Diseases of the Ear — MCQs
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An elderly diabetic patient presents with excruciating ear pain, granulation tissue in the ear canal, and signs of skull base infection including facial paralysis. What is the recommended treatment?
Identify the abscess type indicated by label 'L' in the provided image.
A 60-year-old man complains of gradual hearing loss over several years. He reports difficulty hearing conversations, especially in noisy environments, and has trouble perceiving high-pitched sounds. There are no episodes of vertigo, tinnitus, or ear fullness. What is the most likely diagnosis?
The image below shows a lateral view of the face with a highlighted region in front of the ear. Which type of abscess is most likely indicated in this area?
A 5-year-old child presents with sudden severe ear pain and hearing loss. On otoscopy, you observe hemorrhagic bullae on an inflamed tympanic membrane. What is the most likely diagnosis?
A 45-year-old male presents with progressive hearing loss in the right ear over 2 years, tinnitus, and occasional imbalance. Audiometry shows unilateral sensorineural hearing loss with speech discrimination score of 60%. MRI reveals a 2.5 cm enhancing mass at the cerebellopontine angle. What is the most likely diagnosis?
Name the procedure being done:
All of the following statements regarding this instrument are true except: (Recent NEET Pattern 2016-17)
The instrument shown below is used in ENT for all except: (Recent NEET Pattern 2016-17)
Which is correct about the incisions in tympanic membrane?
Diseases of the Ear Indian Medical PG Practice Questions and MCQs
Question 181: An elderly diabetic patient presents with excruciating ear pain, granulation tissue in the ear canal, and signs of skull base infection including facial paralysis. What is the recommended treatment?
- A. Penicillin (Correct Answer)
- B. Ciprofloxacin
- C. Second-generation cephalosporin
- D. Erythromycin
Explanation: **Explanation:** The clinical presentation of an elderly diabetic patient with excruciating ear pain (otalgia), granulation tissue at the bony-cartilaginous junction, and cranial nerve involvement (facial paralysis) is diagnostic of **Malignant Otitis Externa (MOE)** or Necrotizing Otitis Externa. **1. Why Penicillin is the Correct Answer:** The causative organism in over 95% of MOE cases is ***Pseudomonas aeruginosa***. While modern practice often utilizes fluoroquinolones, the classic "gold standard" and traditionally tested treatment for *Pseudomonas* in this context involves **Anti-pseudomonal Penicillins** (such as Piperacillin-Tazobactam, Ticarcillin, or Carbenicillin) often in combination with an aminoglycoside. In the context of this specific question, Penicillin (specifically the anti-pseudomonal class) is the indicated choice for targeting the specific pathogen. **2. Why Other Options are Incorrect:** * **Ciprofloxacin:** While highly effective against *Pseudomonas* and often used as first-line oral therapy today, resistance is increasing. In many traditional medical exams, the parenteral anti-pseudomonal penicillins remain the academic benchmark for severe skull base infections. * **Second-generation cephalosporins:** These (e.g., Cefuroxime) lack significant activity against *Pseudomonas*. Third-generation (Ceftazidime) or fourth-generation (Cefepime) would be required. * **Erythromycin:** This is a macrolide primarily used for Gram-positive cocci and atypical pneumonia; it has no role in treating *Pseudomonas*. **Clinical Pearls for NEET-PG:** * **Pathognomonic sign:** Granulation tissue at the floor of the external auditory canal (bony-cartilaginous junction). * **Most common nerve involved:** Facial nerve (VII), followed by IX, X, and XI. * **Investigation of Choice (Diagnosis):** CT scan to assess bone destruction. * **Investigation of Choice (Monitoring):** Technetium-99m scan (for diagnosis/activity) and **Gallium-67 scan** (to monitor treatment response/resolution). * **Key Risk Factors:** Diabetes Mellitus (most common) and immunocompromised states.
Question 182: Identify the abscess type indicated by label 'L' in the provided image.
- A. Luc's abscess (Correct Answer)
- B. Post auricular abscess
- C. Bezold's abscess
- D. Citelli's abscess
Explanation: ***Luc's abscess*** - This abscess forms when infection from a **mastoid abscess** spreads **anteriorly** into the **external auditory canal (EAC)**, typically through the fissures of Santorini or a defect in the posterior meatal wall. - Clinically, it presents as a swelling or sagging of the **posterosuperior wall** of the external auditory canal, which can be mistaken for a furuncle. *Citelli's abscess* - This forms when pus from the **mastoid tip** tracks inferiorly along the **posterior belly of the digastric muscle**. - It presents as a deep neck abscess, causing swelling in the **digastric triangle** of the neck. *Bezold's abscess* - This occurs when infection erodes the **mastoid tip** and spreads inferiorly along the sheath of the **sternocleidomastoid muscle**. - It manifests as a tender swelling in the upper part of the neck, deep to the sternocleidomastoid, and can cause **torticollis**. *Post auricular abscess* - Also known as a **subperiosteal abscess**, this forms when infection spreads **laterally** by eroding the mastoid cortex over **MacEwen's triangle**. - It characteristically presents as a tender, fluctuant swelling behind the ear, pushing the **pinna forwards and downwards**.
Question 183: A 60-year-old man complains of gradual hearing loss over several years. He reports difficulty hearing conversations, especially in noisy environments, and has trouble perceiving high-pitched sounds. There are no episodes of vertigo, tinnitus, or ear fullness. What is the most likely diagnosis?
- A. Meniere’s disease
- B. Presbycusis (Correct Answer)
- C. Otosclerosis
- D. Acoustic neuroma
Explanation: ***Correct: Presbycusis*** - It is the most common cause of **gradual, bilateral sensorineural hearing loss** in the elderly, characterized by a protracted course over several years. - The defining feature is difficulty hearing **high-pitched sounds** (loss of high-frequency hearing) and **poor speech discrimination** in noisy environments, consistent with the clinical picture. - This is age-related cochlear degeneration, typically beginning after age 50-60. *Incorrect: Meniere's disease* - This condition is defined by the classic triad of **episodic vertigo**, **fluctuating (usually low-frequency) sensorineural hearing loss**, and **tinnitus** with aural fullness, none of which are present. - The hearing loss is typically episodic and unilateral, contrasting with the patient's chronic, gradual deterioration. *Incorrect: Otosclerosis* - This disorder causes **conductive hearing loss** (or mixed loss) due to abnormal bone growth around the **stapes footplate**, often presenting earlier in life (20s–30s). - Unlike the gradual, high-frequency loss seen here, otosclerosis causes reduced sound transmission to the inner ear, typically improving speech perception in noise (**paracusis Willisii**). *Incorrect: Acoustic neuroma* - Although it causes sensorineural hearing loss, it is typically **unilateral** and often asymmetrical, frequently accompanied by **unilateral tinnitus** and imbalance. - This diagnosis is less likely in a patient with **bilateral**, gradual hearing loss without unilateral symptoms or specific cranial nerve involvement.
Question 184: The image below shows a lateral view of the face with a highlighted region in front of the ear. Which type of abscess is most likely indicated in this area?
- A. Zygomatic abscess
- B. Bezold's abscess
- C. Citelli’s abscess
- D. Luc's abscess (Correct Answer)
Explanation: ***Luc's abscess*** - This is a **subperiosteal abscess** located in the **preauricular region**, on the external surface of the squamous part of the temporal bone, which corresponds to the highlighted area. - It is a rare complication of **acute otitis media** or **mastoiditis**, occurring when infection spreads through the tympanosquamous suture. *Citelli’s abscess* - This abscess is located at the **tip of the mastoid process** and extends into the **digastric triangle** of the neck, which is posterior and inferior to the area shown. - It is formed when pus from mastoiditis tracks along the posterior belly of the **digastric muscle**. *Bezold's abscess* - This is a **deep neck abscess** that forms when infection erodes through the medial aspect of the mastoid tip and spreads inferiorly into the neck. - The swelling is located deep to the **sternocleidomastoid muscle**, far from the preauricular location shown in the image. *Zygomatic abscess* - This abscess forms over the **zygomatic process** of the temporal bone, which is located superior and anterior to the external auditory canal. - It results from the spread of infection from mastoid air cells into the **root of the zygoma**, a location slightly more superior than what is highlighted.
Question 185: A 5-year-old child presents with sudden severe ear pain and hearing loss. On otoscopy, you observe hemorrhagic bullae on an inflamed tympanic membrane. What is the most likely diagnosis?
- A. Myringitis bullosa (Correct Answer)
- B. Serous otitis media
- C. Acute otitis media
- D. Myringitis granulosa
Explanation: ***Myringitis bullosa*** - This diagnosis is strongly suggested by the otoscopic image showing **hemorrhagic or serous bullae (blisters)** on an inflamed tympanic membrane, which is the pathognomonic feature of this condition. - It is an acute inflammation of the tympanic membrane, often associated with viral or bacterial infections (e.g., **Mycoplasma pneumoniae**, Influenza virus), and typically presents with sudden, severe otalgia and hearing loss. *Serous otitis media* - This condition, also known as otitis media with effusion, is characterized by the presence of fluid in the middle ear space, leading to a **dull, retracted tympanic membrane** with visible **air-fluid levels or bubbles**, not bullae on the surface. - It typically presents with conductive hearing loss and a feeling of fullness in the ear, but lacks the severe inflammation and bullae seen in the image. *Acute otitis media* - The classic sign of acute otitis media is a **bulging, erythematous, and opaque tympanic membrane** due to purulent effusion in the middle ear, with loss of normal landmarks. - While bullae can occasionally form in severe cases of AOM, the primary feature is the bulging eardrum, and the prominent, multiple vesicles seen here are more specific to myringitis bullosa. *Myringitis granulosa* - This is a chronic inflammatory condition characterized by the presence of **granulation tissue** on the lateral surface of the tympanic membrane. - It typically presents with persistent otorrhea and conductive hearing loss, and the otoscopic appearance is of a raw, granular surface, which is distinctly different from the fluid-filled bullae shown in the image.
Question 186: A 45-year-old male presents with progressive hearing loss in the right ear over 2 years, tinnitus, and occasional imbalance. Audiometry shows unilateral sensorineural hearing loss with speech discrimination score of 60%. MRI reveals a 2.5 cm enhancing mass at the cerebellopontine angle. What is the most likely diagnosis?
- A. Meningioma
- B. Acoustic neuroma (Vestibular schwannoma) (Correct Answer)
- C. Epidermoid cyst
- D. Arachnoid cyst
Explanation: ***Vestibular Schwannoma*** - This presentation (progressive unilateral **sensorineural hearing loss**, tinnitus, imbalance, and an enhancing CPA mass) is the classic clinical and radiological finding for a **vestibular schwannoma** (acoustic neuroma). - The tumor arises from the superior or inferior vestibular branch of **Cranial Nerve VIII** and is the most common tumor of the **cerebellopontine angle**. *Meningioma* - While the second most common CPA tumor, meningiomas typically show a broad-based attachment on the dura and often present with symptoms of **Cranial Nerve V** (trigeminal neuralgia) or **Cranial Nerve VII** (facial weakness) earlier than pure hearing loss. - On MRI, they classically demonstrate a **dural tail sign** and are less likely to be centered in the internal auditory meatus (IAM) compared to a schwannoma. *Epidermoid Cyst* - These tumors are characterized by following **CSF intensity** (low T1, high T2) on standard MRI sequences and exhibit significant signal restriction (**bright**) on **Diffusion-Weighted Imaging (DWI)**. - They are slow-growing, usually do not significantly **enhance** after contrast, and symptoms are more often positional or related to CN V and VII involvement. *Arachnoid Cyst* - These non-neoplastic cysts are collections of CSF and, therefore, exhibit **no contrast enhancement** on MRI; they follow the exact signal characteristics of **CSF** on all sequences. - They generally cause symptoms through mass effect rather than direct involvement of the hearing organ and are not typically the primary cause of progressive, isolated unilateral SNHL.
Question 187: Name the procedure being done:
- A. Caloric stimulation test
- B. Ear syringing (Correct Answer)
- C. Myringotomy
- D. Tympanoplasty
Explanation: ***Ear syringing*** - The image depicts a procedure where fluid is being irrigated into the ear canal from a syringe-like device, with a bowl held under the ear to collect the outflow. This is characteristic of **ear syringing** or **ear irrigation**. - This procedure is commonly performed to remove accumulated **earwax (cerumen)**, foreign bodies, or debris from the external auditory canal. *Caloric stimulation test* - This test involves introducing warm or cold water/air into the external auditory canal to stimulate the **vestibulo-ocular reflex** and assess vestibular function. - While it involves fluid in the ear, the primary purpose is diagnostic for **vestibular disorders**, not for cleaning the ear canal, and the setup shown does not typically reflect the controlled temperature and precise measurement required for this test. *Myringotomy* - **Myringotomy** is a surgical procedure involving a small incision made in the **tympanic membrane (eardrum)** to relieve pressure or drain fluid from the middle ear. - It is an invasive surgical procedure performed by an ENT specialist, not a simple irrigation as shown in the image. *Tympanoplasty* - **Tympanoplasty** is a surgical procedure to repair a perforated eardrum or reconstruct the middle ear sound-conducting mechanism. - This is a complex reconstructive surgery for hearing improvement, entirely different from the simple ear irrigation depicted.
Question 188: All of the following statements regarding this instrument are true except: (Recent NEET Pattern 2016-17)
- A. Speculum that is used here has a concave lens with a magnification of 2.5 times
- B. This device is used to assess tympanic membrane mobility
- C. This device is used to suck out middle ear secretions
- D. This device is used to administer antibiotics in the middle ear cavity (Correct Answer)
Explanation: ***This device is used to administer antibiotics in the middle ear cavity*** - The image shows a **Pneumatic Otoscope**, which is primarily used for **diagnostic purposes**, specifically to assess tympanic membrane mobility, not for administering medications. - Administering antibiotics directly into the middle ear typically requires more invasive procedures like **myringotomy** with ear tube placement, or direct injection, which are not performed with this device. *Speculum that is used here has a concave lens with a magnification of 2.5 times* - The otoscope head has a **magnifying lens**, typically around **2.5x**, to allow for clearer visualization of the ear canal and tympanic membrane. - While it has a magnifying lens, stating it's a **concave lens** is generally incorrect in the context of an otoscope's primary magnifying lens, which is typically a **convex lens** for magnification. *This device is used to access tympanic membrane mobility* - The rubber bulb and tubing attached to the otoscope are designed to create **positive and negative air pressure** within the external ear canal. - This pressure change allows the clinician to observe the **movement (mobility)** of the tympanic membrane, which is crucial for diagnosing conditions like **otitis media with effusion**. *This device is used to suck out middle ear secretions* - While otoscopes can be used to visualize secretions in the external ear canal or visible through a perforated tympanic membrane, this particular device is not designed for **suctioning middle ear secretions**. - Suctioning middle ear secretions would typically require a **surgical microscope** and specialized **suction instruments** or a **myringotomy** procedure.
Question 189: The instrument shown below is used in ENT for all except: (Recent NEET Pattern 2016-17)
- A. Status of middle ear
- B. Status of tympanic membrane
- C. Acoustic reflex
- D. Oculovestibular reflex (Correct Answer)
Explanation: ***Oculovestibular reflex*** - The image shows a **tympanometer**, which is used to assess the function of the middle ear and Eustachian tube through **impedance audiometry**. - The **oculovestibular reflex** (also known as the **caloric reflex test**) assesses the function of the vestibular system and brainstem using cold or warm water/air irrigation of the ear canal, and is **not evaluated by tympanometry**. - This is the correct answer as it is the only function NOT assessed by the tympanometer. *Status of middle ear* - Tympanometry directly measures the **compliance of the tympanic membrane** and the **pressure in the middle ear space**, providing information about middle ear pathologies. - It can help diagnose conditions like **otitis media with effusion**, **eustachian tube dysfunction**, and **otosclerosis** by analyzing the tympanogram shape (Type A, B, C, etc.). *Status of tympanic membrane* - Tympanometry measures how the **tympanic membrane moves in response to changes in air pressure** in the external ear canal. - This movement pattern, depicted in the tympanogram, indicates the **flexibility and integrity of the tympanic membrane**. *Acoustic reflex* - The **acoustic reflex (stapedial reflex)** CAN be measured using **impedance audiometry**, which includes the tympanometer. - When a loud sound (70-100 dB above hearing threshold) is presented, the stapedius muscle contracts, causing a change in middle ear impedance that is detected by the tympanometer. - This reflex tests the integrity of the **auditory pathway from CN VIII through the brainstem to CN VII**, and is useful in diagnosing conditions like **acoustic neuroma**, **facial nerve palsy**, and **cochlear vs retrocochlear pathology**.
Question 190: Which is correct about the incisions in tympanic membrane?
- A. C= ASOM and R= Otitis media with effusion
- B. C= Otitis media with effusion and R= ASOM (Correct Answer)
- C. C= CSOM and R= Otitis media
- D. Both incisions for ASOM
Explanation: **C= Otitis media with effusion and R= ASOM** - The **"C" incision**, a curvilinear cut in the anterior-inferior quadrant, is well-suited for **Otitis Media with Effusion (OME)** because it allows effective drainage of thick fluid for **ventilation tube insertion**. - The **"R" incision**, a radial cut, is appropriate for **acute suppurative otitis media (ASOM)** as it facilitates efficient drainage of mucopurulent discharge and relieves pain due to pressure buildup. *C= ASOM and R= Otitis media with effusion* - A **radial incision** (like "R") is generally preferred for **acute suppurative otitis media (ASOM)** to allow for rapid drainage of pus. - A **curvilinear incision** (like "C") is typically made for **otitis media with effusion (OME)**, especially if a grommet insertion is planned, to allow for optimal placement and long-term drainage. *C= CSOM and R= Otitis media* - **Chronic suppurative otitis media (CSOM)** usually presents with a pre-existing perforation or needs a more extensive procedure than a simple myringotomy. - "Otitis media" is a broad term, but neither of these incisions is exclusively for "otitis media" without further specification (e.g., acute vs. with effusion). *Both incisions for ASOM* - While both incisions are forms of myringotomy, they are designed for different clinical scenarios requiring specific drainage properties. - The **curvilinear incision** is more suited for persistent fluid requiring a ventilation tube, whereas the **radial incision** is for acute purulent collections.
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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