Diseases of the Ear Practice Questions

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: A 1-year-old child presents with high grade fever for 2 days with multiple episodes of loose motions. The child is inconsolable. The otoscopic finding is given below. What is the diagnosis?

Acute otitis media. ***Acute otitis media*** - The image shows a **red, bulging tympanic membrane** with loss of bony landmarks, which are classic signs of acute otitis media. The child's symptoms of high fever, inconsolability, and loose motions (potentially due to a viral infection predisposing to ear infection) are also consistent with AOM. - The presence of pus or fluid behind the eardrum causes it to bulge, and the inflammation leads to its characteristic red appearance. *Foreign body* - A foreign body in the ear canal would typically be **visible directly** on otoscopy and would not usually cause the drum to bulge in this manner. - While it can cause pain and discomfort, it is less likely to present with systemic symptoms like high fever unless an infection has supervened (which would then manifest as AOM). *Aero otitis media* - **Aero-otitis media**, also known as barotrauma, is caused by rapid changes in air pressure. - While it can cause ear pain, the eardrum typically appears **retracted** or shows **hemorrhage**, not the diffuse bulging seen in the image. *Retraction pockets* - **Retraction pockets** indicate a chronically retracted tympanic membrane, often due to chronic negative middle ear pressure. - The image clearly shows a **bulging, inflamed eardrum**, inconsistent with retraction.

Q: Which of the following is correct about ear speculum insertion?

Pinna : upward, backward and laterally; Tragus: forward. ***Pinna : upward, backward and laterally; Tragus: forward*** - To properly visualize the **tympanic membrane** and ear canal in adults, the **pinna** (auricle) should be gently pulled **upward, backward, and laterally**. This maneuver helps to straighten the **ear canal**. - The **tragus** should be gently pushed **forward** to stabilize the ear and facilitate speculum insertion, minimizing discomfort [1]. *Pinna : downward, backward and laterally; Tragus: forward* - Pulling the **pinna downward** is typically recommended for **children** to straighten their ear canal. - Doing so in adults may not adequately straighten the **ear canal**, hindering visualization. *Pinna : upward, backward and medially; Tragus: forward* - While pulling the pinna **upward and backward** is correct, pulling it **medially** would likely obstruct the view or cause discomfort. - The goal is to open the **ear canal** for better visualization [1]. *Pinna : upward, forward and laterally ; Tragus: forward* - Pulling the pinna **forward** would likely curl the helix and obstruct the **external auditory canal**, making it difficult to insert the speculum. - The correct direction is **backward** to align the cartilaginous and bony parts of the canal [1].

Q: A 2-year-old child presents with profuse odorless ear discharge following a URTI. Otoscopic examination shows:

Tubotympanic chronic suppurative otitis media. ***Tubotympanic chronic suppurative otitis media*** - Presents with **large central perforation** with **profuse, odorless, mucopurulent discharge** - Classic "safe type" CSOM without bone erosion or cholesteatoma - Common in children following **URTI** which causes Eustachian tube dysfunction - Otoscopy shows **central perforation** with granulation tissue and pus - Discharge is odorless (vs foul-smelling in unsafe type) *Atticoantral chronic suppurative otitis media* - The "unsafe type" characterized by **marginal or attic perforation** - Associated with **cholesteatoma** and produces **foul-smelling discharge** - Often involves bone erosion and serious complications - Clinical presentation here lacks foul smell and marginal perforation *Aero otitis media* - Acute **barotrauma** from rapid atmospheric pressure changes (flying, diving) - Presents with acute pain, hearing loss, hemotympanum - Does not cause chronic profuse discharge or perforation - Self-limiting condition, not chronic inflammation *Ear polyp* - **Pedunculated inflammatory mass** arising from middle ear mucosa - Appears as discrete pale/pink growth protruding through perforation - Can occur secondary to chronic otitis media - The description indicates diffuse discharge with granulation tissue, not a discrete polyp

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: Which one of the following conditions produces sensorineural deafness ?

Mixed otosclerosis. ***Mixed otosclerosis*** - **Otosclerosis** is a bone remodeling disease primarily affecting the **ossicles** and **otic capsule**. - **Mixed otosclerosis** involves both **stapes fixation (conductive component)** and **cochlear involvement (sensorineural component)**. - Among the given options, this is the **only condition that produces sensorineural hearing loss**, although it presents as a mixed hearing loss with both conductive and sensorineural components. - The **cochlear otosclerosis** component causes the sensorineural deafness through involvement of the **otic capsule** and **cochlear structures**. *Atelectatic middle ear* - This condition involves the collapse of the **tympanic membrane** onto the ossicles due to **negative middle ear pressure**. - It causes **pure conductive hearing loss** by impairing sound transmission through the middle ear, with no sensorineural component. *Eustachian tube blockage* - Blockage of the **Eustachian tube** leads to **negative pressure** in the middle ear space. - This results in **pure conductive hearing loss** due to impaired movement of the tympanic membrane and ossicles, with no sensorineural component. *Tympanic membrane rupture* - A rupture in the **tympanic membrane** creates a direct opening between the external ear canal and the middle ear. - This condition causes **pure conductive hearing loss** by disrupting the normal sound conduction mechanism, with no sensorineural component.

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.

Question 1

What does the following image show?

Accepted Answer

Politzer test

Answer

Toynbee's test

Answer

Sonotubometry

Answer

Frenzel maneuver

Question 2

What does the following image show?

Accepted Answer

Preauricular sinus

Answer

Preauricular cyst

Answer

Auricular hematoma

Answer

Cryptotia

Question 3

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 4

A 1-year-old child presents with high grade fever for 2 days with multiple episodes of loose motions. The child is inconsolable. The otoscopic finding is given below. All of the following lead to the development of this condition except:

Accepted Answer

Breastfeeding child in supine position

Answer

Cystic fibrosis

Answer

Ciliary dyskinesia

Answer

Cleft Palate

Question 5

A 1-year-old child presents with high grade fever for 2 days with multiple episodes of loose motions. The child is inconsolable. The otoscopic finding is given below. What is the diagnosis?

Accepted Answer

Acute otitis media

Answer

Foreign body

Answer

Aero otitis media

Answer

Retraction pockets

Question 6

Which of the following is correct about ear speculum insertion?

Accepted Answer

Pinna : upward, backward and laterally; Tragus: forward

Answer

Pinna : downward, backward and laterally; Tragus: forward

Answer

Pinna : upward, backward and medially; Tragus: forward

Answer

Pinna : upward, forward and laterally ; Tragus: forward

Question 7

A 2-year-old child presents with profuse odorless ear discharge following a URTI. Otoscopic examination shows:

Accepted Answer

Tubotympanic chronic suppurative otitis media

Answer

Atticoantral chronic suppurative otitis media

Answer

Aero otitis media

Answer

Ear polyp

Question 8

What is the diagnosis shown in the following image?

Accepted Answer

Perichondritis

Answer

Hyperinsulinism

Answer

Conductive hearing defect

Answer

Mucopolysaccharidosis

Question 9

Which one of the following conditions produces sensorineural deafness ?

Accepted Answer

Mixed otosclerosis

Answer

Atelectatic middle ear

Answer

Eustachian tube blockage

Answer

Tympanic membrane rupture

Question 10

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

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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