Diseases of the Ear — MCQs

A 40-year-old man presents to the general medicine clinic with progressive hearing loss in his right ear, difficulty hearing conversations in noisy places, and occasional ringing in his right ear. He denies any associated symptoms and has a normal otoscopic examination. A Weber's test is performed, and the patient reports hearing the vibration loudest in his left ear. Which of the following findings would most likely be observed in this patient?

Q339

Which of the following statements regarding traumatic facial nerve palsy is false?

Q340

A 60-year-old diabetic patient presents with an extremely painful lesion in the external ear and otorrhea that is not responding to antibiotics, accompanied by granulation-type tissue in the external ear, bony erosion, and facial nerve palsy. The most likely diagnosis is

Diseases of the Ear Indian Medical PG Practice Questions and MCQs

Question 331: Which of the following is NOT a feature of a moderately retracted tympanic membrane?

A. Lateral process of malleus becomes more prominent
B. Cone of light is absent or interrupted
C. Tympanic membrane appears bulging outward (Correct Answer)
D. Handle of malleus appears shortened

Explanation: ***Tympanic membrane appears bulging outward*** - A **bulging tympanic membrane** is characteristic of **acute otitis media** or **pus accumulation** in the middle ear, indicating increased pressure pushing the membrane outwards. It IS NOT a feature of retraction. - **Retraction** implies the tympanic membrane is pulled inwards due to negative middle ear pressure, which would make it appear concave rather than convex. *Lateral process of malleus becomes more prominent* - This is a classic sign of a **retracted tympanic membrane**, as the membrane is pulled inwards towards the middle ear space, making the underlying bony structures, such as the lateral process of the malleus, more visible and distinct. - The inward pulling tension accentuates these anatomical landmarks. *Cone of light is absent or interrupted* - The **cone of light**, or light reflex, is normally a bright, triangular reflection on the anterior-inferior quadrant of the tympanic membrane. - In a retracted tympanic membrane, the abnormal curvature and tension can distort or obliterate this reflection, making it appear absent, interrupted, or diffused. *Handle of malleus appears shortened* - This is another typical finding in a **retracted tympanic membrane**, where the inward retraction causes the handle of malleus to appear foreshortened due to the altered angle and position of the membrane. - The normal anatomical landmarks become distorted by the negative middle ear pressure.

Question 332: Throat infection causes ear infection through:

A. Eustachian tube (Correct Answer)
B. Simultaneous infection
C. Hematogenous spread
D. Cranial spread

Explanation: ***Eustachian tube*** - The **Eustachian tube** connects the nasopharynx (area behind the nose and above the soft palate, close to the throat) to the middle ear. - During a throat infection, **pathogens** can travel up this tube, especially in children due to its more horizontal and shorter nature, leading to **otitis media**. *Hematogenous spread* - This refers to the spread of infection through the **bloodstream**, which is not the primary mechanism for a direct throat-to-ear infection. - While possible in some systemic infections, it is not the typical route for **otitis media** following a throat infection. *Cranial spread* - **Cranial spread** implies infection moving directly through the bones or tissues of the skull, which is not how most common ear infections from the throat occur. - This route is typically associated with very severe or complicated infections like **mastoiditis** that erode bone. *Simultaneous infection* - **Simultaneous infection** suggests two separate infections occurring at the same time, possibly from the same source, but it doesn't explain the *route* of spread from the throat to the ear. - The connection between these two sites is anatomical, not merely coincidental timing of infections.

Question 333: Paracusis Willisii is seen in:

A. CSOM
B. ASOM
C. Otosclerosis (Correct Answer)
D. Meniere's disease

Explanation: *CSOM* - **Chronic Suppurative Otitis Media (CSOM)** involves chronic infection and discharge from the middle ear, usually with a tympanic membrane perforation. - While it causes **conductive hearing loss**, it typically does not present with Paracusis Willisii; hearing loss is generally worse in noisy environments due to the masking effect of noise. *ASOM* - **Acute Suppurative Otitis Media (ASOM)** is an acute infection of the middle ear, usually characterized by pain, fever, and a bulging tympanic membrane. - It causes fluctuating **conductive hearing loss** acutely, but Paracusis Willisii is not a characteristic symptom. ***Otosclerosis*** - **Paracusis Willisii** is a classic symptom of otosclerosis, where the patient hears better in noisy environments. - This phenomenon occurs because others raise their voices in noisy environments, which helps the patient with **conductive hearing loss** to hear more clearly. - The stapes fixation in otosclerosis impairs normal air conduction, but when ambient noise forces people to speak louder, the increased sound intensity compensates for the conductive deficit. *Meniere's disease* - **Meniere's disease** is characterized by episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. - The hearing loss in Meniere's is typically **sensorineural**, and Paracusis Willisii is not associated with this condition; patients often experience increased sensitivity to loud sounds (recruitment).

Question 334: A 40-year-old woman presents with a three-day history of irritation, pain, and watery discharge from her left ear. She has recently returned from a holiday, during which she used her towel, artificial nails, and earbuds to alleviate itching in her ear. What is the likely diagnosis?

A. Mastoiditis
B. Otitis Externa (Correct Answer)
C. ASOM
D. Trigeminal Neuralgia

Explanation: ***Otitis Externa*** - The patient's history of manipulating her ear with foreign objects like **artificial nails** and **earbuds**, especially when combined with a recent holiday (often involving swimming), strongly suggests **otitis externa**. - Symptoms such as **irritation, pain**, and **watery discharge** localized to the external ear canal are classic presentations, often exacerbated by a breach in the protective **skin barrier** of the canal. *Mastoiditis* - This is an **infection of the mastoid bone** behind the ear, typically presenting with postauricular pain, swelling, and fever. - It usually occurs as a complication of **untreated acute otitis media**, which is not indicated by the patient's symptoms or history. *ASOM* - **Acute Suppurative Otitis Media (ASOM)** involves **middle ear infection**, characterized by ear pain, fever, and a bulging **tympanic membrane**. - The symptoms described are more consistent with an external ear canal issue, and there is no mention of systemic symptoms or significant middle ear involvement. *Trigeminal Neuralgia* - This condition involves **severe, sudden, shock-like facial pain** along the distribution of the trigeminal nerve. - It does not cause ear discharge, irritation, or persistent ear pain that would be associated with local trauma or infection.

Question 335: What is the most common age of presentation for otosclerosis?

A. 5-10 years
B. 10-20 years
C. 20-30 years (Correct Answer)
D. 30-45 years

Explanation: ***20-30 years*** - Otosclerosis typically manifests in young to middle-aged adults, with the **onset of symptoms most common in the second and third decades of life**. - While diagnosis can occur later, the **progressive conductive hearing loss usually begins in this age range**. *5-10 years* - This age range is generally **too young** for the typical presentation of otosclerosis. - Hearing loss in this age group is more commonly associated with **otitis media** or congenital factors. *10-20 years* - While otosclerosis can begin to manifest in the late teens, the **peak incidence** for symptomatic presentation usually occurs slightly later. - This period is more commonly associated with early signs of genetic hearing loss or noise-induced hearing damage. *30-45 years* - While the condition can continue to progress and be diagnosed in this age range, the **initial appearance of symptoms often predates this period**. - This age range represents a later stage of progression for many individuals with otosclerosis.

Question 336: Which of the following is NOT a feature of a moderately retracted tympanic membrane?

A. Handle of malleus appearance foreshortened
B. Cone of light is absent or interrupted
C. Presence of fluid in the middle ear (Correct Answer)
D. Lateral process of malleus becomes more prominent

Explanation: ***Presence of fluid in the middle ear*** - While fluid in the middle ear may **coexist** with a retracted tympanic membrane, it is **not a direct otoscopic feature of the membrane's retraction itself**. - The presence of fluid represents a **middle ear pathology** (otitis media with effusion) that may result from the same underlying cause (Eustachian tube dysfunction) but is a **separate finding** from the physical appearance changes of the retracted membrane. - The question asks specifically about features of the **retracted tympanic membrane**, not associated middle ear conditions. - Therefore, fluid presence is **NOT a feature of TM retraction**, but rather a concurrent or consequent pathology. *Handle of malleus appears foreshortened* - As the tympanic membrane retracts inward due to **negative middle ear pressure**, the handle of the malleus is pulled medially and appears **shorter and more horizontal** than normal. - This is a **classic direct sign** of tympanic membrane retraction seen on otoscopy. *Cone of light is absent or interrupted* - Retraction alters the **normal concave curvature** of the tympanic membrane, disrupting the light reflection from the otoscope. - The cone of light becomes **dimmed, distorted, or completely absent**, indicating loss of normal membrane contour. - This is a **direct otoscopic feature** of membrane retraction. *Lateral process of malleus becomes more prominent* - As the membrane is pulled inward, the **lateral process of the malleus** becomes more visible and appears **sharper and more pronounced**. - This bony landmark stands out more due to the **increased inward displacement** and altered membrane tension. - This is a **direct sign** of tympanic membrane retraction.

Question 337: Which of the following tests assesses resistance in the middle ear?

A. Pure tone audiometry
B. Caloric test
C. BERA (Brainstem evoked response audiometry)
D. Impedance audiometry (Correct Answer)

Explanation: ***Impedance audiometry*** - This test measures the **impedance** (resistance) of the middle ear and the mobility of the **tympanic membrane** and **ossicular chain** - It also assesses the **acoustic reflex**, which is the contraction of the middle ear muscles in response to loud sound, providing information about the middle ear and auditory pathways *Pure tone audiometry* - This test measures an individual's **hearing sensitivity** across different frequencies - It assesses the **thresholds of hearing** for air conduction and bone conduction, but does not directly measure middle ear resistance *Caloric test* - The caloric test evaluates the function of the **vestibular system** and the **horizontal semicircular canal** - It involves introducing warm or cold water/air into the ear canal to induce nystagmus, but does not assess middle ear resistance *BERA (Brainstem evoked response audiometry)* - BERA measures the **electrical activity** in the auditory pathway from the cochlea to the brainstem in response to auditory stimuli - It is used to assess hearing in infants, differentiate between **sensory** and **neural hearing loss**, and detect neurological disorders, but does not measure middle ear impedance

Question 338: A 40-year-old man presents to the general medicine clinic with progressive hearing loss in his right ear, difficulty hearing conversations in noisy places, and occasional ringing in his right ear. He denies any associated symptoms and has a normal otoscopic examination. A Weber's test is performed, and the patient reports hearing the vibration loudest in his left ear. Which of the following findings would most likely be observed in this patient?

A. Air conduction equals bone conduction in his right ear
B. Air conduction equals bone conduction in his left ear
C. Air conduction is greater than bone conduction in his right ear (Correct Answer)
D. Bone conduction is greater than air conduction in his left ear

Explanation: ***Air conduction is greater than bone conduction in his right ear*** - The patient's presentation with **progressive hearing loss**, **tinnitus**, and **difficulty hearing in noisy environments**, along with Weber test lateralizing to the **left (unaffected) ear**, indicates **sensorineural hearing loss (SNHL)** in the right ear. - In SNHL, the Rinne test remains **positive** (AC > BC) because air conduction is still more efficient than bone conduction, even though both thresholds are elevated proportionally. - The **inner ear (cochlea) or auditory nerve** is affected, but the air conduction pathway remains superior to bone conduction, which is the hallmark of SNHL on tuning fork examination. - **Weber lateralizes to the better ear** (left) in SNHL, confirming right-sided pathology. *Air conduction equals bone conduction in his right ear* - AC = BC is **not a standard finding** in either normal hearing or typical SNHL. - This would represent a borderline or threshold finding, not the characteristic pattern of sensorineural hearing loss. - In SNHL, both AC and BC are reduced, but AC remains greater than BC (Rinne positive). *Air conduction equals bone conduction in his left ear* - The left ear is the **better functioning ear** where Weber lateralizes, suggesting it is likely normal. - In a normal ear, AC > BC (Rinne positive), not AC = BC. - This option does not address the pathology in the affected right ear. *Bone conduction is greater than air conduction in his left ear* - **BC > AC (Rinne negative)** indicates **conductive hearing loss**, not sensorineural loss. - There is no clinical evidence of conductive pathology in the left ear (normal otoscopy, Weber lateralizes toward it). - The patient's symptoms and Weber test point to right-sided SNHL, not left-sided conductive loss.

Question 339: Which of the following statements regarding traumatic facial nerve palsy is false?

A. Posttraumatic facial nerve palsy may be complete at the time of presentation
B. Decompression of the canal can be useful treatment
C. Usually occurs with longitudinal petrous temporal bone fracture (Correct Answer)
D. Usually occurs with transverse petrous temporal bone fracture

Explanation: ***Usually occurs with longitudinal petrous temporal bone fracture*** ✓ FALSE - This is the correct answer - **Longitudinal temporal bone fractures** account for the majority (70-80%) of temporal bone fractures but are **less likely to cause severe facial nerve palsy** (10-20% incidence) compared to transverse fractures. - When facial nerve injury does occur with a longitudinal fracture, it typically involves the **tympanic segment** and can be caused by **edema or contusion**, often presenting with delayed or incomplete palsy rather than direct transection. *Usually occurs with transverse petrous temporal bone fracture* - **Transverse temporal bone fractures** are less common (20-30%) but are associated with a **higher incidence and severity of immediate facial nerve paralysis** (30-50% incidence) due to direct nerve transection or severe compression. - These fractures typically cross the **internal auditory canal** and otic capsule, often damaging the labyrinth and facial nerve directly. *Posttraumatic facial nerve palsy may be complete at the time of presentation* - **Complete facial nerve paralysis** can occur immediately after trauma, particularly with **transverse temporal bone fractures**, indicating severe injury such as nerve transection. - Early assessment of the degree of paralysis using the House-Brackmann grading system is crucial for determining prognosis and guiding management strategies. *Decompression of the canal can be useful treatment* - **Surgical decompression of the facial nerve canal** may be considered for patients with **immediate complete paralysis** or **progressive paralysis** following trauma, especially if imaging shows nerve entrapment or significant edema. - The decision for surgery is usually guided by **electrophysiological studies** (electroneuronography showing >90% degeneration) and high-resolution CT imaging to assess the extent of nerve damage and fracture pattern.

Question 340: A 60-year-old diabetic patient presents with an extremely painful lesion in the external ear and otorrhea that is not responding to antibiotics, accompanied by granulation-type tissue in the external ear, bony erosion, and facial nerve palsy. The most likely diagnosis is

A. Malignant otitis externa (Correct Answer)
B. Nasopharyngeal carcinoma
C. Chronic suppurative otitis media
D. Acute suppurative otitis media

Explanation: **Malignant otitis externa** - The combination of **severe ear pain**, **granulation tissue** in the external ear, **bony erosion**, **facial nerve palsy**, and unresponsiveness to antibiotics in a **diabetic patient** is highly characteristic of malignant otitis externa. - This aggressive infection, typically caused by *Pseudomonas aeruginosa*, can spread from the external auditory canal to the surrounding bone and soft tissues, leading to cranial nerve involvement. *Nasopharyngeal carcinoma* - While nasopharyngeal carcinoma can cause cranial nerve palsies due to local invasion, it typically presents with symptoms such as **nasal obstruction**, **epistaxis**, or **unilateral serous otitis media** due to Eustachian tube obstruction. - It would not typically manifest with severe external ear pain, otorrhea, or visible granulation tissue in the external auditory canal. *Chronic suppurative otitis media* - Chronic suppurative otitis media is characterized by **persistent ear discharge** through a tympanic membrane perforation and can lead to **cholesteatoma** formation. - While it can cause bony erosion and, in advanced cases, facial nerve palsy, it is less likely to present with the severe external ear pain and granulation tissue pattern described in this diabetic patient, who is more susceptible to aggressive external ear infections. *Acute suppurative otitis media* - Acute suppurative otitis media is an infection of the **middle ear**, typically presenting with ear pain, fever, and a **bulging tympanic membrane**. - It does not involve granulation tissue in the external ear, bony erosion, or facial nerve palsy as initial symptoms, and it primarily affects the middle ear cavity, not the external auditory canal or surrounding bone.

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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