Diseases of the Ear — MCQs

Diseases of the Ear Indian Medical PG Practice Questions and MCQs

Question 221: Recruitment phenomenon is seen in:

A. Otitis media with effusion
B. Otosclerosis
C. Acoustic nerve schwannoma
D. Meniere's disease (Correct Answer)

Explanation: ***Meniere's disease*** - The recruitment phenomenon, characterized by an abnormal increase in the perception of loudness for a given increase in sound intensity, is a classic finding in **cochlear hearing loss**, often seen in conditions like **Meniere's disease**. - This occurs due to damage to the **outer hair cells** in the cochlea, which normally compress the dynamic range of hearing. *Otitis media with effusion* - This condition involves **conductive hearing loss** due to fluid in the middle ear, and typically does not cause the recruitment phenomenon. - The problem lies in sound transmission, not in the processing of loudness within the cochlea. *Otosclerosis* - This condition causes **conductive hearing loss** due to abnormal bone growth around the stapes footplate, impeding sound transmission to the inner ear. - While it affects hearing, it does not directly lead to altered loudness perception or recruitment, as the cochlea itself is often intact. *Acoustic nerve schwannoma* - This tumor affects the **vestibulocochlear nerve (CN VIII)**, causing **sensorineural hearing loss** that is typically retrocochlear (beyond the cochlea). - While it causes hearing loss, recruitment is usually absent or minimal, as the pathology is neural, not cochlear.

Question 222: Tobey-Ayer test is done for:

A. Ketosis
B. Acantholysis
C. Lateral sinus thrombosis (Correct Answer)
D. Hemoglobinuria

Explanation: ***Lateral sinus thrombosis*** - The **Tobey-Ayer test** is used to detect **lateral (transverse) sinus thrombosis**, a serious complication of otogenic infections. - The test involves **lumbar puncture with CSF manometry** while sequentially compressing each **internal jugular vein**. - In a normal response, compression of either jugular vein causes a **rapid rise in CSF pressure** (within 10 seconds) due to venous obstruction, followed by rapid fall on release. - In **lateral sinus thrombosis**, compression of the jugular vein on the **affected side** produces **no rise or delayed/sluggish rise** in CSF pressure, indicating obstruction of venous drainage. - This is distinct from the Queckenstedt-Stookey test, which tests for spinal subarachnoid block. *Ketosis* - **Ketosis** is a metabolic state with elevated **ketone bodies** in blood, detected by urine dipsticks or blood ketone meters. - It has no relation to the Tobey-Ayer test or ENT pathology. *Acantholysis* - **Acantholysis** is loss of intercellular connections between **keratinocytes**, seen in blistering skin diseases like Pemphigus. - It is a histological dermatological finding, completely unrelated to neurological or ENT examination. *Hemoglobinuria* - **Hemoglobinuria** is the presence of free **hemoglobin** in urine due to intravascular hemolysis. - It is detected by urinalysis and has no connection to CSF manometry or lateral sinus assessment.

Question 223: Carhart's notch in audiometry is seen in -

A. Ossicular discontinuity
B. Otosclerosis (Correct Answer)
C. Otomycosis
D. Haemotympanum

Explanation: ***Otosclerosis*** - **Carhart's notch** is a characteristic dip in the **bone conduction threshold** at 2000 Hz, typically observed in patients with **otosclerosis**. - This phenomenon is believed to be due to an artifact caused by the **stapes fixation** interfering with the normal inertial and compressional bone conduction mechanisms. *Ossicular discontinuity* - While ossicular discontinuity causes a **conductive hearing loss**, it typically does not present with a specific notch at 2000 Hz in bone conduction. - The audiogram would show a significant **air-bone gap** but without the characteristic bone conduction dip. *Otomycosis* - **Otomycosis** is a fungal infection of the external auditory canal and can cause **conductive hearing loss** if there is significant debris or swelling. - It does not, however, lead to a Carhart's notch on the audiogram. *Haemotympanum* - **Haemotympanum**, or blood behind the tympanic membrane, causes a **conductive hearing loss** by dampening the movement of the tympanic membrane and ossicles. - This condition results in a **flat or low-frequency conductive hearing loss** without the specific audiometric feature of Carhart's notch.

Question 224: Gelle's test is for:

A. NIHL
B. Sensorineural deafness
C. Otosclerosis (Correct Answer)
D. None of the options

Explanation: ***Otosclerosis*** - **Gelle's test** is specifically designed to detect **otosclerosis**, a condition characterized by abnormal bone growth in the middle ear. - In otosclerosis, the **stapes footplate** becomes fixed, leading to a negative Gelle's test where sound perception does not change with pressure alterations in the external auditory canal. *NIHL* - **Noise-induced hearing loss (NIHL)** is a type of **sensorineural hearing loss** caused by prolonged exposure to loud noise. - Diagnostic relies on **audiometry** showing a characteristic notch at 4 kHz, and not Gelle's test. *Sensorineural deafness* - **Sensorineural deafness** affects the **cochlea or auditory nerve**, and is not specifically identified by Gelle's test. - While otosclerosis can lead to a mixed or sensorineural component over time, Gelle's test primarily assesses the **mobility of the ossicular chain**. *None of the options* - This option is incorrect because Gelle's test is a recognized diagnostic tool, particularly for **otosclerosis**. - Its utility is in determining changes in **bone conduction** with altered middle ear pressure.

Question 225: All are true about Mastoid antrum except

A. Surface marking done by McEwen's Triangle
B. It does not communicate with middle ear (Correct Answer)
C. Thickness of bone of lateral wall is about 1.5 cm
D. Air cells are present in the upper part

Explanation: ***It does not communicate with middle ear*** - The **mastoid antrum** is a crucial air-filled cavity located in the mastoid process of the **temporal bone**. - It **communicates directly with the middle ear** cavity through an opening called the **aditus ad antrum**, making this statement false. *Surface marking done by McEwen's Triangle* - **McEwen's Triangle** (also known as the **suprameatal triangle**) is a widely recognized surgical landmark used to locate the **mastoid antrum**. - Its boundaries are formed by the **supramastoid crest**, the **posterior margin of the external auditory meatus**, and a line tangential to the superior margin of the external auditory meatus. *Thickness of bone of lateral wall is about 1.5 cm* - The thickness of the **lateral wall** of the **mastoid antrum** varies among individuals but averages around **1.5 cm** in adults. - This anatomical measure is clinically important during mastoidectomy procedures to avoid intracranial complications. *Air cells are present in the upper part* - The **mastoid antrum** itself is a relatively large, singular air-filled cavity. - However, it **communicates with numerous mastoid air cells**, which are indeed found throughout the mastoid process, with a significant number often present in the **upper part** and surrounding regions.

Question 226: Bezold's abscess is located in -

A. Sternocleidomastoid (Correct Answer)
B. Infratemporal region
C. Digastric triangle
D. Submandibular region

Explanation: ***Sternocleidomastoid*** - A **Bezold's abscess** is a deep neck abscess that originates from an acute mastoiditis and breaks through the medial aspect of the mastoid tip. - This condition then tracks along the **sternocleidomastoid muscle**, causing a painful swelling in the neck. *Infratemporal region* - Abscesses in the infratemporal region typically result from infections of the **molars** or local trauma and would not involve the mastoid. - The **anatomy of the infratemporal fossa** makes it a distinct site for abscess formation, separate from the mastoid tip. *Digastric triangle* - The **digastric triangle** is a subregion of the anterior triangle of the neck, and while it can house abscesses, Bezold's abscesses specifically track along the sternocleidomastoid. - This region is more commonly associated with infections spreading from the **submandibular gland** or lymph nodes within its borders. *Submandibular region* - The submandibular region is located below the jaw and is a common site for abscesses due to infections of the **submandibular gland** or **dental origin**. - A Bezold's abscess, originating from mastoiditis, would track inferiorly from the mastoid tip, not typically into the submandibular space.

Question 227: Trough-shaped curve in audiometry is seen in:

A. Acoustic neuroma
B. Otitis media
C. Congenital SNHL (Correct Answer)
D. Otosclerosis

Explanation: ***Congenital SNHL*** - A **trough-shaped curve** (also known as a **'cookie-bite' audiogram**) is characteristic of congenital sensorineural hearing loss, particularly in some hereditary forms. - This pattern shows **greatest hearing loss in the mid-frequencies** (500 Hz to 2000 Hz) with better hearing in the low and high frequencies. *Otitis media* - Acute or chronic otitis media typically presents with a **conductive hearing loss** due to fluid in the middle ear. - The audiogram typically shows a **flat or upward-sloping bone conduction threshold** with an **air-bone gap**. *Acoustic neuroma* - An acoustic neuroma (vestibular schwannoma) usually causes **unilateral sensorineural hearing loss** that is often more pronounced in the **high frequencies**. - It does not typically produce a trough-shaped audiogram. *Otosclerosis* - Otosclerosis is a disease of the bony labyrinth causing **conductive hearing loss**, often with a characteristic **Carhart notch** (a dip in bone conduction thresholds, primarily at 2000 Hz). - This is distinct from a trough-shaped curve affecting mid-frequencies.

Question 228: Otoacoustic emission arises from?

A. Organ of otolith
B. Outer hair cell (Correct Answer)
C. Inner hair cell
D. Reissner's membrane

Explanation: ***Outer hair cell*** - **Otoacoustic emissions (OAEs)** are sounds generated by the **active electromotility** of outer hair cells in the cochlea - Outer hair cells function as **cochlear amplifiers**, contracting and expanding in response to sound, which produces measurable acoustic energy that travels back through the middle ear - OAEs are used clinically for **newborn hearing screening** and assessing cochlear function, as they are present in normal-hearing individuals and absent when outer hair cell damage occurs *Organ of otolith* - The **organs of otoliths** (utricle and saccule) are part of the **vestibular system**, detecting **linear acceleration** and **head position** relative to gravity - They contain hair cells embedded in a gelatinous layer with calcium carbonate crystals (otoconia), but these structures are involved in balance, not sound generation *Inner hair cell* - **Inner hair cells** are the **primary sensory receptors** for hearing, transducing mechanical vibrations into electrical signals transmitted via the auditory nerve to the brain - They receive amplified signals from outer hair cells but do not actively generate sound emissions themselves *Reissner's membrane* - **Reissner's membrane** (vestibular membrane) separates the **scala vestibuli** from the **scala media** in the cochlea - It maintains the **ionic gradient** between perilymph and endolymph, essential for hair cell function, but does not produce acoustic emissions

Question 229: Telephonophobia refers to -

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

Explanation: ⚠️ **CRITICAL NOTE**: This question contains a terminology error. "Telephonophobia" in medical literature refers to **fear of telephones** (a specific phobia), NOT a physical symptom involving the ears. However, based on the context of this being a NEET-2013 question with "beating on ears" as the answer, this may be: 1. A mistranslation or historical term no longer in use 2. Confusion with another medical term 3. An error in the original examination **For exam purposes, the marked answer reflects the original question**, but students should note: ***Beating on ears*** (Marked as correct per original question) - This answer suggests the question may have intended to ask about a different term or concept - In modern medical terminology, this is **NOT** the definition of telephonophobia - **Telephonophobia** = irrational fear of making or receiving telephone calls (psychiatric condition) *Beating on soles* - This refers to **bastinado**, a form of corporal punishment - Not related to any phobia terminology *Beating on palms* - A form of corporal punishment - Not a recognized medical terminology for any phobia *Pulling of hair* - This describes **trichotillomania**, a body-focused repetitive behavior - Trichotillomania involves recurrent, irresistible urges to pull out hair from the scalp, eyebrows, or other areas **Recommendation**: This question should be reviewed for medical accuracy. The term "telephonophobia" as used here does not align with standard medical terminology.

Question 230: Which of the following tests is positive in lateral sinus thrombophlebitis:

A. Griesinger sign (Correct Answer)
B. Tobey Ayer test
C. Queckenstedt test
D. All of the options

Explanation: ***Griesinger sign*** - This sign is characterized by **edema** and **tenderness** over the **mastoid process** due to thrombophlebitis of the **mastoid emissary vein**, which drains into the lateral sinus. - Its presence indicates an obstruction of venous outflow, strongly suggesting **lateral sinus thrombophlebitis**. *Tobey Ayer test* - The Tobey Ayer test involves **compression of the jugular veins** and observing for changes in CSF pressure. - While it can be indicative of **intracranial pathology** or spinal block, it is not specific to lateral sinus thrombophlebitis. *Queckenstedt test* - The Queckenstedt test is similar to the Tobey Ayer test, assessing the rise and fall of **CSF pressure** in response to **jugular vein compression**. - It is primarily used to detect a **spinal subarachnoid block** and is not a direct or specific indicator of lateral sinus thrombophlebitis. *All of the options* - While other tests might be used in the general evaluation of a patient with suspected intracranial pathology, only the **Griesinger sign** is directly and specifically associated with **lateral sinus thrombophlebitis** due to its anatomical relationship with the mastoid emissary vein.

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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