than inner hair cells. Excessive noise exposure leads to excessive metabolic stress, the formation of Reactive Oxygen Species (ROS), and mechanical exhaustion of the stereocilia. Damage typically begins in the basal turn of the cochlea (high frequencies), specifically at the **4 kHz** mark (the "acoustic notch"). **2. Why other options are incorrect:** * **Inner Hair Cells (IHCs):** These are the primary sensory transducers that send signals to the brain. They are more resilient and are usually only damaged after significant destruction of the OHCs has already occurred. * **Deiter’s Cells:** These are supporting cells that provide a base for the OHCs. While they can be affected in severe trauma, they are not the primary site of initial noise-induced damage. * **Cells of Hensen:** These are supporting cells located lateral to the OHCs. They provide structural support but do not play a direct role in the pathophysiology of noise-induced sensory loss. **3. Clinical Pearls for NEET-PG:** * **Early Sign:** The earliest clinical sign of NIHL on an audiogram is a dip at **4000 Hz (4 kHz notch)**, also known as **Boilermaker's notch**. * **Temporary vs. Permanent:** A "Temporary Threshold Shift" (TTS) involves recovery of OHC function, whereas a "Permanent Threshold Shift" (PTS) involves OHC death and replacement by scar tissue (phalangeal scars). * **Safe Limit:** Prolonged exposure to noise levels above **85 dB** is considered hazardous to the OHCs. * **Presbycusis vs. NIHL:** Both affect high frequencies, but NIHL specifically shows the 4 kHz notch, whereas presbycusis shows a down-sloping curve at the highest frequencies (6-8 kHz).

Q: A 60-year-old man presented with left-sided ear discharge for 7 years accompanied by dull earache. On examination, the tympanic membrane is intact on both sides, and a mass is seen on the posterior canal wall on the left side. What is the most likely diagnosis?

Keratosis obturans. **Explanation:** The clinical presentation of long-standing ear discharge, dull pain, an **intact tympanic membrane (TM)**, and a **mass on the posterior canal wall** in an older patient is classic for **Keratosis Obturans**. **Why Keratosis Obturans is correct:** Keratosis obturans is caused by the accumulation of desquamated keratin scales in the external auditory canal (EAC). Unlike Cholesteatoma, it typically presents with an intact TM. The "mass" described is the keratin plug. Over time, the pressure from this accumulation causes **ballooning of the bony canal** and pressure necrosis, leading to a dull, deep-seated ache and chronic discharge. **Why the other options are incorrect:** * **CSOM:** This diagnosis requires a **perforated tympanic membrane**. The question explicitly states the TM is intact, ruling out CSOM. * **External Otitis:** This is usually an acute, painful inflammatory condition. While it causes discharge, it does not typically present as a localized mass on the posterior wall or persist for 7 years without acute exacerbations. * **Carcinoma of the EAC:** While it can present with pain and discharge in older patients, it usually presents as a friable, bleeding mass or ulcer rather than a keratinous plug, and is often associated with rapid progression and cranial nerve palsies. **High-Yield Clinical Pearls for NEET-PG:** * **Keratosis Obturans vs. Canal Cholesteatoma:** Keratosis obturans involves **circumferential** keratin accumulation and canal widening, often associated with bronchiectasis or sinusitis. Canal Cholesteatoma involves **localized** bone erosion (usually the floor) with a sequestration of bone. * **Triad of Keratosis Obturans:** Severe pain, conductive hearing loss, and a widened bony EAC. * **Management:** Repeated syringing or manual removal of the keratin plug under microscopy.

Q: In Mastoiditis, tenderness is present at which anatomical landmark?

Mastoid tip. ### Explanation **Correct Answer: C. Mastoid tip** **Medical Concept:** Mastoiditis is an inflammation of the mastoid air cells, usually occurring as a complication of Acute Otitis Media (AOM). The mastoid process is a bony prominence located behind the pinna. In acute mastoiditis, pus accumulates under pressure within the mastoid antrum and air cells, leading to hyperemia and osteitis of the overlying periosteum. This results in **exquisite tenderness** over the **mastoid tip** and the **Macewen’s triangle** (suprameatal triangle), which is the surgical landmark for the mastoid antrum. **Analysis of Incorrect Options:** * **A. Tragus:** Tenderness on pressing the tragus (**Tragus sign**) is a classic feature of **Otitis Externa** (inflammation of the external auditory canal) or furunculosis. It is absent in uncomplicated mastoiditis. * **B. Concha:** The concha is part of the external ear cartilage. While it may be displaced laterally or forward in mastoiditis (causing the "proptosis of the pinna"), direct tenderness of the concha itself is not a diagnostic sign of mastoiditis. * **D. All of the above:** Incorrect because tragal tenderness specifically differentiates external ear pathology from middle ear/mastoid pathology. **High-Yield Clinical Pearls for NEET-PG:** * **Reservoir Sign:** If the ear is mopped dry and pus reappears immediately in the meatus, it indicates a large reservoir of pus in the mastoid (highly suggestive of mastoiditis). * **Ironing out effect:** Due to periosteal thickening, the normal bony contours of the mastoid process feel smooth or "ironed out" on palpation. * **Radiology:** The investigation of choice is **HRCT Temporal Bone**, which shows clouding of air cells and loss of bony trabeculae (coalescent mastoiditis). * **Sagging of the posterosuperior meatal wall:** A pathognomonic sign caused by periosteitis adjacent to the mastoid antrum.

Q: What is the most common mode of inheritance for otosclerosis?

Autosomal Dominant. **Explanation:** **Otosclerosis** is a primary metabolic bone disease of the otic capsule characterized by abnormal bone remodeling, leading to the fixation of the stapes footplate and subsequent conductive hearing loss. **1. Why Autosomal Dominant is correct:** The most common mode of inheritance for clinical otosclerosis is **Autosomal Dominant with incomplete penetrance (approx. 40%) and variable expressivity**. This means that while the gene is dominant, not every individual who inherits the gene will manifest the clinical disease. Approximately 50% of cases have a positive family history. **2. Analysis of Incorrect Options:** * **Autosomal Recessive (A):** While many forms of congenital sensorineural deafness (like GJB2 mutations) follow this pattern, otosclerosis is classically associated with a dominant familial pattern. * **X-linked Recessive (B):** This pattern is rare in ear pathology, though it is seen in conditions like *DFNX2* (associated with stapes gusher). It does not apply to otosclerosis. * **Y-linked (D):** Y-linked inheritance is extremely rare in human genetics and does not play a role in otosclerosis. **3. NEET-PG High-Yield Pearls:** * **Demographics:** Most common in females (2:1 ratio), usually presenting in the 2nd–4th decades of life. * **Clinical Sign:** Hearing loss often worsens during **pregnancy** or menopause due to hormonal changes. * **Schwartze Sign:** A flamingo-pink flush seen on the promontory through the tympanic membrane, indicating active disease (otospongiosis). * **Carhart’s Notch:** A characteristic dip in the bone conduction threshold at **2000 Hz**. * **Treatment of Choice:** Stapedotomy (using a Teflon piston).

Q: On examination of the ear of a patient, you observe that the left ear tympanic membrane is reddish, immobile, and bulging, whilst the right ear tympanic membrane is white, mobile, and translucent. These findings suggest:

Right ear normal with left acute otitis media. ### Explanation **1. Why Option A is Correct:** The clinical description of the left ear—**reddish (hyperemic), immobile, and bulging**—is the classic triad for **Acute Otitis Media (AOM)** in the stage of suppuration. * **Redness:** Caused by intense vascular congestion of the tympanic membrane (TM). * **Bulging:** Occurs due to the accumulation of pus in the middle ear space, which increases pressure and pushes the TM outward (loss of landmarks). * **Immobility:** Pneumatic otoscopy would show no movement because the middle ear is filled with fluid/pus rather than air. Conversely, the right ear is described as **white (pearly gray), mobile, and translucent**. These are the hallmarks of a **normal tympanic membrane**. The translucency allows for the visualization of the long process of the incus and the cone of light, while mobility confirms a well-ventilated middle ear via the Eustachian tube. **2. Why Other Options are Incorrect:** * **Option B:** Reverses the findings; a white, mobile TM cannot be acutely infected. * **Option C:** The left ear findings (bulging and redness) are pathological and indicate an inflammatory process. * **Option D:** The right ear lacks any signs of inflammation (erythema) or effusion (immobility), ruling out bilateral involvement. **3. NEET-PG Clinical Pearls:** * **Stages of AOM:** 1. *Tubal Occlusion:* Retracted TM. 2. *Presuppuration:* Cartwheel appearance (vessels radiating from the handle of malleus). 3. *Suppuration:* Bulging TM (Lighthouse sign may be seen if a small perforation exists). 4. *Resolution/Coalescence.* * **Myringotomy Incision:** In AOM, it is performed in the **postero-inferior quadrant** to avoid injury to the ossicles (incus/stapes) and the chorda tympani nerve. * **Most Common Organism:** *Streptococcus pneumoniae* is the most common cause of AOM.

Q: In otoscopy, the presence of a fluid level and an air bubble typically indicates which of the following conditions?

Middle ear effusion. **Explanation:** The presence of a **fluid level** and **air bubbles** behind an intact tympanic membrane is a pathognomonic sign of **Middle Ear Effusion (Otitis Media with Effusion - OME)**. This occurs when the Eustachian tube is dysfunctional, creating negative pressure that draws transudate into the middle ear. When air enters the fluid-filled cavity (often during a Valsalva maneuver or yawning), it creates visible bubbles or a meniscus (fluid level). **Analysis of Options:** * **Middle Ear Effusion (Correct):** Characterized by a retracted or neutral drum with amber-colored fluid. The "hairline" fluid level or bubbles are classic findings. * **Chronic Suppurative Otitis Media (CSOM):** Typically presents with a **permanent perforation** of the tympanic membrane and ear discharge (otorrhea). Fluid levels cannot form if the drum is perforated. * **Acute Suppurative Otitis Media (ASOM):** Presents with signs of acute inflammation, such as a bulging, congested, and erythematous (red) tympanic membrane, usually accompanied by severe pain and fever. * **Otosclerosis:** This is a bony pathology of the otic capsule. The tympanic membrane usually appears completely **normal** (pearly white), though a "Schwartze sign" (flamingo pink flush) may be seen in active cases. **Clinical Pearls for NEET-PG:** * **Gold Standard Investigation:** Tympanometry, which shows a **Type B (flat) curve**. * **Hearing Loss:** OME is the most common cause of conductive hearing loss in children. * **Management:** Initial observation (watchful waiting); if persistent, Myringotomy with **Grommet insertion** is the treatment of choice. * **Bialateral OME in adults:** Always rule out **Nasopharyngeal Carcinoma** by examining the Fossa of Rosenmüller.

Question 1

Which cranial nerve is responsible for referred pain to the ear?

Accepted Answer

Glossopharyngeal nerve (IX)

Answer

Oculomotor nerve (III)

Answer

Accessory nerve (XI)

Answer

Hypoglossal nerve (XII)

Question 2

All are causes of sensorineural deafness except?

Accepted Answer

Rupture of tympanic membrane

Answer

Old age

Answer

Acoustic neuroma

Answer

Ototoxic drugs

Question 3

Which cells of the Organ of Corti are vulnerable to noise-induced damage?

Accepted Answer

Outer hair cells

Answer

Inner hair cells

Answer

Deiter's cells

Answer

Cells of Hensen

Question 4

A 60-year-old man presented with left-sided ear discharge for 7 years accompanied by dull earache. On examination, the tympanic membrane is intact on both sides, and a mass is seen on the posterior canal wall on the left side. What is the most likely diagnosis?

Accepted Answer

Keratosis obturans

Answer

Chronic suppurative otitis media (CSOM)

Answer

External otitis

Answer

Carcinoma of the external auditory canal

Question 5

In Mastoiditis, tenderness is present at which anatomical landmark?

Accepted Answer

Mastoid tip

Answer

Tragus

Answer

Concha

Answer

All of the above

Question 6

Which of the following statements are true about idiopathic sudden sensorineural hearing loss?

Accepted Answer

Hearing loss occurs within 24 hours.

Answer

Vertigo is always present.

Answer

Carbogen (5% CO2 + 95% O2) is beneficial.

Answer

Hearing loss occurs within 72 hours.

Question 7

What is the most common mode of inheritance for otosclerosis?

Accepted Answer

Autosomal Dominant

Answer

Autosomal Recessive

Answer

X-linked Recessive

Answer

Y-linked

Question 8

On examination of the ear of a patient, you observe that the left ear tympanic membrane is reddish, immobile, and bulging, whilst the right ear tympanic membrane is white, mobile, and translucent. These findings suggest:

Accepted Answer

Right ear normal with left acute otitis media

Answer

Left ear normal with right acute otitis media

Answer

Bilateral ear normal

Answer

Bilateral acute otitis media

Question 9

In otoscopy, the presence of a fluid level and an air bubble typically indicates which of the following conditions?

Accepted Answer

Middle ear effusion

Answer

Chronic suppurative otitis media

Answer

Acute suppurative otitis media

Answer

Otosclerosis

Question 10

Scanty, foul-smelling, painless discharge from the ear is a characteristic feature of which of the following lesions?

Accepted Answer

Cholesteatoma

Answer

Acute Suppurative Otitis Media (ASOM)

Answer

Central Perforation

Answer

Otitis Externa

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

On this page

Practice by Chapter

Want unlimited practice?