Otoplasty — MCQs
Mainstay of treatment of glue ear -
Which of the following is not typically performed during septoplasty?
What is the condition commonly known as jumper's knee?
Schwartze's operation is also called as:
For myringoplasty, Graft material of choice is -
Which of the following interventions is least appropriate for an 8-year-old boy with bilateral sensorineural hearing loss?
Prior history of ear surgery and scanty, foul-smelling, painless discharge from the ear are characteristic features of which of the following lesions?
What is the treatment of choice for atticoantral type of chronic suppurative otitis media?
The treatment of choice for atticoantral variety of chronic suppurative otitis media is:
Which of the following is the MOST common complication of chronic otitis media?
Otoplasty Indian Medical PG Practice Questions and MCQs
Question 1: Mainstay of treatment of glue ear -
- A. Temporal bone resection
- B. Tonsillectomy & adenoidectomy
- C. Radical Mastoidectomy
- D. Myringotomy + aeration to middle ear (Correct Answer)
Explanation: ***Myringotomy + aeration to middle ear*** - **Myringotomy** involves creating a small incision in the eardrum to drain fluid, and inserting a **grommet (ventilation tube)** to aerate the middle ear, which is the primary treatment for persistent glue ear (otitis media with effusion). - This procedure aims to restore ventilation to the middle ear, allowing trapped fluid to drain and preventing recurrent fluid accumulation, which improves hearing. *Temporal bone resection* - This is a major surgical procedure involving the removal of part of the temporal bone, typically reserved for extensive **malignant tumors** or severe infections, and is not indicated for glue ear. - It carries significant risks and is disproportionate to the treatment of a benign condition like glue ear. *Tonsillectomy & adenoidectomy* - While **adenoidectomy** can sometimes be performed in conjunction with grommet insertion if enlarged adenoids contribute to eustachian tube dysfunction, it is not the **primary treatment** for glue ear itself. - **Tonsillectomy** is generally performed for recurrent tonsillitis and has no direct role in treating glue ear. *Radical Mastoidectomy* - This is a highly invasive surgical procedure involving the removal of the mastoid air cells and part of the external auditory canal, typically performed for severe **cholesteatoma** or chronic mastoiditis. - It is an extensive and risky operation that is not appropriate for the management of glue ear, which is a much milder condition.
Question 2: Which of the following is not typically performed during septoplasty?
- A. Surgical removal of nasal polyps (Correct Answer)
- B. Throat pack
- C. Nasal packing at the end of surgery
- D. Submucosal resection of deviated cartilage
Explanation: ***Surgical removal of nasal polyps*** - Septoplasty is a surgical procedure specifically designed to correct a **deviated nasal septum** by repositioning or removing obstructing cartilage and bone. - **Nasal polyps** arise from the mucosa of the nasal cavity or sinuses and require a separate procedure, typically **functional endoscopic sinus surgery (FESS)** or polypectomy. - While septoplasty and polypectomy may sometimes be performed together, polyp removal is **not part of standard septoplasty**. *Submucosal resection of deviated cartilage* - This is the **core component of septoplasty** - removing or repositioning deviated septal cartilage while preserving the mucosal lining. - The submucosal approach maintains structural support while correcting the deviation. *Throat pack* - A **throat pack** is routinely placed during septoplasty to **prevent aspiration of blood and secretions** into the pharynx and esophagus. - It protects the airway and is removed at the end of the procedure. *Nasal packing at the end of surgery* - **Nasal packing** (splints or packs) is commonly placed after septoplasty to **control bleeding, support the septum, and prevent hematoma formation**. - Modern techniques may use absorbable or non-absorbable packing materials.
Question 3: What is the condition commonly known as jumper's knee?
- A. Inflammation of the patellar tendon at its insertion on the patella.
- B. Tendinopathy of the quadriceps tendon.
- C. Injury to the hamstring tendon.
- D. Patellar tendonitis due to overuse of the patellar tendon. (Correct Answer)
Explanation: ***Patellar tendonitis due to overuse of the patellar tendon.*** - **Jumper's knee** is the common term for **patellar tendonitis**, which specifically refers to inflammation of the patellar tendon. - This condition is frequently caused by **overuse**, especially in activities involving repetitive jumping and landing. *Inflammation of the patellar tendon at its insertion on the patella.* - While jumper's knee does involve inflammation of the patellar tendon, it is more commonly at its insertion on the **tibial tubercle** or specifically its origin at the **inferior pole of the patella**, not necessarily at the patella itself. - This option is less precise as it describes only one aspect of the condition without mentioning the critical role of overuse. *Tendinopathy of the quadriceps tendon.* - **Tendinopathy of the quadriceps tendon** is a distinct condition affecting the tendon above the patella, known as **quadriceps tendinopathy**. - It presents with pain proximal to the patella, differentiating it from jumper's knee, which involves the tendon distal to the patella. *Injury to the hamstring tendon.* - An **injury to the hamstring tendon** would cause pain and symptoms on the posterior aspect of the knee or thigh. - This is completely unrelated to jumper's knee, which is characterized by anterior knee pain.
Question 4: Schwartze's operation is also called as:
- A. Modified radical mastoidectomy
- B. Radical mastoidectomy
- C. Fenestration operation
- D. Cortical mastoidectomy (Correct Answer)
Explanation: ***Cortical mastoidectomy*** - **Schwartze's operation** is synonymous with **cortical mastoidectomy**, which involves removing diseased mastoid air cells while preserving the ear canal and ossicular chain. - This procedure is typically performed for acute **coalescent mastoiditis**. *Modified radical mastoidectomy* - This involves removing the mastoid air cells and the posterior wall of the external auditory canal while preserving the **tympanic membrane** and ossicles (or a portion of them). - It is often performed for **cholesteatoma** with good hearing. *Radical mastoidectomy* - This is the most extensive mastoidectomy procedure, involving complete removal of mastoid air cells, middle ear structures, and the posterior canal wall to create a common cavity. - It is performed for extensive **cholesteatoma** or chronic ear disease when hearing preservation is not possible. *Fenestration operation* - This is a surgical procedure to create a new opening (fenestra) in the **horizontal semicircular canal** to improve hearing in cases of otosclerosis. - This procedure is not a mastoidectomy and addresses a different etiology of hearing loss.
Question 5: For myringoplasty, Graft material of choice is -
- A. Fascia lata
- B. Peritoneum
- C. Palmar fascia
- D. Temporalis fascia (Correct Answer)
Explanation: ***Temporalis fascia*** - The **temporalis fascia** is the most commonly used graft material in myringoplasty due to its **reliability**, good handling characteristics, and excellent cosmetic outcome. - It is readily available adjacent to the surgical field and provides a strong, durable graft for tympanic membrane repair. *Fascia lata* - **Fascia lata** can be used as a graft material but is typically reserved for cases where other tissues are unavailable or for larger defects, due to its **thicker nature** and less favorable cosmetic outcome. - Its harvest requires a separate incision in the thigh, which may increase surgical time and potential for donor site morbidity. *Peritoneum* - **Peritoneum** is not a standard graft material for myringoplasty. Its thin, fragile nature and the need for an abdominal incision make it an impractical choice for tympanic membrane repair. - It lacks the structural integrity and handling characteristics desired for successful myringoplasty. *Palmar fascia* - **Palmar fascia** is not typically used for myringoplasty. Its location in the hand and the potential for donor site complications make it unsuitable for ear surgery. - Furthermore, its characteristics do not offer advantages over more commonly accepted graft materials.
Question 6: Which of the following interventions is least appropriate for an 8-year-old boy with bilateral sensorineural hearing loss?
- A. Adenoidectomy with grommet insertion (Correct Answer)
- B. Hearing aid
- C. Cochlear implant
- D. Preferential sitting in the classroom
Explanation: ***Adenoidectomy with grommet insertion*** - This procedure addresses **conductive hearing loss** (e.g., due to **otitis media with effusion**), while the boy has **sensorineural hearing loss (SNHL)**. - **Grommet insertion** (tympanostomy tubes) is used to improve middle ear ventilation and drain fluid, which is irrelevant for SNHL. *Hearing aid* - A **hearing aid** amplifies sound and is a common and appropriate intervention for **sensorineural hearing loss**, especially for mild to severe cases. - It can significantly improve a child's ability to hear and develop speech. *Cochlear implant* - A **cochlear implant** is appropriate for children with **severe to profound sensorineural hearing loss** who do not benefit sufficiently from hearing aids. - It directly stimulates the auditory nerve, bypassing damaged parts of the inner ear. *Preferential sitting in the classroom* - This is a simple and effective **accommodative strategy** to improve a child's listening environment and is appropriate for any degree of hearing loss. - It helps the child to better hear the teacher and participate in classroom discussions.
Question 7: Prior history of ear surgery and scanty, foul-smelling, painless discharge from the ear are characteristic features of which of the following lesions?
- A. ASOM
- B. Cholesteatoma (Correct Answer)
- C. Central perforation
- D. Otitis externa
Explanation: ***Cholesteatoma*** - The **combination of all three features** (prior ear surgery + scanty, foul-smelling, painless discharge) is highly characteristic of cholesteatoma. - A prior history of ear surgery, particularly for **chronic otitis media**, can predispose to or be related to an **acquired cholesteatoma**. - **Scanty, foul-smelling, painless discharge** (otorrhea) is a hallmark symptom of cholesteatoma, with the **foul smell** being particularly distinctive due to breakdown of keratin debris and secondary infection. - The **painless** nature helps differentiate it from acute infections. *ASOM (Acute Suppurative Otitis Media)* - ASOM typically presents with **acute otalgia** (ear pain) and a **profuse purulent, non-foul-smelling discharge** following tympanic membrane perforation. - It is an acute infection and usually does not have a prior history of ear surgery as a direct cause of the current discharge. - The presence of **pain** and absence of foul smell distinguish it from cholesteatoma. *Central perforation* - A central perforation of the tympanic membrane often results in **intermittent, mucoid discharge** during upper respiratory tract infections, which is usually not foul-smelling. - While it can be associated with discharge, the characteristic **foul smell** and **prior surgery history** point away from simple central perforation as the primary diagnosis. - The discharge is typically more profuse during active infection. *Otitis externa* - **Otitis externa** primarily affects the ear canal, causing **pain, tenderness, and sometimes a watery or purulent discharge**, but it does not typically present with a foul-smelling discharge associated with a prior ear surgery history. - It is usually due to infection of the external auditory canal skin and not related to middle ear pathology or prior surgery in the way a cholesteatoma is. - The **painful** nature is a key distinguishing feature.
Question 8: What is the treatment of choice for atticoantral type of chronic suppurative otitis media?
- A. Tympanoplasty
- B. Modified radical mastoidectomy (Correct Answer)
- C. Antibiotics
- D. None of the options
Explanation: ***Modified radical mastoidectomy*** - This procedure is the treatment of choice for **atticoantral type of chronic suppurative otitis media (CSOM)** due to the presence of **cholesteatoma**, which requires complete surgical removal. - It involves removing the posterior and superior canal wall, exenterating the mastoid air cells, and exteriorizing the **aditus and antrum** into the external auditory canal to create a common cavity. - Unlike radical mastoidectomy, it **attempts to preserve the tympanic membrane and ossicular chain when disease extent permits**, thereby maintaining the middle ear transformer mechanism and optimizing hearing outcomes. *Antibiotics* - While antibiotics may be used to manage acute exacerbations or infections, they cannot eradicate the inherent **cholesteatoma** found in atticoantral CSOM. - They primarily target bacteria and have no effect on the **pathological skin growth** that characterizes cholesteatoma. *Tympanoplasty* - **Tympanoplasty** is a reconstructive procedure primarily used for repairing a **perforated tympanic membrane** or ossicular chain defects, typically in the tubotympanic type of CSOM. - It does not address the fundamental problem of **cholesteatoma** and its destructive potential in atticoantral disease. *None of the options* - This is incorrect because **modified radical mastoidectomy** is a well-established and effective treatment for atticoantral CSOM. - Omitting treatment would lead to progressive destruction of middle ear structures and potentially life-threatening complications.
Question 9: The treatment of choice for atticoantral variety of chronic suppurative otitis media is:
- A. Mastoidectomy (Correct Answer)
- B. Medical management
- C. Underlay myringoplasty
- D. Insertion of ventilation tube
Explanation: **Correct: Mastoidectomy** - The **atticoantral** variety of chronic suppurative otitis media (CSOM) is typically associated with **cholesteatoma**, which necessitates surgical eradication to prevent complications such as intracranial infection, facial nerve palsy, and labyrinthine destruction. - **Mastoidectomy** is the treatment of choice to remove the cholesteatoma and achieve a safe, dry ear by clearing disease from the mastoid air cells and attic. *Incorrect: Medical management* - This approach is typically used for the **tubotympanic** (mucosal/safe) type of CSOM, which involves a central perforation without cholesteatoma. - It is **ineffective in the presence of cholesteatoma**, as antibiotics cannot penetrate the keratinized debris matrix and do not eradicate the underlying pathology. *Incorrect: Underlay myringoplasty* - This procedure repairs a **tympanic membrane perforation** but does not address the underlying cholesteatoma or disease within the mastoid and attic. - It is used for **safe, dry perforations**, usually associated with the tubotympanic type of CSOM after the ear has been rendered inactive. *Incorrect: Insertion of ventilation tube* - Ventilation tubes (grommets) are primarily used for **recurrent acute otitis media** or **otitis media with effusion (glue ear)** to equalize middle ear pressure and facilitate drainage. - They are **not indicated for CSOM**, especially the atticoantral type with cholesteatoma, as they do not resolve the chronic infection or remove the pathological tissue.
Question 10: Which of the following is the MOST common complication of chronic otitis media?
- A. Hearing loss (Correct Answer)
- B. Epistaxis
- C. Facial nerve paralysis
- D. Mastoiditis
Explanation: ***Hearing loss*** - **Chronic otitis media** is the **MOST common complication**, affecting virtually all patients to some degree. - Damage to the **ossicles**, tympanic membrane perforation, and middle ear effusion lead primarily to **conductive hearing loss**. - Long-standing disease can also cause **sensorineural hearing loss** through toxin diffusion to the inner ear or erosion of the otic capsule. - This is the hallmark and nearly universal consequence of chronic otitis media. *Epistaxis* - **Epistaxis (nosebleeds)** originates from the nasal passages and has no direct relationship to middle ear pathology. - Not a complication of **chronic otitis media**. *Facial nerve paralysis* - While a recognized complication, **facial nerve paralysis** is relatively uncommon and typically occurs with **cholesteatoma** eroding the facial nerve canal or in severe suppurative disease. - Represents an advanced complication rather than the most frequent outcome. *Mastoiditis* - **Mastoiditis** is indeed a complication of chronic otitis media, occurring when infection spreads to the **mastoid air cells**. - Presents with postauricular tenderness, swelling, and fever. - However, with modern antibiotic therapy, it is **less common** than hearing loss, which occurs in nearly all cases of chronic otitis media.
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