Diseases of the Ear — MCQs

Diseases of the Ear Indian Medical PG Practice Questions and MCQs

Question 171: A 22-year-old man presents with itching, earache, and watery discharge with a musty odor from his ear. Examination reveals a black-headed filamentous growth resembling wet blotting paper. What is the likely diagnosis?

A. Acute Otitis externa
B. Otomycosis by Aspergillus niger (Correct Answer)
C. Otomycosis by Aspergillus fumigatus
D. Otomycosis by Candida

Explanation: ### Explanation **Correct Answer: B. Otomycosis by Aspergillus niger** **1. Why it is correct:** The clinical presentation is classic for **Otomycosis**, a fungal infection of the external auditory canal. The diagnosis is confirmed by the specific morphology of the fungal growth. * **Aspergillus niger** is characterized by **black-headed filamentous growth** (conidiophores) that gives the appearance of **"wet blotting paper"** or a "newspaper print" appearance in the ear canal. * The symptoms of intense itching (pruritus), earache, and a watery discharge with a **musty odor** are hallmark features of this fungal colonization. **2. Why other options are incorrect:** * **A. Acute Otitis externa:** This is typically a bacterial infection (often *Pseudomonas*). While it causes pain and discharge, it presents with diffuse canal edema and exquisite tenderness on tragal pressure, without the characteristic filamentous fungal debris. * **C. Aspergillus fumigatus:** While a common cause of otomycosis, it typically presents with **pale blue or greenish** fungal growth rather than black. * **D. Candida:** *Candida albicans* presents as a **white, creamy, or curd-like** discharge (resembling oral thrush) rather than filamentous black heads. **3. NEET-PG High-Yield Pearls:** * **Predisposing factors:** Hot/humid climates, prolonged use of topical antibiotic ear drops (which alters canal flora), and immunocompromised states. * **Key Pathogens:** *Aspergillus niger* (Black), *Aspergillus fumigatus* (Green/Blue), *Aspergillus flavus* (Yellow), and *Candida* (White). * **Treatment:** Thorough **aural toilet** (cleaning) followed by topical antifungal agents like **Clotrimazole** (most common) or Nystatin. Acetic acid drops can be used to restore the acidic pH of the canal. * **Classic Description:** Always look for the keywords "Wet blotting paper" or "Musty odor" to identify Otomycosis in exams.

Question 172: Vasodilators in Meniere's disease are useful because they:

A. Dilate tympanic vessels
B. Decrease endolymph secretion
C. Increase endolymph reabsorption (Correct Answer)
D. Are of no use

Explanation: **Explanation:** Meniere’s disease is characterized by **endolymphatic hydrops**, which is an accumulation of excess endolymph within the inner ear. The primary goal of medical management is to reduce this pressure. **Why Option C is Correct:** The underlying pathophysiology involves either the overproduction of endolymph or, more commonly, its decreased absorption through the endolymphatic sac. **Vasodilators** (such as Betahistine or Nicotinic acid) are used because they improve microcirculation to the inner ear, specifically the **stria vascularis** and the **endolymphatic sac**. By increasing blood flow to these areas, they facilitate the **reabsorption of endolymph**, thereby reducing the hydrops and alleviating symptoms like vertigo and fullness. **Analysis of Incorrect Options:** * **Option A:** Dilating tympanic vessels affects the middle ear, not the inner ear (labyrinth) where the pathology of Meniere’s resides. * **Option B:** While some drugs (like Carbonic anhydrase inhibitors) may decrease secretion, the primary therapeutic mechanism of vasodilators in this context is enhancing the drainage/reabsorption pathway. * **Option C:** Vasodilators are a cornerstone of maintenance therapy in Meniere’s to reduce the frequency of attacks. **NEET-PG High-Yield Pearls:** * **Betahistine** is the most commonly used vasodilator (H1 agonist/H3 antagonist). * **Dietary management:** Low salt diet (<2g/day) is crucial to reduce hydrops. * **Classic Triad:** Episodic vertigo, Sensorineural hearing loss (fluctuating, low-frequency), and Tinnitus. * **Lermoyez Syndrome:** A variant where hearing improves during a vertigo attack (the "reverse" Meniere’s).

Question 173: Hemorrhagic external otitis media is caused by:

A. Influenza (Correct Answer)
B. Proteus
C. Staphylococcus
D. Streptococcus

Explanation: ### Explanation **Hemorrhagic External Otitis (Otitis Externa Hemorrhagica)**, also known as **Bullous Myringitis**, is a specific viral infection characterized by the formation of blood-filled vesicles (bullae) on the tympanic membrane and the deep external auditory canal. **Why Influenza is Correct:** The primary causative agent is the **Influenza virus** (most commonly associated with epidemics). The condition often follows an upper respiratory tract infection. The virus causes localized inflammation and serosanguinous fluid accumulation between the layers of the tympanic membrane, leading to severe, throbbing ear pain (otalgia) that subsides once the bullae rupture. **Why Other Options are Incorrect:** * **B, C, and D (Proteus, Staphylococcus, Streptococcus):** These are common **bacterial** pathogens. While they cause typical Acute Otitis Media (AOM) or Otitis Externa (Swimmer's ear), they typically present with purulent (pus-forming) discharge and diffuse inflammation rather than the classic hemorrhagic bullae seen in viral infections. *Staphylococcus aureus* is the most common cause of furunculosis (localized otitis externa), while *Proteus* is often associated with chronic suppurative otitis media (CSOM). **NEET-PG High-Yield Pearls:** * **Clinical Presentation:** Sudden onset of excruciating pain followed by serosanguinous (bloody) ear discharge upon bulla rupture. * **Key Finding:** Hemorrhagic bullae on the tympanic membrane. * **Management:** Treatment is primarily symptomatic (analgesics). Antibiotics are only indicated if a secondary bacterial infection is suspected. * **Differential Diagnosis:** Always rule out **ASOM (Acute Suppurative Otitis Media)**; however, in bullous myringitis, the hearing loss is usually minimal unless the middle ear is also involved. * **Associated Finding:** Occasionally associated with sensorineural hearing loss (SNHL) or facial palsy if the virus affects the inner ear or cranial nerves.

Question 174: A child presents with barotrauma pain. There is no inflammation of the middle ear. What is the appropriate management?

A. Antibiotics
B. Paracetamol
C. Suppurative management (Correct Answer)
D. Grommet tube insertion

Explanation: ### Explanation **Core Concept: Understanding Barotrauma Management** Barotrauma of the ear (Otitic Barotrauma) occurs due to a failure of the Eustachian tube to equalize pressure between the middle ear and the atmosphere, typically during rapid altitude changes (diving or flying). The term **"Suppurative Management"** in this context refers to **Supportive/Symptomatic Management**. In a child with barotrauma pain but *no signs of inflammation or infection* (no fever, no purulent discharge, no bulging membrane), the primary goal is to restore middle ear pressure and alleviate pain. **Why "Suppurative" (Supportive) Management is Correct:** Most cases of acute barotrauma are self-limiting. Management focuses on: 1. **Pain relief:** Analgesics. 2. **Decongestion:** Nasal decongestants (topical or systemic) to shrink the mucosa around the Eustachian tube orifice. 3. **Pressure Equalization:** Autoinflation techniques (e.g., Valsalva maneuver or chewing gum). **Analysis of Incorrect Options:** * **A. Antibiotics:** Not indicated as there is no active infection or inflammation mentioned. Overuse leads to resistance. * **B. Paracetamol:** While used for pain, it is only one component of supportive care. "Suppurative (Supportive) management" is a broader, more comprehensive clinical approach. * **D. Grommet tube insertion:** This is a surgical intervention reserved for chronic Eustachian tube dysfunction or recurrent serous otitis media. It is not the first-line treatment for acute barotrauma. --- ### NEET-PG High-Yield Pearls * **Pathophysiology:** Occurs when the negative pressure in the middle ear reaches **-90 mmHg**, causing the Eustachian tube to "lock." * **Clinical Sign:** You may see a retracted tympanic membrane, hemotympanum (blue drum), or serous effusion. * **Prevention:** Avoid flying with an upper respiratory tract infection (URTI). Use the **Valsalva maneuver** during descent. * **Grading:** Uses the **Teed Scale** (Grade 0-5) to classify the severity of tympanic membrane changes.

Question 175: Which sign is seen due to thrombosis of mastoid emissary veins?

A. Battle sign
B. Gresinger sign (Correct Answer)
C. Irwin Moore Sign
D. Hennebe's sign

Explanation: ### Explanation **Correct Answer: B. Griesinger's Sign** **Griesinger's Sign** is a clinical hallmark of **Lateral Sinus Thrombophlebitis** (a complication of chronic suppurative otitis media). It refers to edema and tenderness over the posterior part of the mastoid process. * **Mechanism:** It occurs due to the retrograde thrombosis of the **mastoid emissary vein**, which drains into the sigmoid sinus. When the sigmoid sinus is thrombosed, venous return through the emissary vein is obstructed, leading to localized congestion and edema over the mastoid bone. **Analysis of Incorrect Options:** * **A. Battle Sign:** This is post-auricular ecchymosis (bruising) over the mastoid. It is a classic sign of a **Basilar Skull Fracture**, specifically involving the petrous portion of the temporal bone. * **C. Irwin Moore Sign:** This refers to a positive "squeeze test" where pressure on the tonsil expresses pus or debris from the supratonsillar fossa, typically seen in **Chronic Tonsillitis**. * **D. Hennebert's Sign:** This is a false positive fistula test. It refers to nystagmus/vertigo induced by pressure changes in the external ear canal in the absence of a bony fistula. It is classically seen in **Meniere’s disease** (fibrous bands) or **Congenital Syphilis** (hypermobile stapes). **High-Yield Clinical Pearls for NEET-PG:** * **Tobey-Ayer Test:** Used during lumbar puncture to diagnose lateral sinus thrombosis; manual compression of the jugular vein on the affected side fails to cause a rise in CSF pressure. * **Crowe-Beck Test:** Engorgement of retinal veins and supraorbital veins upon compressing the internal jugular vein on the healthy side. * **Delta Sign (Empty Triangle Sign):** The characteristic finding on Contrast-Enhanced CT (CECT) for lateral sinus thrombosis.

Question 176: What is cauliflower ear?

A. Keloid
B. Perichondritis in boxers (Correct Answer)
C. Squamous cell carcinoma
D. Anaplastic cell carcinoma

Explanation: **Explanation:** **Cauliflower ear** (also known as Boxer’s ear or Wrestler’s ear) is an acquired deformity of the external ear resulting from repeated blunt trauma. **Why Option B is correct:** When the pinna is subjected to shearing forces (common in contact sports like boxing and wrestling), a **subperichondrial hematoma** forms. This collection of blood separates the cartilage from its overlying perichondrium, which is its only source of nutrition. If the hematoma is not drained promptly, it undergoes organization and fibrosis. This leads to the formation of new, irregular fibrocartilage and permanent thickening, giving the pinna a shrivelled, "cauliflower-like" appearance. This process is essentially a chronic sequela of **traumatic perichondritis**. **Why other options are incorrect:** * **Option A (Keloid):** While keloids can occur on the ear (often following ear piercing), they are excessive growths of scar tissue (collagen) that extend beyond the boundaries of the original wound. They do not typically involve the entire pinna or follow the specific mechanism of subperichondrial hematoma. * **Options C & D (Carcinomas):** Squamous cell and Anaplastic carcinomas are malignancies. While they can cause structural destruction of the ear, they present with ulceration, bleeding, or fungating masses rather than the characteristic fibrotic thickening seen in cauliflower ear. **High-Yield Clinical Pearls for NEET-PG:** * **Management:** The immediate treatment for an auricular hematoma is **incision and drainage** under aseptic conditions, followed by a **pressure dressing** to prevent re-accumulation. * **Complication:** If the hematoma becomes infected, it leads to **suppurative perichondritis**, which can cause rapid necrosis of the auricular cartilage. * **Cartilage Sparing:** In cases of perichondritis or cauliflower ear, the **ear lobule** is typically spared because it contains no cartilage.

Question 177: What is the essential radiological feature of acute mastoiditis?

A. Temporal bone pneumatization
B. Clouding of air cells of mastoid (Correct Answer)
C. Rarefaction of petrous bone
D. Thickening of temporal bone

Explanation: ### Explanation **Acute Mastoiditis** is a clinical diagnosis characterized by the spread of infection from the middle ear to the mastoid air cell system. **1. Why "Clouding of air cells" is correct:** In a healthy state, mastoid air cells are filled with air, appearing black (radiolucent) on imaging. In acute mastoiditis, the inflammatory process leads to the accumulation of fluid, pus, and inflammatory mucosal thickening within these cells. This replaces the air, resulting in a hazy, "cloudy," or opaque appearance on X-ray (Schuller’s view) or CT scan. If the condition progresses to **coalescent mastoiditis**, the bony septa between these cells break down, leading to the formation of a single large abscess cavity. **2. Analysis of Incorrect Options:** * **A. Temporal bone pneumatization:** This refers to the normal development of air cells. While the degree of pneumatization can influence the spread of infection, it is a physiological feature, not a sign of pathology. * **C. Rarefaction of petrous bone:** This is associated with **Gradenigo’s Syndrome** (petrositis), which is a complication where infection spreads to the petrous apex, not the primary feature of simple acute mastoiditis. * **D. Thickening of temporal bone:** Chronic irritation (as in Chronic Suppurative Otitis Media) may lead to sclerotic (thickened/dense) bone, but it is not a feature of acute mastoiditis. **3. High-Yield Clinical Pearls for NEET-PG:** * **Clinical Triad:** Post-auricular swelling, tenderness, and "ironing out" of the retroauricular sulcus (mastoid obliteration). * **Reservoir Sign:** If the ear is mopped dry, it refills immediately with pus (due to the mastoid acting as a reservoir). * **Imaging of Choice:** **HRCT Temporal Bone** is the gold standard to visualize the breakdown of bony septa (coalescence). * **Sagging of the posterosuperior meatal wall** is a classic otoscopic finding.

Question 178: What is "Telefono"?

A. Pulling of hair
B. Beating on soles
C. Beating on ears (Correct Answer)
D. Beating on fingers

Explanation: **Explanation:** **Telefono** (also known as *teléfono* or "telephone") is a form of physical torture or abuse characterized by **simultaneous forceful slapping or beating on both ears** with cupped hands. **Why the correct answer is right:** The medical significance of "Telefono" lies in the sudden, massive increase in air pressure within the external auditory canal. This creates a **pneumatic shockwave** that frequently results in: * **Traumatic Perforation of the Tympanic Membrane:** Usually a central, jagged, or stellate-shaped perforation. * **Ossicular Disruption:** Most commonly involving the incudostapedial joint. * **Inner Ear Trauma:** Resulting in sensorineural hearing loss, tinnitus, or vertigo due to the sudden movement of the stapes footplate. **Why the incorrect options are wrong:** * **Pulling of hair (Trichotillomania/Trauma):** While a form of physical abuse, it does not involve the specific barotrauma mechanism associated with Telefono. * **Beating on soles (Falanga/Bastinado):** This is a specific form of torture involving the feet, leading to chronic pain and gait issues, but it is unrelated to otological trauma. * **Beating on fingers:** This is a general form of physical trauma but lacks a specific eponymous medical term in the context of ENT barotrauma. **High-Yield Clinical Pearls for NEET-PG:** 1. **Management of Traumatic Perforation:** Most traumatic perforations (like those from Telefono) heal spontaneously within 3–6 months. The primary rule is to **keep the ear dry** and avoid topical ear drops unless infected. 2. **Audiometry:** In cases of Telefono, a **Pure Tone Audiometry (PTA)** should be performed to assess for both conductive (perforation/ossicles) and sensorineural (inner ear) hearing loss. 3. **Differential Diagnosis:** Other causes of sudden pneumatic trauma include a slap on the ear, diving into water, or a nearby explosion (blast injury).

Question 179: What is the most common congenital dysplasia of the ear?

A. Michel aplasia
B. Mondini's dysplasia
C. Alexander's dysplasia
D. Scheibe's dysplasia (Correct Answer)

Explanation: **Explanation:** The correct answer is **Scheibe’s dysplasia** (Cochleosaccular dysplasia). It is the **most common** congenital inner ear anomaly, accounting for approximately 70% of cases. **1. Why Scheibe’s Dysplasia is Correct:** In this condition, the bony labyrinth is normal, but there is malformation of the membranous labyrinth. Specifically, it involves the **cochlea and the saccule** (the phylogenetically younger parts of the inner ear). The utricle and semicircular canals (older parts) remain functional. It is frequently associated with syndromes like Usher’s and Waardenburg syndrome. **2. Analysis of Incorrect Options:** * **Michel Aplasia:** This is the most severe but **rarest** form. It involves complete absence of both the bony and membranous inner ear structures due to developmental arrest at the 3rd week of gestation. * **Mondini’s Dysplasia:** This involves a bony abnormality where the cochlea has only **1.5 turns** instead of the normal 2.5 to 2.75 turns. While high-yield, it is less common than Scheibe’s. * **Alexander’s Dysplasia:** This involves a malformation of the **basal turn of the cochlea**, resulting in high-frequency sensorineural hearing loss. **Clinical Pearls for NEET-PG:** * **Scheibe’s Dysplasia:** Most common; affects membranous labyrinth only; Saccule + Cochlea involved. * **Mondini’s Dysplasia:** Associated with a risk of spontaneous CSF otorrhoea/rhinorrhoea and recurrent meningitis. * **Imaging:** Michel and Mondini dysplasias are visible on CT scans (bony defects), whereas Scheibe’s dysplasia is **not visible on CT** because the bony labyrinth is intact. * **Management:** Cochlear implants are the treatment of choice for profound bilateral cases in all the above, except Michel aplasia (where an Auditory Brainstem Implant is required).

Question 180: Meniere's disease is characterized by all of the following except?

A. Conductive deafness (Correct Answer)
B. Sensorineural deafness
C. Vertigo
D. Tinnitus

Explanation: ### Explanation **Meniere’s Disease** (Endolymphatic Hydrops) is a disorder of the inner ear characterized by an increased volume of endolymph, leading to distension of the membranous labyrinth. **Why "Conductive Deafness" is the correct answer:** Meniere’s disease affects the **inner ear** (specifically the cochlea and vestibular system). Conductive hearing loss occurs due to pathologies in the external or middle ear (e.g., ASOM, CSOM, Otosclerosis). Because Meniere’s involves damage to the hair cells in the cochlea, it results in **Sensorineural Hearing Loss (SNHL)**, not conductive deafness. **Analysis of other options:** * **Sensorineural Deafness:** This is a hallmark of the disease. It is typically fluctuating and progressive. In early stages, it characteristically affects **low frequencies** (rising curve on audiometry). * **Vertigo:** Patients experience episodic, spontaneous, and severe rotational vertigo, often accompanied by nausea and vomiting, lasting minutes to hours. * **Tinnitus:** This is usually low-pitched and described as "roaring" or "seashell" in nature. It often worsens during an acute attack. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Vertigo, SNHL, and Tinnitus (A fourth symptom, **Aural Fullness**, is often added to form a tetrad). * **Recruitment Phenomenon:** Present (indicates cochlear pathology). * **Glycerol Test:** Used for diagnosis; it acts as an osmotic diuretic to temporarily reduce endolymphatic pressure, improving hearing. * **Audiometry:** Early stage shows low-frequency SNHL; late stage shows a flat configuration. * **Lermoyez Syndrome:** A variant where hearing improves during a vertigo attack ("The phenomenon of reverse symptoms"). * **Burn-out Phenomenon:** Over time, vertigo spells may cease as the vestibular system is completely destroyed, leaving the patient with permanent SNHL and imbalance.

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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