Diseases of the Ear Practice Questions

Q: A patient with CSOM presented to the OPD with seizures. On examination, homonymous hemianopia was present. Identify the condition based on the CT scan given below.

Temporal abscess. ***Temporal abscess*** - The patient's history of **CSOM** (Chronic Suppurative Otitis Media) is a classic risk factor for an **otogenic brain abscess**, with the temporal lobe being the most common site due to its proximity to the middle ear and mastoid. - The clinical signs of **seizures** and **homonymous hemianopia** (from involvement of optic radiations), combined with the characteristic **ring-enhancing lesion** on the CT scan, are pathognomonic for a temporal lobe abscess. *Cerebellar abscess* - A cerebellar abscess would present with signs of **cerebellar dysfunction**, such as **ataxia**, **nystagmus**, and **dysmetria**, which are absent in this patient's presentation. - While also a potential complication of otitis media, the focal neurological deficit of **homonymous hemianopia** localizes the lesion to the cerebrum, not the cerebellum. *Extradural abscess* - An extradural abscess is located between the dura mater and the skull and appears as a **lens-shaped (biconvex)** collection on CT, which is morphologically distinct from the **intraparenchymal, ring-enhancing lesion** shown. - Such an abscess is less likely to cause focal signs like hemianopia unless there is significant mass effect on the underlying brain parenchyma. *Meningitis* - Meningitis involves diffuse inflammation of the meninges and does not typically form a **focal, ring-enhancing mass** on a CT scan; findings are often normal or show diffuse meningeal enhancement. - The presence of a specific focal neurological deficit like **homonymous hemianopia** strongly points towards a localized lesion like an abscess rather than diffuse meningitis.

Q: 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?

Myringitis bullosa. ***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.

Q: Identify the instruments shown in the image:

A= Politzer bag, B= Hartmann catheter. ***A= Politzer bag, B= Hartmann catheter*** - Image A depicts a **Politzer bag**, a rubber bulb device used to inflate air into the middle ear through the Eustachian tube via nasal route (Politzer's maneuver). - Image B shows a **Hartmann Eustachian catheter**, a curved metal catheter with an olive-shaped tip used in conjunction with the Politzer bag for middle ear inflation and Eustachian tube catheterization. *A= Siegel speculum, B= Hartmann catheter* - Image A is not a Siegel speculum, which is an otoscope attachment with a rubber bulb used for pneumatic otoscopy to assess tympanic membrane mobility and compliance. - Image B is correctly identified as Hartmann catheter, but this partial identification makes the option incorrect. *A= Politzer bag, B= Higginson catheter* - Image B is not a Higginson catheter (or Higginson's syringe), which is a double-bulb pump device used for irrigation and aspiration, typically for bowel procedures, not for Eustachian tube work. - Image A is correctly identified as Politzer bag, but this partial identification makes the option incorrect. *A= Siegel speculum, B= Higginson catheter* - Neither instrument is correctly identified in this option. - Image A shows a Politzer bag (not Siegel speculum) and image B shows a Hartmann catheter (not Higginson catheter).

Q: Name the procedure being done:

Ear syringing. ***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.

Q: The image shows presence of the following:

Cryptotic ear. ***Cryptotic ear*** - This image clearly depicts a **cryptotic ear**, where the superior helix is abnormally buried beneath the skin of the temporal region. - This deformity is characterized by the **lack of a normal superior auricular fold**, making the ear appear compressed or partially hidden. *Macrotia* - **Macrotia** refers to abnormally large ears, a characteristic not evident in the provided image. - The size of the ears in the image appears to be within a normal range, despite the abnormal folding. *Stahl's ear deformity* - **Stahl's ear deformity** is characterized by an extra fold of cartilage, often creating a pointed or "Spock ear" appearance, which is not what is shown. - The distinctive feature of Stahl's ear is a **third crus** in the antihelix, leading to a prominent, pointed upper helix. *Cauliflower ear* - **Cauliflower ear** results from trauma to the ear cartilage, leading to a lumpy, scarred appearance due to hematoma and subsequent fibrosis. - This condition is typically seen in boxers or wrestlers and presents with a **deformed, irregular ear surface**, unlike the smooth appearance in the image.

Q: Which is correct about the incisions in tympanic membrane?

C= Otitis media with effusion and R= ASOM. ***C= Otitis media with effusion and R= ASOM*** - The **"C" incision** (curvilinear) in the anterior-inferior quadrant is ideal for **otitis media with effusion (OME)** as it provides optimal access for **grommet/ventilation tube insertion** and allows controlled drainage of thick mucoid fluid. - The **"R" incision** (radial) is preferred for **acute suppurative otitis media (ASOM)** because it facilitates rapid drainage of **purulent discharge** and heals quickly due to natural tension lines. *C= ASOM and R= Otitis media with effusion* - **Radial incisions** heal faster and are better suited for **ASOM** where immediate pus drainage and quick healing are priorities, not for chronic effusion management. - **Curvilinear incisions** remain open longer and are specifically designed for **OME** cases requiring **ventilation tube placement**, not for acute purulent infections. *C= CSOM and R= Otitis media* - **Chronic suppurative otitis media (CSOM)** typically involves pre-existing **tympanic membrane perforation** and requires surgical repair rather than simple myringotomy incisions. - "Otitis media" is too **non-specific** a term, and neither incision type is universally applicable without considering the specific pathology and treatment goals. *Both incisions for ASOM* - Different incision types serve **distinct clinical purposes** - curvilinear for **long-term ventilation** and radial for **acute drainage**. - Using both incision types for the same condition would be **clinically inappropriate** as each is optimized for different pathophysiological requirements and healing characteristics.

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 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.

Question 1

A patient with CSOM presented to the OPD with seizures. On examination, homonymous hemianopia was present. Identify the condition based on the CT scan given below.

Accepted Answer

Temporal abscess

Answer

Meningitis

Answer

Cerebellar abscess

Answer

Extradural abscess

Question 2

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?

Accepted Answer

Myringitis bullosa

Answer

Serous otitis media

Answer

Acute otitis media

Answer

Myringitis granulosa

Question 3

Identify the instruments shown in the image:

Accepted Answer

A= Politzer bag, B= Hartmann catheter

Answer

A= Siegel speculum, B= Hartmann catheter

Answer

A= Politzer bag, B= Higginson catheter

Answer

A= Siegel speculum, B= Higginson catheter

Question 4

Name the procedure being done:

Accepted Answer

Ear syringing

Answer

Caloric stimulation test

Answer

Myringotomy

Answer

Tympanoplasty

Question 5

The image shows presence of the following:

Accepted Answer

Cryptotic ear

Answer

Macrotia

Answer

Stahl's ear deformity

Answer

Cauliflower ear

Question 6

Which is correct about the incisions in tympanic membrane?

Accepted Answer

C= Otitis media with effusion and R= ASOM

Answer

C= ASOM and R= Otitis media with effusion

Answer

C= CSOM and R= Otitis media

Answer

Both incisions for ASOM

Question 7

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 8

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

Accepted Answer

Posteroinferior

Answer

Posterosuperior

Answer

Anteroinferior

Answer

Anterosuperior

Question 9

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 10

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

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

On this page

Practice by Chapter

Want unlimited practice?