Diseases of the Ear Practice Questions

Q: Bezold's abscess is located in -

Sternocleidomastoid. ***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.

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

Griesinger sign. ***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.

Q: True about Pendred syndrome:

Bilateral sensorineural deafness. ***Bilateral sensorineural deafness*** - Pendred syndrome is characterized by **bilateral sensorineural hearing loss**, often congenital or early-onset, and can range from moderate to profound. - This deafness results from a defect in the **pendrin protein** (encoded by the *SLC26A4* gene), which is crucial for iodine transport and inner ear function. - Associated inner ear abnormalities include **Mondini dysplasia** and **enlarged vestibular aqueduct**. *Generalized edema* - **Generalized edema** is not a characteristic feature of Pendred syndrome. - Edema is typically associated with conditions like **congestive heart failure**, **kidney disease**, or **liver failure**, which are distinct from Pendred syndrome. *Intellectual disability* - **Intellectual disability** is not a direct or characteristic manifestation of Pendred syndrome. - While other genetic conditions can lead to developmental delays, Pendred syndrome primarily affects **hearing** and **thyroid function**. *No goiter* - Pendred syndrome is associated with a **goiter** in about 60-75% of cases due to impaired thyroid hormone synthesis. - The goiter often appears in late childhood or adolescence and may be accompanied by **hypothyroidism**.

Q: All of the following are true regarding Bell's palsy except:

Immediate nerve decompression is required. ***Immediate nerve decompression is required*** - **Bell's palsy** is typically managed with medical therapy, primarily **steroids**, to reduce inflammation and promote recovery. - **Surgical decompression** of the facial nerve is rarely indicated and is not a standard or immediate treatment. *Unilateral facial weakness* - This is the **hallmark symptom** of Bell's palsy, affecting one side of the face. - Patients experience difficulty with facial expressions, eye closure, and oral competence [1]. *Steroids are the treatment of choice* - **Corticosteroids**, such as prednisone, are the primary treatment to reduce inflammation of the **facial nerve (cranial nerve VII)** [1]. - Early initiation of steroids significantly improves the chances of full recovery [1]. *Herpes simplex virus is commonly implicated* - **Reactivation of HSV-1** is thought to be a major underlying cause, leading to inflammation and swelling of the facial nerve. - Other viruses, such as **varicella-zoster virus (VZV)**, can also cause facial paralysis (Ramsay Hunt syndrome), which is clinically distinct.

Q: All the following are TRUE of Ramsay-Hunt syndrome EXCEPT

Results of spontaneous recovery of facial nerve are 85%. ***Results of spontaneous recovery of facial nerve are 85%*** - The **prognosis** for **facial nerve recovery** in Ramsay Hunt syndrome is significantly poorer than in Bell's palsy, with complete recovery rates often cited between 21% and 75%, and sometimes as low as 30-50%. [1] - The 85% recovery rate refers more commonly to **Bell's palsy**, not Ramsay Hunt syndrome, which typically involves more severe nerve damage due to direct viral neuritis. [1] *Ear ache is a symptom* - **Severe pain** in the ear, often preceding the rash, is a characteristic and prominent symptom of Ramsay Hunt syndrome, which is caused by the **reactivation of varicella-zoster virus** in the geniculate ganglion. - This pain is typically more intense and debilitating than in Bell's palsy, reflecting the inflammatory involvement of sensory nerves. *VII nerve involved* - Ramsay Hunt syndrome is specifically defined by **facial paralysis**, which results from the involvement and **inflammation of the facial nerve (cranial nerve VII)**. [1] - The virus reactivates in the **geniculate ganglion**, affecting the facial nerve, leading to paralysis on one side of the face. *Viral aetiology* - The syndrome is caused by the **reactivation of the varicella-zoster virus (VZV)**, the same virus that causes chickenpox and shingles. - VZV reactivation leads to **inflammation of the geniculate ganglion** and surrounding structures, resulting in characteristic symptoms like facial paralysis and vesicular rash.

Q: A patient with Bell's palsy comes on day 3. Treatment given to him would be:

Oral steroids + vitamin B. ***Oral steroids + vitamin B*** - **Oral steroids** are the cornerstone of Bell's palsy treatment, especially when initiated within **72 hours** of symptom onset, to reduce inflammation and swelling of the facial nerve [1]. - While **vitamin B** (particularly B12) is often co-administered for its neurotrophic properties, its specific benefit in Bell's palsy is not as strongly evidence-based as steroids, but it may aid in nerve regeneration and recovery. *Oral steroids + Acyclovir* - **Acyclovir** (or other antiviral agents) is sometimes used in Bell's palsy, but primarily when there's suspicion of a **viral etiology** like herpes simplex virus (e.g., in Ramsay Hunt syndrome), which is not explicitly stated here. Antiviral drugs are generally not considered effective for standard idiopathic Bell's palsy [1]. - Antivirals provide minimal additional benefit when given alongside steroids for idiopathic Bell's palsy unless there are specific indications. *Intratympanic steroids* - **Intratympanic steroids** are typically reserved for conditions like **sudden sensorineural hearing loss** or Meniere's disease, where local anti-inflammatory effects in the inner ear are desired. - This route of administration is not the standard treatment for systemic impact on the facial nerve in Bell's palsy. *Vitamin B + vasodilators* - While **vitamin B** may support nerve health, there is no strong evidence to support the use of **vasodilators** in the treatment of Bell's palsy. - The pathophysiology of Bell's palsy is primarily inflammatory, not related to vascular insufficiency that would be amenable to vasodilators.

Q: A case of CSOM presenting with vertigo can have any of the following except -

Dural sinus thrombosis. ***Dural sinus thrombosis (Correct - Does NOT typically cause vertigo)*** - Dural sinus thrombosis is an intracranial complication of CSOM that presents with **headache**, **papilledema**, **seizures**, and **focal neurological deficits** - **Vertigo is NOT a characteristic feature** of dural sinus thrombosis - While it's a serious complication of CSOM, it does not directly affect the vestibular system, making it the exception in this list *Cerebellar abscess (Incorrect - DOES cause vertigo)* - Cerebellar abscess is a serious intracranial complication of CSOM that **commonly causes vertigo** - Due to proximity to the **vestibular nuclei** and brainstem pathways, cerebellar pathology disrupts balance and coordination - Presents with prominent **vertigo**, **ataxia**, **nystagmus**, and other cerebellar signs *Fistula with semicircular canal (Incorrect - DOES cause vertigo)* - **Labyrinthine fistula** is a direct cause of vertigo in CSOM - Erosion from chronic infection creates an abnormal communication between the middle ear and inner ear (commonly affects the **lateral semicircular canal**) - Produces **pressure-induced vertigo** (positive fistula test) as pressure changes directly stimulate the vestibular system - Classic presentation: vertigo triggered by loud sounds (Tullio phenomenon) or pressure changes *Any of the above (Incorrect)* - This option is incorrect because NOT all listed complications cause vertigo - While cerebellar abscess and labyrinthine fistula are well-established causes of vertigo in CSOM, dural sinus thrombosis does not typically present with vertigo - Therefore, "any of the above" is not accurate

Q: True about Ramsay-hunt syndrome except -

Surgical removal gives excellent prognosis. ***Surgical removal gives excellent prognosis*** - Ramsay Hunt Syndrome (RHS) is caused by **reactivation of varicella-zoster virus (VZV)** [2], not a condition treated by surgical removal. [3] - Prognosis depends on the **degree of nerve damage** and **timely antiviral treatment** [1], not surgery. [3] *May involves VIII nerve* - Reactivation of VZV in RHS can affect the **vestibulocochlear nerve (VIII)**, leading to symptoms like **vertigo, hearing loss, and tinnitus**. [4] - This involvement is due to the close proximity of the geniculate ganglion to the VIII nerve, allowing for viral spread. *Causative agent is virus* - The causative agent of Ramsay Hunt Syndrome is the **varicella-zoster virus (VZV)** [4], which is the same virus that causes chickenpox and shingles. [2] - VZV reactivation in the geniculate ganglion of the facial nerve leads to the characteristic symptoms. *Involves VII nerve* - Ramsay Hunt Syndrome primarily involves the **facial nerve (VII)**, leading to symptoms such as **facial muscle paralysis (Bell's palsy)**, taste disturbances, and dry eye/mouth on the affected side. [3] - The classic presentation includes **vesicular rash in the external auditory canal** or on the auricle in the distribution of the VII nerve. [2]

Q: Tobey-Ayer test is positive in which of the following conditions?

Lateral sinus thrombosis. ***Lateral sinus thrombosis*** - The **Tobey-Ayer test** (or Queckenstedt's maneuver) assesses the patency of the **internal jugular vein** by observing changes in CSF pressure during compression. - In **lateral sinus thrombosis**, compression of the unaffected internal jugular vein leads to a rise in CSF pressure, but compression of the affected side yields **no or a blunted rise**, indicating obstruction. *Subarachnoid haemorrhage* - This condition involves bleeding into the subarachnoid space, which can elevate **intracranial pressure (ICP)**, but it isn't directly diagnosed by a differential CSF pressure response to jugular compression. - The primary diagnostic methods are **CT scans** and **lumbar puncture** showing xanthochromia. *Petrositis* - Also known as Gradenigo's syndrome, petrositis is an infection of the **petrous apex** of the temporal bone, often presenting with ear discharge, facial pain, and abducens nerve palsy. - While it's a complication of otitis media, it does not typically involve obstruction of the internal jugular vein or present with a positive Tobey-Ayer test. *Cerebral abscess* - A cerebral abscess is a localized collection of pus within the brain parenchyma, which can cause **localized neurological deficits** and increased ICP. - The Tobey-Ayer test would not specifically diagnose a cerebral abscess, as it assesses venous outflow from the brain rather than focal brain lesions.

Q: Pendred's syndrome is:

Deaf and goitrous patient since infancy.. ***Deaf and goitrous patient since infancy*** - **Pendred's syndrome** is an autosomal recessive disorder characterized by **sensorineural hearing loss** and a **goiter** due to a defect in iodine organification [1]. - The symptoms typically manifest from **infancy** or early childhood, with profound deafness being one of the earliest signs [1]. *Thyroiditis extending into adjacent structures* - This describes an inflammatory process of the thyroid gland that has spread, which is not characteristic of **Pendred's syndrome**. - **Pendred's syndrome** is a genetic developmental disorder, not primarily an inflammatory condition causing direct tissue invasion. *None* - This option is incorrect because there is a correct description of Pendred's syndrome provided. - **Pendred's syndrome** is a well-defined genetic condition with specific clinical manifestations. *Autoimmune thyroiditis* - **Autoimmune thyroiditis** (e.g., Hashimoto's thyroiditis) involves the immune system attacking the thyroid gland, leading to hypothyroidism and goiter. - While it can cause a goiter, it does not typically present with congenital **sensorineural deafness** as a primary feature.

Question 1

Bezold's abscess is located in -

Accepted Answer

Sternocleidomastoid

Answer

Infratemporal region

Answer

Digastric triangle

Answer

Submandibular region

Question 2

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

Accepted Answer

Griesinger sign

Answer

Tobey Ayer test

Answer

Queckenstedt test

Answer

All of the options

Question 3

True about Pendred syndrome:

Accepted Answer

Bilateral sensorineural deafness

Answer

Generalized edema

Answer

Intellectual disability

Answer

No goiter

Question 4

All of the following are true regarding Bell's palsy except:

Accepted Answer

Immediate nerve decompression is required

Answer

Unilateral facial weakness

Answer

Steroids are the treatment of choice

Answer

Herpes simplex virus is commonly implicated

Question 5

All the following are TRUE of Ramsay-Hunt syndrome EXCEPT

Accepted Answer

Results of spontaneous recovery of facial nerve are 85%

Answer

Ear ache is a symptom

Answer

VII nerve involved

Answer

Viral aetiology

Question 6

A patient with Bell's palsy comes on day 3. Treatment given to him would be:

Accepted Answer

Oral steroids + vitamin B

Answer

Oral steroids + Acyclovir

Answer

Intratympanic steroids

Answer

Vitamin B + vasodilators

Question 7

A case of CSOM presenting with vertigo can have any of the following except -

Accepted Answer

Dural sinus thrombosis

Answer

Cerebellar abscess

Answer

Fistula with semicircular canal

Answer

Any of the above

Question 8

True about Ramsay-hunt syndrome except -

Accepted Answer

Surgical removal gives excellent prognosis

Answer

May involves VIII nerve

Answer

Causative agent is virus

Answer

Involves VII nerve

Question 9

Tobey-Ayer test is positive in which of the following conditions?

Accepted Answer

Lateral sinus thrombosis

Answer

Subarachnoid haemorrhage

Answer

Petrositis

Answer

Cerebral abscess

Question 10

Pendred's syndrome is:

Accepted Answer

Deaf and goitrous patient since infancy.

Answer

Thyroiditis extending into adjacent structures.

Answer

None.

Answer

Autoimmune thyroiditis.

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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