Diseases of the Ear Practice Questions

Q: Which abscess is related to the sternocleidomastoid muscle?

Bezold abscess. **Explanation:** The correct answer is **Bezold abscess**. This condition occurs as a complication of acute coalescent mastoiditis. When the mastoid tip is thin-walled and well-pneumatized, pus can erode through the inner aspect of the mastoid tip (at the digastric notch). The pus then tracks deep to the **sternocleidomastoid (SCM)** muscle, presenting as a painful, fluctuant swelling in the upper neck. **Analysis of Options:** * **Luc abscess:** This is a subperiosteal abscess resulting from the tracking of pus through the external auditory canal wall. It presents as a swelling in the ear canal, unrelated to the SCM. * **Citelli abscess:** This occurs when pus tracks through the mastoid tip but follows the posterior belly of the digastric muscle to the **digastric fossa**. It presents as a swelling in the occipital region/posterior neck. * **Parapharyngeal abscess:** This involves the lateral pharyngeal space. While it presents with neck swelling and trismus, its origin is typically odontogenic or tonsillar, not the mastoid tip. **High-Yield Clinical Pearls for NEET-PG:** * **Bezold Abscess:** Pus is deep to the SCM; the swelling is often firm because it is covered by the thick muscle and fascia. * **Citelli Abscess:** Pus tracks along the digastric muscle. * **Mastoiditis Triad:** Reservoir sign (ear canal refills with pus after mopping), sagging of the posterosuperior canal wall, and mastoid tenderness. * **Imaging:** Contrast-enhanced CT (CECT) is the gold standard for diagnosing these complications.

Q: What complication results from mastoid infection that erodes through the outer table of the bone?

Subperiosteal abscess. ### Explanation The correct answer is **Subperiosteal abscess**. #### 1. Why Subperiosteal Abscess is Correct Mastoiditis is an inflammation of the mastoid air cells. When the infection progresses, it can cause bone resorption (coalescent mastoiditis). If the infection erodes through the **outer (lateral) table** of the mastoid bone, pus escapes the bone but remains trapped beneath the periosteum of the mastoid process. This results in a **subperiosteal abscess**, which typically pushes the pinna **forward and downward** (proptosis of the auricle). #### 2. Why Other Options are Incorrect * **Epidural Abscess:** This occurs when the infection erodes through the **inner (medial) table** of the mastoid bone, leading to a collection of pus between the bone and the dura mater. It is an intracranial complication. * **Perichondritis:** This is an infection of the cartilage of the pinna (auricle), usually following trauma or surgery. It does not involve the mastoid bone or its outer table. * **Lateral Sinus Thrombosis:** This is an intracranial vascular complication caused by the spread of infection to the sigmoid sinus, usually via the destruction of the **sinus plate** (part of the inner table). #### 3. NEET-PG High-Yield Pearls * **Most common site:** The most frequent subperiosteal abscess is the **Post-auricular abscess**, located over the mastoid. * **Bezold’s Abscess:** Pus erodes through the mastoid tip into the **sternocleidomastoid muscle** sheath. * **Luc’s Abscess:** Pus erodes through the **posterior meatal wall** into the external auditory canal. * **Citelli’s Abscess:** Pus tracks into the **digastric triangle**. * **Radiology:** The "Gold Standard" for diagnosing mastoid complications is a **Contrast-Enhanced CT (CECT)** of the temporal bone, which shows the loss of bony septa (coalescence).

Q: A diabetic female patient presents with severe ear pain, granulation tissue in the external auditory canal, and facial palsy. What is the most likely diagnosis?

Malignant otitis externa. **Explanation:** The clinical presentation of a diabetic patient with severe otalgia, granulation tissue at the bony-cartilaginous junction of the external auditory canal (EAC), and cranial nerve involvement (facial palsy) is a classic description of **Malignant Otitis Externa (Necrotizing Otitis Externa).** 1. **Why Option A is Correct:** Malignant Otitis Externa is a life-threatening infection, typically caused by *Pseudomonas aeruginosa*, that occurs in elderly diabetics or immunocompromised individuals. The infection starts in the EAC and spreads to the skull base (osteomyelitis). The presence of **granulation tissue** is a hallmark sign. Facial nerve palsy indicates advanced disease and spread to the stylomastoid foramen. 2. **Why Other Options are Incorrect:** * **Option B (Herpes Zoster Oticus/Ramsay Hunt Syndrome):** While it presents with facial palsy and ear pain, it is characterized by **vesicular eruptions** in the concha and EAC, not granulation tissue. * **Option C (Otomycosis):** This is a fungal infection causing itching and debris (wet newspaper appearance). It does not cause bone destruction, granulation tissue, or cranial nerve palsies. **High-Yield Clinical Pearls for NEET-PG:** * **Organism:** *Pseudomonas aeruginosa* is the most common causative agent. * **Pathognomonic Sign:** Granulation tissue at the floor of the EAC (bony-cartilaginous junction). * **Investigation of Choice:** **CT scan** to assess bone destruction; **Technetium-99m scan** for early diagnosis (detects osteoblastic activity); **Gallium-67 scan** to monitor treatment response/resolution. * **Treatment:** Long-term intravenous anti-pseudomonal antibiotics (e.g., Ciprofloxacin, Ceftazidime) and strict glycemic control.

Q: What surgery is the treatment of choice in otosclerosis?

Stapedectomy. **Explanation** **Otosclerosis** is a primary metabolic bone disease of the otic capsule characterized by abnormal bone remodeling, leading to fixation of the stapes footplate and progressive conductive hearing loss. **Why Stapedectomy is the Correct Answer:** Stapedectomy (or the more modern variation, **stapedotomy**) is the gold standard surgical treatment. The procedure involves removing the fixed stapes (or creating a hole in the footplate) and replacing it with a piston-like prosthesis. This bypasses the mechanical obstruction, restoring the ossicular chain's mobility and effectively closing the air-bone gap. **Analysis of Incorrect Options:** * **B. Stapes mobilization:** Historically used by Rosen, this involves manually breaking the stapedial fixations. It is no longer preferred because the bone regrowth (refixation) rate is extremely high, leading to surgical failure. * **C. Fenestration:** An obsolete procedure where a new window was created in the lateral semicircular canal. It was abandoned due to poor hearing results compared to stapedectomy and the requirement of a mastoid cavity. * **D. Chemical labyrinthectomy:** This involves the use of ototoxic drugs (like Gentamicin) to destroy vestibular function. It is used for **Meniere’s disease**, not otosclerosis. **High-Yield Clinical Pearls for NEET-PG:** * **Schwartz Sign:** A flamingo-pink blush seen on the promontory through the TM, indicating active otosclerosis. * **Carhart’s Notch:** A characteristic dip in the bone conduction curve at **2000 Hz**, which disappears after successful surgery. * **Gelle’s Test:** Negative in otosclerosis (no change in hearing with increased ear canal pressure). * **Contraindication:** Surgery should not be performed in the only hearing ear or in patients with active infection/Meniere’s disease.

Q: What are the characteristic features of tuberculous otitis media?

Painful otorrhea. **Explanation:** Tuberculous Otitis Media (TOM) is a chronic granulomatous infection of the middle ear, typically secondary to pulmonary tuberculosis. **Why the correct answer is "Painful otorrhea":** In the context of this specific question, **Painful otorrhea** is the correct choice because it is a **negative characteristic** (an exception). Classically, TOM is defined by **painless otorrhea** that is out of proportion to the degree of bone destruction. If a patient presents with significant ear discharge but reports no pain, suspicion for TB increases. Therefore, "Painful otorrhea" is the feature that does *not* belong to the classic clinical triad of TOM. **Analysis of other options (Characteristic features):** * **Multiple tympanic perforations:** This is a classic, high-yield sign. Multiple small "sieve-like" perforations occur due to the coalescence of multiple tubercles on the drum. These later merge into a single large central perforation. * **Pale granulation:** The middle ear mucosa typically shows pale, flabby granulations. * **Facial palsy:** TOM is notorious for early onset of complications. Facial nerve paralysis occurs in approximately 15-40% of cases due to the bone-eroding nature of the granulomas. **NEET-PG High-Yield Pearls:** * **Classic Triad:** Painless otorrhea, multiple perforations, and profound hearing loss. * **Hearing Loss:** Usually profound and sensorineural or mixed, occurring earlier than in pyogenic otitis media. * **Diagnosis:** Confirmed by identifying *Mycobacterium tuberculosis* in ear discharge (AFB staining) or via culture/PCR of middle ear granulations. * **Treatment:** Standard Anti-Tubercular Therapy (ATT). Surgery is reserved for complications like mastoiditis or sequestra.

Q: Otitic barotrauma occurs during which of the following activities?

Underwater diving. **Explanation:** Otitic barotrauma (Aerotitis media) occurs due to a failure of the **Eustachian tube (ET)** to equalize a rapid pressure difference between the middle ear and the external environment. **Why "Underwater Diving" is the correct answer:** Otitic barotrauma occurs when there is a **rapid increase in ambient pressure** (relative negative pressure in the middle ear). During **underwater diving** (descent) or **aircraft descent**, the external atmospheric pressure rises quickly. If the ET fails to open, the relative negative pressure in the middle ear causes the tympanic membrane to retract, followed by mucosal edema and transudation of fluid or blood (hemotympanum). **Why other options are incorrect:** * **Ascending in an aircraft / Decreasing ambient pressure:** During ascent, the ambient pressure decreases. This creates a relative **positive pressure** in the middle ear. The ET acts as a passive one-way valve, allowing air to escape easily from the middle ear to the nasopharynx. Therefore, barotrauma is rare during ascent; it is almost exclusively a disease of **descent**. **High-Yield Clinical Pearls for NEET-PG:** * **Teed Classification:** Used to grade the severity of tympanic membrane findings in barotrauma (Grade 0 to Grade 5). * **The "Locking" Phenomenon:** If the pressure differential exceeds **80-90 mmHg**, the nasopharyngeal opening of the ET is sucked shut, making it impossible for the tensor veli palatini muscle to open it. * **Prevention:** Instruct patients to perform the **Valsalva maneuver** or chew gum during descent. * **Contraindication:** Patients with Upper Respiratory Tract Infections (URTI) or nasal allergy should avoid flying/diving due to ET mucosal edema.

Q: Cauliflower ear is typically seen in which condition?

Hematoma of the auricle. **Explanation:** **Cauliflower ear** is an acquired deformity of the external ear resulting from an untreated or inadequately treated **Auricular Hematoma**. 1. **Why Option A is correct:** The auricle's cartilage depends on the overlying perichondrium for its blood supply. Trauma (common in wrestlers and boxers) causes blood to accumulate in the subperichondrial space. This **hematoma** separates the cartilage from its nutrient source, leading to ischemic necrosis. During the healing process, asymmetrical fibrosis and neocartilage formation occur, resulting in a shriveled, lumpy appearance resembling a cauliflower. 2. **Why other options are incorrect:** * **Option B (Carcinoma):** Squamous cell carcinoma usually presents as a non-healing ulcer or an exophytic growth, not a diffuse shriveled deformity. * **Option C (Fungal infection):** Fungal infections (Otomycosis) typically affect the external auditory canal, causing itching and debris, but do not structuraly deform the auricle into a "cauliflower" shape. * **Option D (Congenital deformity):** Conditions like Microtia or Anotia are developmental failures of the branchial arches, presenting at birth, unlike the acquired nature of cauliflower ear. **NEET-PG High-Yield Pearls:** * **Management:** The gold standard treatment for an acute auricular hematoma is **incision and drainage** followed by a **pressure dressing** to prevent re-accumulation of blood. * **Complication:** If the hematoma becomes infected, it leads to **Perichondritis**, which can further accelerate cartilage destruction. * **Commonly tested associations:** Often referred to as "Wrestler’s Ear" or "Boxer’s Ear."

Question 1

Which abscess is related to the sternocleidomastoid muscle?

Accepted Answer

Bezold abscess

Answer

Luc abscess

Answer

Citelli abscess

Answer

Parapharyngeal abscess

Question 2

What complication results from mastoid infection that erodes through the outer table of the bone?

Accepted Answer

Subperiosteal abscess

Answer

Epidural abscess

Answer

Perichondritis

Answer

Lateral sinus thrombosis

Question 3

A diabetic female patient presents with severe ear pain, granulation tissue in the external auditory canal, and facial palsy. What is the most likely diagnosis?

Accepted Answer

Malignant otitis externa

Answer

Herpes zoster otitis

Answer

Otomycosis

Answer

None of the above

Question 4

Malignant otitis externa is primarily due to which underlying condition?

Accepted Answer

Diabetes mellitus

Answer

Wax impaction

Answer

Hypertension

Answer

None of the above

Question 5

What surgery is the treatment of choice in otosclerosis?

Accepted Answer

Stapedectomy

Answer

Stapes mobilization

Answer

Fenestration

Answer

Chemical labyrinthectomy

Question 6

An elderly patient with chronic otitis media might have all the following complications, EXCEPT:

Accepted Answer

Inability to chew food due to injury to the mandibular division of the trigeminal nerve (CN V)

Answer

Loss of taste in the anterior part of the tongue due to injury to the chorda tympani nerve

Answer

Mastoiditis

Answer

Paralysis of facial muscles due to an injury to the facial nerve (CN VII)

Question 7

What are the characteristic features of tuberculous otitis media?

Accepted Answer

Painful otorrhea

Answer

Multiple tympanic perforations

Answer

Pale granulation

Answer

Facial palsy

Question 8

What is the operation of choice for coalescent mastoiditis?

Accepted Answer

Cortical mastoidectomy

Answer

Modified radical mastoidectomy

Answer

Radical mastoidectomy

Answer

Fenestration operation

Question 9

Otitic barotrauma occurs during which of the following activities?

Accepted Answer

Underwater diving

Answer

Ascending in an aircraft

Answer

When ambient pressure is decreasing

Answer

All of the above

Question 10

Cauliflower ear is typically seen in which condition?

Accepted Answer

Hematoma of the auricle

Answer

Carcinoma of the auricle

Answer

Fungal infection of the auricle

Answer

Congenital deformity of the auricle

Diseases of the Ear — MCQs

Diseases of the Ear — MCQs

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