Diseases of the Ear — MCQs

Diseases of the Ear Indian Medical PG Practice Questions and MCQs

Question 281: All of the following are true about malignant otitis externa except which of the following?

A. Pseudomonas is the most common cause
B. Severe hearing loss is the chief presenting complaint (Correct Answer)
C. ESR is used for follow up after treatment
D. Granulation tissues are seen on the floor of the external auditory canal

Explanation: ***Severe hearing loss is the chief presenting complaint*** - While otitis externa can cause mild to moderate conductive **hearing loss** due to swelling and debris, severe hearing loss is **not** typically the chief presenting complaint of **malignant otitis externa**. Instead, patients usually present with severe **otalgia** (ear pain), **otorrhea** (ear discharge), and granulation tissue in the external auditory canal. - The hallmark presentation is **severe, unrelenting otalgia** that is out of proportion to clinical findings, often worse at night. Hearing loss is a secondary feature, not the primary complaint. *ESR is used for follow up after treatment* - **Erythrocyte Sedimentation Rate (ESR)** is a valuable marker for assessing inflammatory activity in **malignant otitis externa** and is commonly utilized to monitor treatment response. - A decrease in ESR indicates successful treatment and resolution of the infection, making it a reliable tool for follow-up. *Granulation tissues are seen on the floor of the external auditory canal* - The presence of **granulation tissue** at the bony-cartilaginous junction of the external auditory canal, particularly on the **floor (inferior wall)**, is a hallmark diagnostic sign of **malignant otitis externa**. - This finding at the floor of the EAC is a classic and highly specific sign indicating osteomyelitis of the temporal bone. *Pseudomonas is the most common cause* - **Pseudomonas aeruginosa** is indeed the predominant pathogen responsible for approximately **90-95%** of **malignant otitis externa** cases. - This gram-negative bacterium is particularly opportunistic in immunocompromised individuals, especially elderly diabetics.

Question 282: A 10 year old child presents with painless, non-foul-smelling purulent discharge from the ear. Patient reports that he is able to hear better in the presence of discharge than when the ear is dry. The most probable diagnosis is

A. Chronic suppurative otitis media (CSOM) with tympanic membrane perforation (Correct Answer)
B. Otitis media with effusion
C. Mastoiditis with pain and swelling
D. Cholesteatoma with foul-smelling discharge

Explanation: ***Chronic suppurative otitis media (CSOM) with tympanic membrane perforation*** - The presence of **painless, non-foul purulent discharge** is characteristic of CSOM. The improved hearing in the presence of discharge (known as the **'reservoir phenomenon'** or **'wet ear improved hearing'**) suggests that the fluid within the middle ear is acting as a conductive medium, bridging the gap created by a **tympanic membrane perforation**, which is typically present in CSOM. - This condition involves chronic inflammation and infection of the middle ear and mastoid, often associated with a **permanent perforation of the tympanic membrane**. *Otitis media with effusion* - This condition involves **non-purulent fluid in the middle ear** without signs of acute infection and typically does not present with discharge unless the tympanic membrane ruptures, which would then be purulent. - While it causes **conductive hearing loss**, it does not typically present with the "wet ear improved hearing" phenomenon or purulent discharge. *Mastoiditis with pain and swelling* - **Mastoiditis** is an acute inflammation of the mastoid air cells, typically presenting with **postauricular pain, swelling, and redness**, often accompanied by fever and systemic symptoms, which are not described in this case. - While it can be a complication of otitis media, the primary complaint here is painless discharge without signs of acute inflammation or pain. *Cholesteatoma with foul-smelling discharge* - A **cholesteatoma** is characterized by an **expanding growth of squamous epithelium within the middle ear**, often leading to **foul-smelling, often scanty, discharge** due to secondary infection and debris. - The discharge described in the patient is **non-foul-smelling**, making cholesteatoma less likely as the primary diagnosis, although CSOM can sometimes precede or coexist with cholesteatoma.

Question 283: Pink reflex through intact tympanic membrane in active otosclerosis is known as

A. Schwartz sign (Correct Answer)
B. Schwabach's test
C. Lyre's phenomenon
D. Chvostek's reflex

Explanation: ***Schwartz sign*** - The **Schwartz sign** (also known as the **flaming or pink tympanum sign**) is a reddish hue visible through the tympanic membrane. - It is caused by **hyperemia** (increased blood flow) to the promontory's mucosa, indicating active, vascularized otosclerotic foci. *Schwabach's test* - This is a **tuning fork test** that compares the patient's bone conduction with the examiner's. - It assesses **sensorineural hearing loss** but does not involve direct visualization of the tympanic membrane. *Lyre's phenomenon* - This term is **not typically associated** with otosclerosis or ear examination findings. - It appears to be a **distractor** and does not describe any known clinical sign in otology. *Chvostek's reflex* - This is a **clinical sign of hypocalcemia**, characterized by twitching of the facial muscles when tapping the facial nerve. - It is **neurological in nature** and unrelated to ear pathology or otosclerosis.

Question 284: Which ossicle is most commonly involved in CSOM?

A. Stapes
B. Long process of incus (Correct Answer)
C. Head of malleus
D. Handle of malleus

Explanation: ***Long process of incus*** - The **long process of the incus** is particularly vulnerable to erosion in CSOM due to its relatively **poor blood supply** and slender structure. - This anatomical susceptibility makes it the most common site for **ossicular damage** in chronic middle ear inflammation. *Stapes* - While the stapes can be affected, it is generally **less commonly eroded** than the incus, especially its footplate. - The **stapes superstructure** is somewhat more protected within the oval window niche. *Head of malleus* - The **head of the malleus** is situated in the **epitympanum** and is relatively robust, making it less prone to early erosion. - Its position often shields it from direct inflammatory damage that affects more exposed ossicular parts. *Handle of malleus* - The **handle of the malleus** is more resistant to erosion compared to the incus's long process because of its thicker bone and more direct connection to the **tympanic membrane**. - Though it can be involved in severe cases, it is not the most frequently affected ossicle.

Question 285: Which of the following statements about serous otitis media is false?

A. Affect school going children
B. Also called glue ear
C. Type C tympanogram (Correct Answer)
D. Fluid in middle ear

Explanation: ***Type C tympanogram*** (FALSE statement) - A **Type C tympanogram** indicates **negative middle ear pressure**, which suggests **eustachian tube dysfunction** or early/resolution phase, but is **NOT the characteristic finding** in active serous otitis media with persistent fluid. - In serous otitis media with established fluid, a **Type B tympanogram** (flat) is the typical finding, indicating limited or no tympanic membrane mobility due to fluid behind the drum. - Type C may be seen in early eustachian tube dysfunction before fluid accumulates, or during resolution, but not in established glue ear. *Also called glue ear* (TRUE statement) - Serous otitis media is indeed commonly referred to as **"glue ear"** due to the thick, viscous fluid that accumulates in the middle ear space. - This term highlights the characteristic consistency of the effusion, which can significantly impair hearing. *Affect school going children* (TRUE statement) - **School-going children** are highly susceptible to serous otitis media, with peak prevalence between **2 and 6 years of age**. - Contributing factors include developing **eustachian tube anatomy**, frequent upper respiratory infections, and adenoid hypertrophy. *Fluid in middle ear* (TRUE statement) - The defining characteristic of serous otitis media is the presence of **non-purulent fluid** in the middle ear space. - This fluid accumulates due to **eustachian tube dysfunction**, leading to negative pressure and transudation of fluid.

Question 286: Which of the following is included in the Levenson criteria for congenital cholesteatoma?

A. White mass medial to normal tympanic membrane (Correct Answer)
B. Atticoantral perforation of the tympanic membrane
C. Definite history of otorrhoea
D. History of prior otologic procedures

Explanation: ***White mass medial to normal tympanic membrane*** - The presence of a **white mass** behind an **intact, normal tympanic membrane** is a hallmark finding for congenital cholesteatoma according to the Levenson criteria. - This criterion specifically excludes acquired forms that might involve tympanic membrane perforation or retraction. *Atticoantral perforation of the tympanic membrane* - An **atticoantral perforation** is characteristic of **acquired cholesteatoma**, not congenital cholesteatoma. - The Levenson criteria require an **intact tympanic membrane** to diagnose congenital cholesteatoma. *Definite history of otorrhoea* - **Otorrhoea (ear discharge)** suggests an **infection or perforation**, which is more commonly associated with acquired cholesteatoma or chronic otitis media. - Congenital cholesteatoma typically presents without a history of ear discharge. *History of prior otologic procedures* - A history of prior **otologic procedures** (e.g., tympanostomy tube placement, myringotomy) is an **exclusion criterion** for congenital cholesteatoma as per Levenson. - Such procedures could potentially introduce epithelial cells into the middle ear, mimicking a congenital lesion but actually representing an acquired form.

Question 287: What condition is characterized by multiple perforations of the tympanic membrane?

A. Tuberculous Otitis Media (Correct Answer)
B. Otitis Media due to Syphilis
C. Otitis Media due to Pseudomonas
D. Fungal Otitis Media

Explanation: ***Tuberculous Otitis Media*** - This condition is characterized by **multiple perforations of the tympanic membrane**, often described as a **'sieve-like' appearance**. - It also commonly presents with **painless otorrhea** and **granulations** in the middle ear. *Otitis Media due to Syphilis* - **Syphilitic otitis media** is rare and typically presents with sensorineural hearing loss, often bilateral, and sometimes vestibular symptoms. - While it can cause inflammatory changes, **multiple tympanic membrane perforations** are not a primary distinguishing feature. *Otitis Media due to Pseudomonas* - *Pseudomonas aeruginosa* is a common cause of **chronic suppurative otitis media (CSOM)**, often associated with a single large perforation or a marginal perforation. - It usually presents with **fetid otorrhea** and can be aggressive, but **multiple perforations** are not a characteristic sign. *Fungal Otitis Media* - **Fungal otitis media**, or **otomycosis**, typically presents with **itching, earache, and aural fullness**, with examination revealing fungal debris. - While the tympanic membrane can be involved, **multiple perforations** are not a typical finding; rather, it often causes inflammation and possible superficial erosion.

Question 288: Which cranial nerve is most commonly damaged in Chronic Suppurative Otitis Media (CSOM)?

A. VII (Correct Answer)
B. IV
C. VI
D. III

Explanation: ***VII*** - The **facial nerve (VII)** passes directly through the middle ear via the **facial canal**, making it highly vulnerable to inflammation, granulation tissue, and cholesteatoma associated with CSOM. - Damage to the facial nerve can result in **facial paralysis**, a serious complication of inadequately treated CSOM. *III* - The **oculomotor nerve (III)** supplies most of the extrinsic eye muscles and is located in the midbrain, far from the middle ear cavity. - Damage to cranial nerve III is generally associated with **intracranial pathologies** or orbital issues, not otitis media. *IV* - The **trochlear nerve (IV)** innervates the superior oblique muscle of the eye and originates in the midbrain, having no direct anatomical relationship with the middle ear. - Injury to cranial nerve IV typically results in **diplopia** and is uncommon in scenarios involving ear infections. *VI* - The **abducens nerve (VI)** supplies the lateral rectus muscle of the eye and is also located intracranially, distant from the middle ear. - While intracranial complications of CSOM can rarely affect adjacent structures, direct involvement of cranial nerve VI due to middle ear infection is less common than facial nerve involvement.

Question 289: What is the primary treatment for attico-antral disease?

A. Modified radical mastoidectomy (Correct Answer)
B. Antibiotics
C. Grommet insertion
D. Syringing

Explanation: ***Modified radical mastoidectomy*** - This procedure is the primary treatment for **attico-antral disease**, which often involves **cholesteatoma**. - It involves removing the **posterior canal wall**, mastoid air cells, diseased ossicles, and marsupializing the epitympanum, antrum, and mastoid cavity into a common cavity to eradicate the disease and create a safe ear. *Antibiotics* - While antibiotics can treat acute infections associated with **otitis media**, they do not address the underlying **cholesteatoma** or chronic inflammatory changes seen in attico-antral disease. - **Cholesteatoma** is a structural problem requiring surgical removal, not medical management. *Grommet insertion* - **Grommet insertion** (tympanostomy tube) is primarily used to treat **secretory otitis media** or recurrent acute otitis media by ventilating the middle ear. - It does not address the bone erosion or destructive nature of **attico-antral disease** that involves the attic and antrum. *Syringing* - **Ear syringing** is used to remove **earwax (cerumen)** impaction from the external auditory canal. - It is completely unrelated to the management of **middle ear pathologies** like attico-antral disease.

Question 290: Identify the condition of the given image:

A. Acquired cholesteatoma
B. Congenital cholesteatoma
C. Rupture of tympanic membrane
D. Keratosis obturans (Correct Answer)

Explanation: ***Keratosis obturans*** - The image shows a **plug of desquamated keratin** filling the external auditory canal. This is the characteristic appearance of keratosis obturans. - This condition is often associated with severe pain, conductive hearing loss, and sometimes **bone erosion** of the external auditory canal. *Acquired cholesteatoma* - This condition involves a **retraction pocket** or **perforation** of the tympanic membrane with ingrowth of keratinizing squamous epithelium into the middle ear, forming a sac. - The image does not show a retraction pocket or a middle ear mass, which are typical features of acquired cholesteatoma. *Congenital cholesteatoma* - This is a **pearly white mass** located behind an intact tympanic membrane, without any history of ear infections or perforations. - The image shows an external auditory canal filled with a plug, not a middle ear mass behind an intact tympanic membrane. *Rupture of tympanic membrane* - A rupture of the tympanic membrane would present as a **visible defect or perforation** in the eardrum. - The image shows an accumulation of material within the ear canal, and the tympanic membrane itself is not clearly visible or perforated in a manner indicative of rupture.

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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