Diseases of the Ear — MCQs

Diseases of the Ear Indian Medical PG Practice Questions and MCQs

Question 271: A 35-year-old male presents with pulsatile tinnitus and a reddish mass behind the tympanic membrane. What is the most likely diagnosis?

A. Cholesteatoma
B. Glomus tumor (Correct Answer)
C. Otosclerosis
D. Acoustic neuroma

Explanation: ***Glomus tumor*** - A **glomus tumor** (paraganglioma) typically presents with **pulsatile tinnitus** due to its vascular nature and appears as a **reddish mass behind the tympanic membrane**. - Its presence can lead to **conductive hearing loss** and, in some cases, cranial nerve palsies due to local invasion. *Cholesteatoma* - A **cholesteatoma** is a benign growth of **squamous epithelium** that causes a white, pearly mass, not a reddish one, and often leads to foul-smelling discharge and bone erosion. - While it can cause hearing loss and tinnitus, the tinnitus is usually not pulsatile, and the visual appearance behind the tympanic membrane is distinct. *Otosclerosis* - **Otosclerosis** is characterized by abnormal bone remodeling in the middle ear, leading to **progressive conductive hearing loss**, typically without a visible mass behind the tympanic membrane. - It does not cause pulsatile tinnitus or a reddish mass; rather, the tympanic membrane often appears normal or may show a "Schwartze sign" (reddish hue over the promontory) in active disease, which is different from a distinct mass. *Acoustic neuroma* - An **acoustic neuroma** (vestibular schwannoma) is a benign tumor of the **vestibulocochlear nerve** that typically causes **unilateral sensorineural hearing loss**, tinnitus (often non-pulsatile), and balance issues. - It does not present as a visible mass behind the tympanic membrane, as it is located internally within the cerebellopontine angle.

Question 272: A 60-year-old male presents with unilateral conductive hearing loss and a pearly white mass behind the tympanic membrane. What is the most likely diagnosis?

A. Cholesteatoma (Correct Answer)
B. Otitis media with effusion
C. Tympanosclerosis
D. Foreign body

Explanation: ***Cholesteatoma*** - A **pearly white mass** behind an intact tympanic membrane, along with **unilateral conductive hearing loss**, is characteristic of a cholesteatoma. - Cholesteatomas are **destructive epithelial cysts** that can erode ossicles and bone, leading to progressive hearing loss and potential complications. *Otitis media with effusion* - This typically presents with a **dull, retracted tympanic membrane** and a **serous or mucoid effusion**, not a pearly white mass. - While it causes **conductive hearing loss**, it lacks the specific visual hallmark of a cholesteatoma. *Tympanosclerosis* - Characterized by **white plaques** on the tympanic membrane due to hyalinization and calcification, often after recurrent otitis media. - These plaques are usually **superficial** and do not present as a distinct mass *behind* the eardrum. *Foreign body* - A foreign body behind the tympanic membrane is **rare** and would typically be visible as an object, not a pearly white mass. - The history would likely include a clear event of foreign body insertion, which is not mentioned here.

Question 273: A patient undergoes tympanometry and is found to have a Type B tympanogram. What is the most likely underlying condition?

A. Middle ear effusion (Correct Answer)
B. Chronic suppurative otitis media
C. Acute otitis media
D. Tympanic membrane retraction

Explanation: ***Middle ear effusion*** - A **Type B tympanogram** indicates a flat line with no compliance peak, suggesting fluid filling the middle ear space. - This pattern is characteristic of **middle ear effusion**, where sound transmission is significantly impaired by the fluid. *Chronic suppurative otitis media* - While it involves fluid, **chronic suppurative otitis media** typically presents with a **perforated tympanic membrane**, which would alter the tympanogram significantly (often a large volume type B or unreadable). - The primary characteristic of cSOM is **otorrhea** through a perforation, not just fluid accumulation behind an intact drum. *Acute otitis media* - **Acute otitis media** can cause a Type B tympanogram due to middle ear effusion, but the question asks for the *most likely* underlying condition. - While it involves effusion, the term **middle ear effusion** directly describes the state causing the Type B curve, whereas AOM is an infection leading to that state and may also present with pain, fever, and bulging eardrum. *Tympanic membrane retraction* - **Tympanic membrane retraction** (negative middle ear pressure) is typically associated with a **Type C tympanogram**, showing a peak shifted to the negative pressure side. - Retraction indicates abnormal Eustachian tube function but not necessarily fluid fill, which would flatten the curve.

Question 274: A 4-year-old child presents with a history of recurrent ear infections, poor school performance, and behavioral problems. Audiometry confirms bilateral conductive hearing loss. What is the most likely diagnosis?

A. Otitis media with effusion (Correct Answer)
B. Otosclerosis
C. Congenital hearing loss
D. Acute otitis media

Explanation: ***Otitis media with effusion*** - **Recurrent ear infections** and **bilateral conductive hearing loss** in a child are classic signs of otitis media with effusion, often leading to **poor school performance** and **behavioral problems** due to impaired communication. - The effusion in the middle ear dampens sound transmission, causing **conductive hearing loss**. *Otosclerosis* - This condition is characterized by **abnormal bone growth** in the middle ear, leading to **progressive conductive hearing loss**, but it typically affects **adults**, not children. - It usually presents with a gradual onset of hearing loss and **tinnitus**, without a history of recurrent infections. *Congenital hearing loss* - While it causes **bilateral hearing loss**, it is present **from birth** and would likely be identified earlier during newborn screening or developmental milestones. - It is not typically associated with a history of **recurrent ear infections** or poor school performance as a presenting symptom in a 4-year-old in this manner. *Acute otitis media* - This involves an **acute bacterial or viral infection** of the middle ear, causing symptoms like **fever**, **ear pain**, and temporary hearing loss. - While recurrent episodes can lead to OME, **acute otitis media** itself describes a transient, painful infection, not the chronic effusion and associated developmental issues described.

Question 275: What is the most common cause of conductive hearing loss in children?

A. Otosclerosis
B. Cholesteatoma
C. Otitis media with effusion (Correct Answer)
D. Acoustic neuroma

Explanation: ***Otitis media with effusion*** - **Otitis media with effusion** (OME), also known as **glue ear**, is the most common cause of conductive hearing loss in children due to fluid accumulation in the middle ear. - This fluid impedes the transmission of sound waves to the inner ear, resulting in temporary hearing impairment. *Otosclerosis* - **Otosclerosis** is a condition where abnormal bone growth in the middle ear, particularly around the stapes, impairs sound transmission. - It typically affects **adults** and usually presents with progressive hearing loss; it is rare in childhood. *Cholesteatoma* - A **cholesteatoma** is an abnormal, noncancerous skin growth that can develop in the middle ear or mastoid bone, gradually eroding the bone and causing hearing loss. - While it can occur in children, it is **less common** than otitis media with effusion as a primary cause of conductive hearing loss. *Acoustic neuroma* - An **acoustic neuroma** (vestibular schwannoma) is a benign tumor that grows on the vestibulocochlear nerve (cranial nerve VIII), affecting balance and hearing. - It primarily causes **sensorineural hearing loss** and is extremely rare in children.

Question 276: A 3-year-old child presents with severe otalgia, fever of 39.5°C for 2 days, and bulging tympanic membrane. What is the primary treatment for this acute otitis media?

A. Antibiotics (Correct Answer)
B. Antiviral medication
C. Steroids
D. Observation only

Explanation: ***Antibiotics*** - **Antibiotics** are the primary treatment for **severe acute otitis media (AOM)** with high fever (≥39°C), severe otalgia, or bilateral disease in young children. - Common pathogens include *Streptococcus pneumoniae*, *Haemophilus influenzae*, and *Moraxella catarrhalis*. - First-line therapy is **high-dose amoxicillin** (80-90 mg/kg/day); **amoxicillin-clavulanate** if amoxicillin failure or recent antibiotic use. - Prompt treatment in severe cases prevents complications like **mastoiditis**, **meningitis**, and **hearing loss**. *Antiviral medication* - **Antiviral medications** are ineffective against AOM, which is primarily a **bacterial infection**. - While viral URTIs may precede AOM, the middle ear infection itself requires antibacterial therapy in severe cases. *Steroids* - **Steroids** reduce inflammation but do not address the underlying **bacterial infection**. - No role as primary treatment; may be considered as adjunct in specific cases with severe inflammation. *Observation only* - **Watchful waiting** (observation with analgesics) is appropriate for **non-severe AOM** in children >6 months with: - Unilateral AOM without severe symptoms - Mild otalgia and fever <39°C - Reliable follow-up available - However, in **severe AOM** with high fever and severe pain (as in this case), **immediate antibiotics** are indicated per AAP guidelines.

Question 277: A 35-year-old patient presents with recurrent otitis media. Tympanometry reveals a type B tympanogram. What is the best management option?

A. Surgical consultation for ossicular chain
B. Topical antibiotics for perforation
C. Myringotomy with tube placement (Correct Answer)
D. Decongestants for Eustachian dysfunction

Explanation: ***Myringotomy with tube placement*** - A type B tympanogram indicates greatly reduced or no **tympanic membrane (TM) mobility**, signifying **middle ear effusion** or **perforation**. Recurrent otitis media in this context suggests persistent middle ear fluid, for which **myringotomy with tube placement** is the definitive treatment to drain fluid and ventilate the middle ear. - This procedure prevents further fluid accumulation, reduces the frequency of acute otitis media episodes, and helps improve hearing. *Surgical consultation for ossicular chain* - While ossicular chain problems can cause hearing loss, they typically do not present with **recurrent otitis media** or a **type B tympanogram** indicating fluid. Ossicular issues are more likely to present with a **Type As tympanogram** (stiff ossicles) or a **Type Ad tympanogram** (disarticulation). - Investigating the ossicular chain would be indicated if other causes were ruled out or if conductive hearing loss persists after middle ear fluid resolution. *Topical antibiotics for perforation* - Topical antibiotics are used to treat active **infections in cases of tympanic membrane perforation** but do not address the underlying Eustachian tube dysfunction or persistent middle ear fluid that leads to recurrent otitis media. - A type B tympanogram could indicate a perforation if volume is large, but the primary issue in recurrent OM is typically fluid, not just the perforation itself. *Decongestants for Eustachian dysfunction* - **Decongestants** are sometimes used for **Eustachian tube dysfunction** but have limited efficacy in cases of recurrent otitis media with established middle ear effusion, especially in adults. - Their primary role is to reduce nasal congestion, which can indirectly help Eustachian tube function, but they don't directly resolve persistent fluid.

Question 278: Which of the following is not a direct treatment option for central safe perforation of the tympanic membrane?

A. Avulsion of aural polyp (Correct Answer)
B. Aural toilet (cleaning of the ear)
C. Topical antibiotic ear drops
D. Myringoplasty (surgical repair of the eardrum)

Explanation: ***Avulsion of aural polyp*** - This is a treatment for an **aural polyp**, which is a granulation tissue mass, frequently associated with **chronic otitis media** and sometimes **cholesteatoma**. - While otitis media can lead to tympanic membrane perforation, avulsion of the polyp itself is a removal of symptomatic tissue, not a direct repair of the perforation itself. *Aural toilet (cleaning of the ear)* - **Aural toilet** is crucial for managing any type of tympanic membrane perforation (safe or unsafe) by removing debris and discharge, which helps in preventing infection and promoting healing. - It clears the ear canal and middle ear of accumulated discharge, improving the efficacy of topical medications and reducing the risk of further infection. *Topical antibiotic ear drops* - These are used to treat or prevent **secondary infections** that can develop due to the perforation, especially when there is discharge. - They reduce inflammation and bacterial load in the middle ear, which is vital for healing and preventing complications. *Myringoplasty (surgical repair of the eardrum)* - **Myringoplasty** is the definitive surgical treatment for **tympanic membrane perforation**, aiming to close the hole and restore hearing. - This procedure directly addresses the perforation itself by reconstructing the eardrum.

Question 279: A diabetic patient presents with foul smelling ear discharge, fever and severe pain in the ear. On examination there is thick yellow coloured discharge from the ear and granulation tissue in the canal. Which of the following is the appropriate management for this patient?

A. Surgical debridement
B. Antibiotic therapy (Correct Answer)
C. Cryotherapy
D. Laser removal of granulation tissue

Explanation: ***Antibiotic therapy*** - The clinical picture of a **diabetic patient** with **foul-smelling ear discharge**, **granulation tissue in the ear canal**, and severe pain strongly suggests **malignant otitis externa** (MOE), which is an aggressive bacterial infection, typically caused by *Pseudomonas aeruginosa*. - **High-dose intravenous antipseudomonal antibiotics** are the mainstay of treatment to eradicate the infection and prevent its spread to adjacent bone and soft tissues. *Surgical debridement* - While debridement may be necessary in advanced cases with **osteomyelitis** or persistent necrotic tissue, initial management of MOE primarily focuses on **systemic antibiotic therapy**. - Extensive surgical debridement is generally reserved for cases that fail to respond to medical treatment or show evidence of **extensive bone destruction**. *Cryotherapy* - **Cryotherapy** involves using extreme cold to destroy abnormal tissues and is typically used for specific dermatological conditions or small tumors, not for treating bacterial infections like MOE. - It has no role in the management of an infectious process causing widespread tissue inflammation and potential bone involvement. *Laser removal of granulation tissue* - **Laser removal** is a method for precisely excising or ablating tissue, which might be considered for specific types of benign or malignant growths. - Although **granulation tissue** is present, its removal alone would not address the underlying aggressive bacterial infection that defines malignant otitis externa.

Question 280: Most common malignancy of middle ear is

A. Glomus tumor
B. Adenocarcinoma
C. Sarcoma
D. Squamous cell carcinoma (Correct Answer)

Explanation: ***Squamous cell carcinoma*** - Squamous cell carcinoma (SCC) is the **most common malignancy of the middle ear**, accounting for approximately 60-80% of middle ear malignancies. - Often arises in the context of **chronic otitis media**, with or without cholesteatoma, where chronic inflammation and irritation can lead to malignant transformation of the squamous epithelium. - Presents with symptoms similar to chronic ear disease: **otorrhea, hearing loss, otalgia**, and sometimes facial nerve paralysis or bleeding. *Glomus tumor* - A glomus tumor (paraganglioma) is a **benign, highly vascular tumor** that commonly occurs in the middle ear. - While it can be locally aggressive and destructive, it is **not a malignancy** and typically does not metastasize. - Characteristic features include **pulsatile tinnitus** and a reddish mass behind the tympanic membrane. *Adenocarcinoma* - Adenocarcinoma of the middle ear is an **extremely rare malignancy**, arising from glandular elements (ceruminous glands). - Far less common than squamous cell carcinoma in the middle ear. *Sarcoma* - Sarcomas (such as rhabdomyosarcoma) can occur in the ear region, particularly in **children**, but are much less common as primary middle ear malignancies in adults. - These tumors originate from **mesenchymal tissue** rather than epithelial tissue, distinguishing them from carcinomas.

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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