Diseases of the Ear — MCQs
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In the context of acute otitis media, Weber's test will be:
A 2-year-old male with recurrent otitis media presents for the fourth episode this year. There is no hearing loss. On physical examination, the tympanic membrane is erythematous and bulging, with no perforation. The middle ear effusion persists after antibiotic treatment. Analyze the situation and recommend the next step.
A child with a history of recurrent otitis media presents with fever, ear pain, and a protruding auricle. What is the most likely diagnosis?
A 55-year-old female presents with progressive hearing loss. Audiometry reveals conductive hearing loss, and a CT scan shows ossification of the stapes. What is the most likely diagnosis?
Which of the following is the treatment of choice for a patient with recurrent cholesteatoma?
Which of the following statements is true about otosclerosis?
A child presents with a foreign body in the ear. What is the initial step in management?
A patient presents with a history of recurrent otitis media and a tympanic membrane perforation. What is the most common complication?
A 25-year-old swimmer presents with ear pain and discharge. Otoscopy reveals inflammation of the external ear canal. What is the most likely diagnosis?
A 4-year-old child presents with difficulty hearing and frequent ear infections. An otoscopic examination reveals fluid in the middle ear without signs of acute infection. What is the most likely diagnosis?
Diseases of the Ear Indian Medical PG Practice Questions and MCQs
Question 261: In the context of acute otitis media, Weber's test will be:
- A. Not lateralized
- B. Lateralized to the better ear
- C. Inconclusive
- D. Lateralized to the affected ear (Correct Answer)
Explanation: ***Lateralized to the affected ear*** - **Weber's test** is used to detect **unilateral conductive or sensorineural hearing loss**. In acute otitis media, there is often fluid in the middle ear space, leading to **conductive hearing loss**. - With **conductive hearing loss**, bone conduction is perceived as louder in the affected ear because the masking effect of ambient noise transmitted via air conduction is reduced, causing the sound to be **lateralized to the affected (poorer) ear**. - This occurs because the affected ear with middle ear fluid has reduced air conduction, making the bone-conducted sound relatively more prominent in that ear. *Not lateralized* - This would imply either **no hearing loss** or **symmetrical hearing loss** (either conductive or sensorineural), which is not typical for unilateral acute otitis media. - A lack of lateralization suggests the sound is perceived equally in both ears, which is not the expected finding when one ear has significant middle ear pathology. *Lateralized to the better ear* - Lateralization to the **better ear** typically indicates **sensorineural hearing loss** in the poorer ear. - Acute otitis media primarily causes **conductive hearing loss** due to fluid accumulation in the middle ear, not sensorineural pathology. *Inconclusive* - Weber's test is generally a **reliable and conclusive test** for differentiating between unilateral conductive and sensorineural hearing loss. - If performed correctly, it should yield a clear lateralization or lack thereof, providing valuable diagnostic information in acute otitis media.
Question 262: A 2-year-old male with recurrent otitis media presents for the fourth episode this year. There is no hearing loss. On physical examination, the tympanic membrane is erythematous and bulging, with no perforation. The middle ear effusion persists after antibiotic treatment. Analyze the situation and recommend the next step.
- A. Watchful waiting for 3 months
- B. Tympanostomy tube insertion (Correct Answer)
- C. Corticosteroid ear drops
- D. Switch to broad-spectrum antibiotics
Explanation: ***Tympanostomy tube insertion*** - This child has **recurrent acute otitis media (AOM)** with 4 episodes in one year, which meets the definition of recurrent AOM (≥4 episodes in 12 months or ≥3 episodes in 6 months). - **Tympanostomy tube insertion** is indicated for recurrent AOM with persistent middle ear effusion, even in the absence of documented hearing loss, to provide ventilation, prevent future episodes, and reduce the risk of complications such as hearing impairment and speech delay. - The tubes help equalize middle ear pressure, facilitate drainage, and significantly reduce the frequency of subsequent AOM episodes. *Watchful waiting for 3 months* - Watchful waiting for 3 months is appropriate for **uncomplicated otitis media with effusion (OME)** following a single episode, particularly when there is no hearing loss. - However, this child has **recurrent AOM** (4 episodes this year) with persistent effusion after treatment, indicating poor Eustachian tube function and a higher risk of continued infections and potential developmental impact. - Active intervention is preferred over prolonged observation in cases of recurrent infection to prevent cumulative hearing effects and further episodes. *Switch to broad-spectrum antibiotics* - The child has already received antibiotic treatment for the current episode, and the persistence of effusion indicates that antibiotics alone are **insufficient** to resolve the underlying problem of poor middle ear ventilation and Eustachian tube dysfunction. - Repeated courses of broad-spectrum antibiotics increase the risk of **antibiotic resistance** and do not address the mechanical ventilation issues that predispose to recurrent infections. *Corticosteroid ear drops* - **Corticosteroid ear drops** are used for external ear canal inflammation (otitis externa) and are completely **ineffective** for middle ear pathology such as AOM or middle ear effusion. - They cannot penetrate an intact tympanic membrane to reach the middle ear space and do not address bacterial infection or ventilation dysfunction.
Question 263: A child with a history of recurrent otitis media presents with fever, ear pain, and a protruding auricle. What is the most likely diagnosis?
- A. Otitis externa
- B. Acute mastoiditis (Correct Answer)
- C. Cholesteatoma
- D. Otitis media with effusion
Explanation: ***Acute mastoiditis*** * The child's history of **recurrent otitis media**, coupled with **fever**, **ear pain**, and a **protruding auricle**, is highly suggestive of acute mastoiditis. * **Mastoiditis** is an infection of the **mastoid air cells** that typically arises as a complication of **untreated or recurrent acute otitis media**; the protruding auricle is due to inflammation and edema pushing the pinna outward. *Otitis externa* * **Otitis externa** primarily affects the **ear canal**, causing pain, discharge, and itching, but typically does not involve a **protruding auricle**. * It is less likely to present with significant **fever** unless there is extensive cellulitis or a severe underlying condition. *Cholesteatoma* * A **cholesteatoma** is an abnormal, non-cancerous skin growth in the middle ear, which can cause **hearing loss** and **chronic ear discharge**, but it does not typically cause acute fever or a protruding auricle as an initial presentation. * It is usually a chronic condition and its acute complications, such as an **abscess**, would be needed to explain the protruding auricle and fever. *Otitis media with effusion* * **Otitis media with effusion** involves fluid in the middle ear without signs of acute infection, leading to **hearing loss** but not usually associated with pain, fever, or a **protruding auricle**. * This condition is typically **painless** and afebrile, differentiating it from the child's acute symptoms.
Question 264: A 55-year-old female presents with progressive hearing loss. Audiometry reveals conductive hearing loss, and a CT scan shows ossification of the stapes. What is the most likely diagnosis?
- A. Otosclerosis (Correct Answer)
- B. Chronic suppurative otitis media
- C. Serous otitis media
- D. Acoustic neuroma
Explanation: ***Otosclerosis*** - **Otosclerosis** is characterized by abnormal bone remodeling in the **otic capsule**, leading to **stapes fixation** and conductive hearing loss. - The CT scan finding of **ossification of the stapes** is pathognomonic for otosclerosis. *Chronic suppurative otitis media* - This condition involves **persistent infection and inflammation** of the middle ear, often with a **perforated tympanic membrane** and discharge. - While it can cause conductive hearing loss due to ossicular destruction or tympanic membrane perforation, it does not typically present with isolated **stapes ossification**. *Serous otitis media* - **Serous otitis media** is characterized by the presence of **fluid in the middle ear space** without signs of acute infection, commonly causing conductive hearing loss. - It does not involve **ossification of the stapes** or other bone remodeling processes like otosclerosis. *Acoustic neuroma* - An **acoustic neuroma** is a benign tumor of the **vestibulocochlear nerve** (cranial nerve VIII), typically causing **sensorineural hearing loss**, tinnitus, and balance issues. - It does not cause conductive hearing loss or ossification of the stapes; rather, it originates from the nerve itself.
Question 265: Which of the following is the treatment of choice for a patient with recurrent cholesteatoma?
- A. Antibiotics
- B. Corticosteroids
- C. Surgical excision (Correct Answer)
- D. Radiotherapy
Explanation: ***Surgical excision*** - **Surgical excision** is the definitive treatment for **cholesteatoma**, especially in cases of recurrence, to completely remove the abnormal growth and prevent complications. - The goal is to eradicate the disease, preserve or improve hearing, and prevent further bone erosion or intracranial spread. *Antibiotics* - **Antibiotics** are typically used to treat associated **bacterial infections** or **otitis media**, but they do not resolve the underlying cholesteatoma. - **Cholesteatoma** is an epithelial growth, not primarily an infection, so antibiotics alone are insufficient. *Corticosteroids* - **Corticosteroids** may be used to reduce **inflammation** or swelling associated with cholesteatoma but do not remove the epithelial mass itself. - They are adjunctive therapies and not the primary treatment for the surgical nature of cholesteatoma. *Radiotherapy* - **Radiotherapy** is generally not indicated for **cholesteatoma** as it is a benign, non-malignant condition that requires physical removal. - The risks associated with radiation exposure outweigh any potential benefits in treating this specific condition.
Question 266: Which of the following statements is true about otosclerosis?
- A. Primarily affects the inner ear structures.
- B. Approximately 60-70% have a family history.
- C. More common in African descendants than in Caucasians.
- D. More common in females than in males. (Correct Answer)
Explanation: ***More common in females than in males.*** - **Otosclerosis** is observed more frequently in females, with a female-to-male ratio of approximately **2:1**, and it often worsens during **pregnancy**. - This higher prevalence in women suggests a potential influence of **hormonal factors** on disease progression. *More common in African descendants than in Caucasians.* - This is **incorrect**. Otosclerosis shows a clear **racial predilection**, being significantly more common in **Caucasian populations** compared to African, Asian, or Native American populations. - The prevalence is highest in White populations (especially of European descent) and lowest in African and Asian populations. *Approximately 60-70% have a family history.* - While otosclerosis does have a **genetic component** and a significant percentage of patients have a positive family history, the reported figures are closer to **50%**, making 60-70% an overestimation. - Familial otosclerosis suggests an **autosomal dominant inheritance pattern** with incomplete penetrance. *Primarily affects the inner ear structures.* - Otosclerosis is primarily a disease of the **middle ear**, specifically involving the ossicles and the **stapes footplate**, leading to progressive **conductive hearing loss**. - Although it can rarely extend to the inner ear (cochlear otosclerosis), the primary pathology is in the **bony labyrinth** affecting the stapes at the oval window.
Question 267: A child presents with a foreign body in the ear. What is the initial step in management?
- A. Antibiotic therapy
- B. CT scan
- C. Observation
- D. Otoscopic examination (Correct Answer)
Explanation: ***Otoscopic examination*** - An **otoscopic examination** is the critical initial step to **visualize the foreign body**, assess its size, type, location, and rule out tympanic membrane perforation or other complications. - This assessment guides the choice of the safest and most effective **removal technique**. *Antibiotic therapy* - **Antibiotic therapy** is not indicated as an initial step unless there are signs of **infection** secondary to the foreign body presence. - Administering antibiotics prematurely can mask symptoms or promote **antibiotic resistance**. *CT scan* - A **CT scan** is generally reserved for complex cases where the foreign body is not visible, deeply impacted, or suspected to be within the middle ear or mastoid, and is **not an initial diagnostic tool**. - It involves radiation exposure and is **unnecessary** for most visible foreign bodies. *Observation* - **Observation** is inappropriate as a foreign body in the ear can lead to complications such as **pain**, **infection**, **hearing loss**, or damage to the ear canal and **tympanic membrane**. - Prompt removal is usually necessary to prevent these adverse outcomes.
Question 268: A patient presents with a history of recurrent otitis media and a tympanic membrane perforation. What is the most common complication?
- A. Mastoiditis
- B. Facial nerve palsy
- C. Hearing loss (Correct Answer)
- D. Labyrinthitis
Explanation: ***Hearing loss*** - Chronic otitis media with tympanic membrane perforation almost invariably leads to **conductive hearing loss** due to ossicular damage, inflammation, or fluid in the middle ear. - This is the most common and often an early complication observed in patients with recurrent ear infections and perforations. *Mastoiditis* - While a serious complication, **mastoiditis** is less common than hearing loss and involves infection spreading to the mastoid air cells, often presenting with postauricular pain and swelling. - It typically occurs when acute otitis media is left untreated or inadequately treated, leading to bone erosion. *Facial nerve palsy* - **Facial nerve palsy** is a rare and severe complication, typically associated with extensive local inflammation or cholesteatoma eroding towards the facial nerve canal. - Its occurrence is much less frequent compared to the high incidence of hearing impairment with recurrent otitis media. *Labyrinthitis* - **Labyrinthitis**, an inflammation of the inner ear, is also a less common complication, often manifesting as vertigo, nystagmus, and sensorineural hearing loss. - It usually occurs due to direct extension of infection from the middle ear to the inner ear, or via toxins, and is not the most frequent consequence.
Question 269: A 25-year-old swimmer presents with ear pain and discharge. Otoscopy reveals inflammation of the external ear canal. What is the most likely diagnosis?
- A. Acute otitis media
- B. Chronic otitis media
- C. Otitis externa (Correct Answer)
- D. Eustachian tube dysfunction
Explanation: ***Otitis externa*** - The patient's presentation with **ear pain** and discharge, especially as a **swimmer**, along with otoscopy findings of **inflammation of the external ear canal**, is highly characteristic of otitis externa, also known as **swimmer's ear**. - This condition is an inflammation or infection of the **external auditory canal**, often precipitated by moisture and trauma. *Acute otitis media* - Acute otitis media primarily involves infection of the **middle ear**, not the external ear canal, and is typically characterized by a **red, bulging tympanic membrane** (eardrum) with potential effusion behind it. - While it presents with ear pain, the otoscopy findings here specifically describe **external ear canal inflammation**, ruling out typical acute otitis media. *Chronic otitis media* - This condition is characterized by **persistent inflammation or infection of the middle ear and mastoid cavity**, often resulting in a **tympanic membrane perforation** and chronic drainage (otorrhea) from the middle ear. - The findings of primary **external ear canal inflammation** do not align with the hallmark features of chronic otitis media. *Eustachian tube dysfunction* - Eustachian tube dysfunction involves impaired function of the **Eustachian tube**, leading to a feeling of **ear fullness**, pressure, or mild hearing loss due to negative pressure in the middle ear. - It does not typically present with significant **ear pain and discharge** or overt inflammation of the external ear canal.
Question 270: A 4-year-old child presents with difficulty hearing and frequent ear infections. An otoscopic examination reveals fluid in the middle ear without signs of acute infection. What is the most likely diagnosis?
- A. Otitis media with effusion (Correct Answer)
- B. Acute otitis media
- C. Otitis externa
- D. Cholesteatoma
Explanation: ***Otitis media with effusion*** - The presence of **fluid in the middle ear** without signs of acute infection (e.g., fever, ear pain, bulging tympanic membrane) is characteristic of otitis media with effusion (OME). - This condition is a common cause of **hearing difficulty** and recurrent ear infections in children due to impaired Eustachian tube function. *Acute otitis media* - This diagnosis requires signs of **acute inflammation** and infection, such as ear pain, fever, and a **bulging, erythematous tympanic membrane**, which are absent in this case. - The fluid in acute otitis media is typically purulent and associated with more acute symptoms. *Otitis externa* - **Otitis externa** involves inflammation or infection of the **external ear canal**, often referred to as "swimmer's ear." - Symptoms typically include **ear pain**, itching, and discharge from the ear canal, and the tympanic membrane is usually normal. *Cholesteatoma* - A **cholesteatoma** is an abnormal, **non-cancerous skin growth** that develops in the middle ear, behind the eardrum. - While it can cause hearing loss and recurrent infections, it is characterized by a **retraction pocket** or **perforation** with **squamous debris**, which is not described here.
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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