Diseases of the Ear Practice Questions

Q: The image shows ear syringing/irrigation being performed in an adult. Which is the correct technique for this procedure?

Ear pushed up and backwards, syringe posterosuperior. ***Ear pushed up and backwards, syringe posterosuperior*** - For **adults**, the earlobe is typically pulled **upwards and backwards** to straighten the ear canal for optimal irrigation. - The syringe tip is directed **posterosuperiorly** (towards the back and top) along the ear canal to avoid direct pressure on the tympanic membrane and allow for effective wax removal. *Ear pushed down and backwards, syringe anterosuperior* - Pulling the ear **down and backwards** is the technique used for **children**, not adults, to straighten their ear canal due to anatomical differences. - Directing the syringe **anterosuperiorly** (forward and up) in an adult could direct fluid towards the eardrum, increasing risk of injury. *Ear pushed down and forwards, syringe anteroinferior* - Pulling the ear **down and forwards** is an incorrect maneuver for ear irrigation in both adults and children, as it does not straighten the ear canal effectively. - Directing the syringe **anteroinferiorly** (forward and down) would be ineffective for wax removal and could cause discomfort or injury. *Ear pushed up and forwards, syringe anterosuperior* - While pulling the ear **upwards** is correct for adults, pulling it **forwards** does not optimally straighten the canal. - Directing the syringe **anterosuperiorly** increases the risk of impacting the tympanic membrane with the irrigation stream.

Q: What is the preferred site of insertion of device shown below?

Posteroinferior. ***Posteroinferior*** - The **posteroinferior quadrant** of the **tympanic membrane** is the preferred site for **myringotomy** and insertion of a **tympanostomy tube** (the device shown). - This quadrant is generally **thinner** and **less vascular**, and it avoids vital structures like the **ossicles** and nerve bundles. *Posterosuperior* - The **posterosuperior quadrant** should be avoided due to the proximity of the **ossicular chain** (especially the incus and stapes) and the niche of the **facial nerve**. - Incision in this area carries a higher risk of **ossicular damage** or **facial nerve injury**. *Anteroinferior* - While relatively safe, the **anteroinferior quadrant** is not the primary choice because it is often **thicker** and less accessible than the posteroinferior quadrant. - The **annulus** (fibrous ring) tends to be thicker in the anterior quadrants, making incision slightly more challenging. *Anterosuperior* - The **anterosuperior quadrant** contains the **eustachian tube orifice** and is close to the **tensor tympani muscle**. - Placing a tube here can lead to increased discomfort and is less ideal for effective ventilation.

Q: The given image shows:

Jobson Horne probe. ***Jobson Horne probe*** - The image displays a **Jobson Horne probe**, an instrument commonly used in **ear, nose, and throat (ENT) procedures**. - It features a **curette** at one end for wax removal and a **cotton wool carrier** at the other for medication application or drying. *Ear Vectis and curette* - An **ear vectis** typically has a small, spoon-shaped or hooked end, while a **curette** is usually scoop-shaped, both designed for cerumen removal. - The instrument shown in the image has two distinct ends, one being a wax curette and the other a cotton carrier, which is characteristic of a Jobson Horne probe, not just a vectis and curette. *Periosteal elevator* - A **periosteal elevator** is used in surgery to lift the **periosteum** (the membrane covering bone) from the bone surface. - These instruments are typically broader, flatter, and more robust, designed for scraping and lifting substantial tissue, unlike the slender instrument shown. *Jansen elevator* - The **Jansen elevator** is a specific type of periosteal elevator often used in **neurosurgery or orthopedic procedures**. - Its design is specialized for bone retraction and has a distinct shape, which differs significantly from the instrument depicted.

Q: The test shown in the image is used for identifying a lesion in which cranial nerve?

VII. ***VII*** - The image shows a **Schirmer's test** being conducted, which measures **tear production**. - Tear production is primarily innervated by the **facial nerve (cranial nerve VII)**, making this test relevant for evaluating its function related to lacrimation. *III* - Cranial nerve III (oculomotor nerve) controls most **extraocular muscles**, pupillary constriction, and lid elevation. A lesion would manifest as issues with eye movement, ptosis, or pupil dilation, not tear production. - The Schirmer's test does not directly assess the function of the **oculomotor nerve**. *VI* - Cranial nerve VI (abducens nerve) innervates the **lateral rectus muscle**, responsible for abducting the eye (moving it outwards). - A lesion in CN VI would cause **diplopia** and inability to move the eye laterally, which is unrelated to tear production. *VIII* - Cranial nerve VIII (vestibulocochlear nerve) is responsible for **hearing** and **balance**. - Lesions affect hearing (e.g., deafness, tinnitus) or balance (e.g., vertigo, nystagmus), and have no direct involvement in tear production.

Q: What does the following image show?

Politzer test. ***Politzer test*** - The image shows a **Politzer bag** being used to insufflate air into the nasal cavity while the patient swallows, which is the procedure for the Politzer test. - This test is used to assess the patency of the **Eustachian tube** and to aerate the middle ear. *Toynbee's test* - This test involves the patient **swallowing with their mouth and nose closed**. - It assesses the function of the **Eustachian tube** under negative pressure. *Sonotubometry* - This is a **diagnostic method** that uses sound waves to assess Eustachian tube function. - It involves emitting a sound into the nasopharynx and detecting it in the external ear canal. *Frenzel maneuver* - This is a **hands-free Valsalva-like maneuver** used by divers to equalize pressure in the middle ear. - It involves closing the glottis and contracting muscles in the neck and pharynx to force air into the Eustachian tubes.

Q: What does the following image show?

Preauricular sinus. **Preauricular sinus** - The image shows a small opening or pit (indicated by arrows) located anterior to the **helix** of the ear, which is characteristic of a **preauricular sinus**. These are congenital malformations. - While often asymptomatic, they can become infected, leading to pain, swelling, and discharge. *Preauricular cyst* - A preauricular cyst is a **closed sac** filled with fluid or debris, and it would typically present as a palpable, swollen lump rather than a visible opening or pit. - While it can occur in the same area, its appearance would be distinctly different from the sinus shown. *Auricular hematoma* - An auricular hematoma is a collection of blood between the **perichondrium** and the cartilage of the ear, usually caused by trauma. - It would present as a **swollen, tender, and discolored ear**, giving a "cauliflower ear" appearance if left untreated, which is not seen here. *Cryptotia* - **Cryptotia** is a congenital ear deformity where the upper pole of the ear is partially buried beneath the skin of the temporal region. - This condition involves an abnormal ear shape and position, entirely different from the small opening depicted in the image.

Q: All are true about the lesion marked except:

Lined by stratified columnar epithelium. ***Lined by stratified columnar epithelium*** - The lesion shown is a **preauricular sinus or fistula**, which is typically lined by **stratified squamous epithelium** (similar to skin) or occasionally by ciliated columnar epithelium when it extends deeper. - It is **never lined exclusively by stratified columnar epithelium**, therefore this statement is incorrect. *Faulty union of hillocks of first and second brachial arches* - **Preauricular sinuses/fistulae** result from the **incomplete fusion** of the six auricular hillocks, which are derived primarily from the **first and second branchial arches**. - This developmental anomaly leads to the formation of a **blind tract or pit** in the preauricular region. *Repeated infections* - These sinuses have a **tendency to get infected** due to trapped debris, desquamated epithelium, and bacteria within the epithelial-lined tract, forming a cyst or abscess. - Infections can lead to **pain, swelling, discharge**, and potentially surgical intervention. *Located anterior to crus of helix* - As depicted in the image, the lesion (preauricular sinus) is characteristically located at the anterior margin of the ascending limb of the helix, specifically **anterior to the crus of the helix**. - This anatomical position is typical for the majority of these congenital anomalies.

Q: The electrode of the hearing implant shown below is placed in:

Scala tympani. ***Scala tympani*** - The electrode array of a cochlear implant is typically inserted into the **scala tympani** to deliver electrical stimulation directly to the auditory nerve fibers. - This placement avoids damage to the delicate **organ of Corti** located in the scala media. *Scala vestibuli* - The scala vestibuli is separated from the scala media by **Reissner's membrane** and contains perilymph. - Inserting the electrode here is not the standard approach and could potentially damage the **cochlear duct**. *Scala media* - The scala media (cochlear duct) contains the **organ of Corti** and endolymph, which is crucial for natural hearing. - Placing an electrode here would likely **destroy the hair cells** and organ of Corti, preventing any residual natural hearing. *Tectorial membrane* - The tectorial membrane lies above the hair cells within the **scala media** and is essential for converting mechanical vibrations into electrical signals in natural hearing. - This membrane is not a fluid-filled space and is too delicate and structurally integral for electrode insertion.

Q: All of the following are true about the hearing aid shown in the figure except:

Indicated in patients with unilateral profound hearing loss. ***Indicated in patients with unilateral profound hearing loss*** - While **bone conduction hearing implants** can be used for **unilateral hearing loss**, they are typically indicated for **single-sided deafness with normal hearing in the contralateral ear** to provide sound awareness to the deaf side. However, in cases of **profound unilateral hearing loss, cochlear implantation** is often the preferred and more effective intervention for direct sound perception. *Bypasses the external and middle ear* - This statement is true; the device shown is a **bone conduction hearing system** (like BAHA), which transmits sound vibrations directly to the inner ear via the bone, thus **bypassing problems in the external auditory canal and middle ear**. - It is effective for **conductive or mixed hearing loss** where the inner ear function is relatively preserved. *Osseointegration of titanium fixture takes 2-6 months* - This statement is true; **osseointegration** is the biological process where the titanium implant fuses with the bone, which typically takes **2 to 6 months** before the external sound processor can be safely attached. - This fusion is crucial for stable and effective **bone sound conduction**. *Disadvantage of multi-stage surgery* - This statement is true; traditional bone conduction implants often require a **two-stage surgical procedure**: one for implanting the fixture and another for attaching the abutment after successful osseointegration. - This involves **multiple clinic visits, recovery periods**, and potential complications associated with two separate surgeries.

Question 1

The image shows ear syringing/irrigation being performed in an adult. Which is the correct technique for this procedure?

Accepted Answer

Ear pushed up and backwards, syringe posterosuperior

Answer

Ear pushed down and backwards, syringe anterosuperior

Answer

Ear pushed down and forwards, syringe anteroinferior

Answer

Ear pushed up and forwards, syringe anterosuperior

Question 2

What is the preferred site of insertion of device shown below?

Accepted Answer

Posteroinferior

Answer

Posterosuperior

Answer

Anteroinferior

Answer

Anterosuperior

Question 3

The given image shows:

Accepted Answer

Jobson Horne probe

Answer

Ear Vectis and curette

Answer

Periosteal elevator

Answer

Jansen elevator

Question 4

The test shown in the image is used for identifying a lesion in which cranial nerve?

Accepted Answer

VII

Answer

III

Answer

VI

Answer

VIII

Question 5

Which is correct about the location of abscess formation secondary to mastoiditis?

Accepted Answer

A= Bezold's abscess, B= Postauricular abscess, C= Zygomatic abscess

Answer

A= Zygomatic abscess, B= Postauricular abscess, C= Bezold's abscess

Answer

A= Citelli's abscess, B= Postauricular abscess, C= Luc's abscess

Answer

A= Luc's abscess, B= Postauricular abscess, C= Citelli's abscess

Question 6

What does the following image show?

Accepted Answer

Politzer test

Answer

Toynbee's test

Answer

Sonotubometry

Answer

Frenzel maneuver

Question 7

What does the following image show?

Accepted Answer

Preauricular sinus

Answer

Preauricular cyst

Answer

Auricular hematoma

Answer

Cryptotia

Question 8

All are true about the lesion marked except:

Accepted Answer

Lined by stratified columnar epithelium

Answer

Faulty union of hillocks of first and second brachial arches

Answer

Repeated infections

Answer

Located anterior to crus of helix

Question 9

The electrode of the hearing implant shown below is placed in:

Accepted Answer

Scala tympani

Answer

Scala vestibuli

Answer

Scala media

Answer

Tectorial membrane

Question 10

All of the following are true about the hearing aid shown in the figure except:

Accepted Answer

Indicated in patients with unilateral profound hearing loss

Answer

Bypasses the external and middle ear

Answer

Osseointegration of titanium fixture takes 2-6 months

Answer

Disadvantage of multi-stage surgery

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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