Diseases of the Ear Practice Questions

Q: Which of the following is the diagnosis of the audiogram shown below?

Noise induced hearing loss. ***Noise induced hearing loss*** - The audiogram shows a classic **'noise notch'**, characterized by a dip in hearing at **3000-6000 Hz**, with recovery at 8000 Hz, reflecting damage to hair cells in the cochlea from excessive noise exposure. - Both air conduction (solid line) and bone conduction (dashed line) thresholds are depressed in the same pattern, indicating a **sensorineural hearing loss**. *Otosclerosis* - Otosclerosis typically causes a **conductive hearing loss**, meaning air conduction thresholds would be significantly worse than bone conduction thresholds, showing an **air-bone gap**. - It often results in a characteristic **Carhart notch** (a dip at 2000 Hz) in bone conduction, but this audiogram shows sensorineural loss without a significant air-bone gap. *Ototoxicity* - Ototoxicity usually results in a **high-frequency sensorineural hearing loss**, often affecting frequencies above 4000 Hz first, and typically shows a more gradual, sloping loss rather than a sharp notch. - While it is sensorineural, the specific 'notch' pattern seen here is more characteristic of noise exposure. *Meniere's disease* - Meniere's disease classically presents with a **low-frequency sensorineural hearing loss** that can fluctuate, accompanied by **tinnitus, vertigo, and aural fullness**. - The audiogram does not show a low-frequency loss, nor does it typically present with a noise notch.

Q: What is the diagnosis shown in the following image?

Perichondritis. ***Perichondritis*** - The image exhibits signs of **inflammation and swelling** of the external ear, consistent with **perichondritis**, an infection of the tissue surrounding the ear cartilage. - This condition can lead to **redness**, **pain**, and fluid collection (abscess formation) that distorts the ear's normal architecture. - Typically spares the **lobule** (which lacks cartilage) and presents as an **acute inflammatory condition**. *Hyperinsulinism* - **Hyperinsulinism** is a metabolic disorder characterized by excessive insulin secretion and has no relationship to external ear pathology. - This is not an appropriate option for an acute inflammatory ear condition shown in clinical images. *Conductive hearing defect* - A **conductive hearing defect** is a functional diagnosis, not a structural/pathological diagnosis visible on examination. - It refers to problems in sound transmission through the **external or middle ear**, but is not itself visible as inflammation or swelling. - The image shows an **acute inflammatory condition**, not a hearing disorder. *Mucopolysaccharidosis* - **Mucopolysaccharidoses** are lysosomal storage disorders that can cause progressive dysmorphic facial features, including ear structure changes. - However, these present with **chronic, diffuse structural changes** rather than acute inflammation and swelling. - The acute inflammatory presentation in the image is inconsistent with this genetic storage disorder.

Q: In a child aged 3-12 years with an ear problem, which one of these situations merits urgent referral to hospital?

Tender swelling behind the ear. ***Tender swelling behind the ear*** - A **tender swelling behind the ear**, particularly in a child with an ear problem, is a classic sign of **mastoiditis**, which is a serious complication requiring urgent medical attention due to the risk of intracranial spread. - **Mastoiditis** often presents with fever, pain, and a prominent, pushed-out auricle. *Pus seen draining from the ear, and discharge reported for more than or equal to 14 days* - This suggests **chronic suppurative otitis media (CSOM)**, which typically requires a referral to ENT for assessment and management but is not usually an *urgent* referral unless there are signs of complications. - While concerning, the chronicity itself doesn't immediately indicate an acute emergency in the absence of other symptoms like fever or severe pain. *Pus seen draining from the ear, and discharge reported for less than 14 days* - This indicates acute otitis media (AOM) with perforation, which is very common in children. - It usually resolves with antibiotics and local care, and while a follow-up is important, it doesn't typically require urgent hospital referral. *Pus seen draining from both ears, irrespective of duration* - Bilateral ear discharge suggests bilateral acute or chronic otitis media, but does not inherently imply an acute emergency that requires urgent hospital referral. - The key factor for urgency would be signs of complications, such as mastoiditis or intracranial involvement, rather than the bilaterality of discharge alone.

Q: The treatment of choice for a mastoid fracture with immediate complete facial nerve paralysis is

Nerve decompression. ***Nerve decompression*** - For a mastoid (temporal bone) fracture causing **facial nerve paralysis**, surgical **nerve decompression** is the treatment of choice when surgery is indicated. - Most cases of facial nerve paralysis from temporal bone fractures result from **nerve compression or edema** within the fallopian canal, not complete transection. - **Decompression** relieves pressure on the nerve, allowing recovery of function, and is performed via **mastoidectomy** to access the facial nerve in its intratemporal course. - Indications for surgical decompression include **immediate complete paralysis** with evidence of nerve degeneration on electrodiagnostic testing, or failed conservative management. *Mastoidectomy with nerve grafting* - **Nerve grafting** is reserved for cases where the facial nerve is **completely transected or severed**, which is rare in temporal bone fractures. - Most temporal bone trauma causes nerve injury from compression or hematoma, not complete anatomical discontinuity requiring grafting. - Grafting would only be considered after direct visualization confirms irreparable nerve transection. *Steroid therapy* - High-dose **corticosteroids** are actually the **first-line treatment** for facial nerve paralysis following temporal bone fractures, especially in cases of **delayed or incomplete paralysis**. - Steroids reduce **inflammation and edema** around the injured nerve and are often effective for **delayed-onset paralysis**. - However, they are typically used as conservative management rather than the definitive "treatment of choice" when immediate complete paralysis occurs. *Sling operation* - A **sling operation** (facial reanimation surgery) is used for **long-standing, irreversible facial paralysis** when nerve recovery is no longer possible. - It provides **static facial support** but does not restore nerve function. - This is not appropriate for acute management of traumatic facial nerve injury.

Q: A female patient aged 30 years with bilateral conductive deafness is wearing a hearing aid. What is the probable diagnosis?

Otosclerosis. ***Otosclerosis*** - **Otosclerosis** is a common cause of **conductive hearing loss** in young to middle-aged adults, often presenting bilaterally. - It involves abnormal bone remodeling in the **otic capsule**, primarily affecting the **stapes footplate**, which leads to fixation and impaired sound transmission. *Presbycusis* - **Presbycusis** is an **age-related sensorineural hearing loss** that typically affects older individuals, not a 30-year-old. - It is characterized by difficulty hearing high-frequency sounds, not conductive hearing loss. *Chronic suppurative otitis media* - **Chronic suppurative otitis media (CSOM)** involves a **perforated tympanic membrane** with chronic discharge and hearing loss. - While it causes conductive hearing loss, it is typically associated with a history of recurrent infections and ear discharge, which are not mentioned here. *Meniere's disease* - **Meniere's disease** is characterized by episodic **vertigo**, **tinnitus**, **fluctuating sensorineural hearing loss**, and aural fullness. - It causes sensorineural, not conductive, hearing loss and is associated with additional symptoms absent in this case.

Q: A female patient presents with mild conductive hearing loss (CHL) and tinnitus. Based on the pure tone audiometry (PTA) shown in the image, what is the most likely diagnosis?

Otosclerosis. ***Otosclerosis*** - The audiogram shows a **conductive hearing loss** with a notable **Carhart notch** (bone conduction dip at 2000 Hz), which is characteristic of otosclerosis. - The patient's symptoms of **mild CHL** and **tinnitus** are consistent with the presentation of otosclerosis, a condition involving abnormal bone growth in the middle ear. *Ménière's disease* - This condition primarily causes **sensorineural hearing loss**, often fluctuating and affecting low frequencies initially, along with **vertigo, tinnitus, and aural fullness**. - The audiogram indicates **conductive hearing loss**, not sensorineural, and **vertigo** is not mentioned as a primary symptom. *Ototoxicity* - Ototoxicity typically results in **sensorineural hearing loss**, often bilateral and affecting high frequencies first. - The audiogram demonstrates **conductive hearing loss**, and there is no information about exposure to ototoxic medications. *Noise-Induced Hearing Loss (NIHL)* - NIHL is characterized by **sensorineural hearing loss**, typically with a **notch at 3000-6000 Hz** (most commonly 4000 Hz notch) on the audiogram. - The audiogram reflects **conductive hearing loss**, and the specific pattern does not match that of NIHL.

Q: A 72-year-old man presents to his primary care physician with progressively worsening hearing loss. He states that his trouble with hearing began approximately 7-8 years ago. He is able to hear when someone is speaking to him; however, he has difficulty with understanding what is being said, especially when there is background noise. In addition to his current symptoms, he reports a steady ringing in both ears, and at times experiences dizziness. Medical history is significant for three prior episodes of acute otitis media. Family history is notable for his father being diagnosed with cholesteatoma. His temperature is 98.6°F (37°C), blood pressure is 138/88 mmHg, pulse is 74/min, and respirations are 13/min. On physical exam, when a tuning fork is placed in the middle of the patient's forehead, sound is appreciated equally on both ears. When a tuning fork is placed by the external auditory canal and subsequently on the mastoid process, air conduction is greater than bone conduction. Which of the following is most likely the cause of this patient's symptoms?

Cochlear hair cell degeneration. ***Cochlear hair cell degeneration*** - The patient's **progressive, bilateral hearing loss** over several years, difficulty understanding speech in noise, and **tinnitus** are classic symptoms of **presbycusis**, which results from age-related **degeneration of cochlear hair cells**. - The **normal Weber test** (no lateralization) and **Rinne test** (air conduction > bone conduction) indicate a **sensorineural hearing loss**, consistent with cochlear pathology rather than conductive issues. *Stapedial abnormal bone growth* - This condition (**otosclerosis**) causes **conductive hearing loss** due to fixation of the stapes, which would present with an **abnormal Rinne test** (bone conduction > air conduction) in the affected ear. - While it can cause progressive hearing loss and tinnitus, the normal Rinne test contradicts this diagnosis. *Endolymphatic hydrops* - This is the underlying pathology of **Ménière's disease**, which typically presents with episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. - The patient's dizziness is non-episodic, and the absence of fluctuating hearing loss and aural fullness makes Ménière's less likely. *Accumulation of desquamated keratin debris* - This describes a **cholesteatoma**, which typically causes **conductive hearing loss** and often presents with otorrhea, earache, and possibly vestibular symptoms. - The normal Rinne test (indicating sensorineural loss) and lack of otorrhea or earache make cholesteatoma unlikely, despite a family history.

Q: Mainstay of treatment of glue ear -

Myringotomy + aeration to middle ear. ***Myringotomy + aeration to middle ear*** - **Myringotomy** involves creating a small incision in the eardrum to drain fluid, and inserting a **grommet (ventilation tube)** to aerate the middle ear, which is the primary treatment for persistent glue ear (otitis media with effusion). - This procedure aims to restore ventilation to the middle ear, allowing trapped fluid to drain and preventing recurrent fluid accumulation, which improves hearing. *Temporal bone resection* - This is a major surgical procedure involving the removal of part of the temporal bone, typically reserved for extensive **malignant tumors** or severe infections, and is not indicated for glue ear. - It carries significant risks and is disproportionate to the treatment of a benign condition like glue ear. *Tonsillectomy & adenoidectomy* - While **adenoidectomy** can sometimes be performed in conjunction with grommet insertion if enlarged adenoids contribute to eustachian tube dysfunction, it is not the **primary treatment** for glue ear itself. - **Tonsillectomy** is generally performed for recurrent tonsillitis and has no direct role in treating glue ear. *Radical Mastoidectomy* - This is a highly invasive surgical procedure involving the removal of the mastoid air cells and part of the external auditory canal, typically performed for severe **cholesteatoma** or chronic mastoiditis. - It is an extensive and risky operation that is not appropriate for the management of glue ear, which is a much milder condition.

Q: 35 years old female presents with tinnitus, vertigo and aural fullness. Likely diagnosis:

Meniere's Disease. ***Meniere's Disease*** - The classic triad of symptoms for Meniere's disease includes **tinnitus**, **vertigo**, and **aural fullness**, along with fluctuating sensorineural hearing loss. - This condition is thought to be caused by an excess of **endolymphatic fluid** within the inner ear. *Ototoxicity* - This condition typically presents with **bilateral, symmetrical hearing loss** and tinnitus, often induced by certain medications (e.g., aminoglycosides, aspirin in high doses). - It usually does not involve episodic vertigo or aural fullness, which are characteristic of Meniere's. *Noise Induced Hearing Loss* - Characterized primarily by **permanent sensorineural hearing loss**, often at specific frequencies (e.g., 4000 Hz notch), and **tinnitus** after prolonged exposure to loud noise. - It does not typically cause the episodic vertigo or sense of aural fullness seen in Meniere's disease. *Otosclerosis* - This condition causes **progressive conductive hearing loss** due to abnormal bone growth around the stapes bone, impairing its movement. - While it can cause tinnitus, it typically does not present with vertigo or aural fullness, and the primary hearing loss is conductive, not sensorineural.

Q: Most common cause of sensorineural hearing loss (SNHL)

Presbycusis. ***Presbycusis*** - **Presbycusis**, or age-related hearing loss, is the most common cause of **sensorineural hearing loss (SNHL)**, affecting a significant portion of the elderly population. - It typically results from **degenerative changes** in the inner ear, specifically the hair cells and nerve fibers, leading to a gradual, symmetrical, high-frequency SNHL. *Labyrinthitis* - **Labyrinthitis** is an inflammation of the inner ear that can cause sudden SNHL, often accompanied by **vertigo** and **tinnitus**. - While it causes SNHL, it is an acute condition and not the most common overall cause, especially when considering the prevalence of age-related hearing loss. *Meniere's disease* - **Meniere's disease** is characterized by recurrent episodes of **vertigo, fluctuating low-frequency SNHL, tinnitus**, and aural fullness. - It is a specific condition causing SNHL, but its prevalence is much lower than presbycusis, making it a less common overall cause. *Vestibular Schwannoma* - A **vestibular schwannoma** (acoustic neuroma) is a benign tumor that arises from the Schwann cells of the **vestibulocochlear nerve**. - It can cause **progressive unilateral SNHL**, tinnitus, and balance issues, but it is a relatively rare condition compared to presbycusis.

Question 1

Which of the following is the diagnosis of the audiogram shown below?

Accepted Answer

Noise induced hearing loss

Answer

Otosclerosis

Answer

Ototoxicity

Answer

Meniere's disease

Question 2

What is the diagnosis shown in the following image?

Accepted Answer

Perichondritis

Answer

Hyperinsulinism

Answer

Conductive hearing defect

Answer

Mucopolysaccharidosis

Question 3

In a child aged 3-12 years with an ear problem, which one of these situations merits urgent referral to hospital?

Accepted Answer

Tender swelling behind the ear

Answer

Pus seen draining from the ear, and discharge reported for more than or equal to 14 days

Answer

Pus seen draining from the ear, and discharge reported for less than 14 days

Answer

Pus seen draining from both ears, irrespective of duration

Question 4

The treatment of choice for a mastoid fracture with immediate complete facial nerve paralysis is

Accepted Answer

Nerve decompression

Answer

Sling operation

Answer

Steroid therapy

Answer

Mastoidectomy with nerve grafting

Question 5

A female patient aged 30 years with bilateral conductive deafness is wearing a hearing aid. What is the probable diagnosis?

Accepted Answer

Otosclerosis

Answer

Presbycusis

Answer

Chronic suppurative otitis media

Answer

Meniere’s disease

Question 6

A female patient presents with mild conductive hearing loss (CHL) and tinnitus. Based on the pure tone audiometry (PTA) shown in the image, what is the most likely diagnosis?

Accepted Answer

Otosclerosis

Answer

Ménière's disease

Answer

Ototoxicity

Answer

Noise-Induced Hearing Loss (NIHL)

Question 7

A 72-year-old man presents to his primary care physician with progressively worsening hearing loss. He states that his trouble with hearing began approximately 7-8 years ago. He is able to hear when someone is speaking to him; however, he has difficulty with understanding what is being said, especially when there is background noise. In addition to his current symptoms, he reports a steady ringing in both ears, and at times experiences dizziness. Medical history is significant for three prior episodes of acute otitis media. Family history is notable for his father being diagnosed with cholesteatoma. His temperature is 98.6°F (37°C), blood pressure is 138/88 mmHg, pulse is 74/min, and respirations are 13/min. On physical exam, when a tuning fork is placed in the middle of the patient's forehead, sound is appreciated equally on both ears. When a tuning fork is placed by the external auditory canal and subsequently on the mastoid process, air conduction is greater than bone conduction. Which of the following is most likely the cause of this patient's symptoms?

Accepted Answer

Cochlear hair cell degeneration

Answer

Stapedial abnormal bone growth

Answer

Endolymphatic hydrops

Answer

Accumulation of desquamated keratin debris

Question 8

Mainstay of treatment of glue ear -

Accepted Answer

Myringotomy + aeration to middle ear

Answer

Temporal bone resection

Answer

Tonsillectomy & adenoidectomy

Answer

Radical Mastoidectomy

Question 9

35 years old female presents with tinnitus, vertigo and aural fullness. Likely diagnosis:

Accepted Answer

Meniere's Disease

Answer

Ototoxicity

Answer

Noise Induced Hearing Loss

Answer

Otosclerosis

Question 10

Most common cause of sensorineural hearing loss (SNHL)

Accepted Answer

Presbycusis

Answer

Labyrinthitis

Answer

Meniere's disease

Answer

Vestibular Schwannoma

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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