Sudden Sensorineural Hearing Loss — MCQs
A 25-year-old woman presents with episodes of dizziness, tinnitus, and hearing loss in the right ear. What is the most likely diagnosis?
Differential diagnosis of Meniere's disease includes all except -
A female patient presents with mild conductive hearing loss (CHL) and tinnitus. Based on the pure tone audiometry (PTA) shown in the image, what is the most likely diagnosis?
Which of the following statements concerning sensorineural hearing loss in children with bacterial meningitis are TRUE?
A child aged 3 yrs, presented with severe sensorineural deafness was prescribed hearing aids, but showed no improvement. What is the next line of management:
Rinne's test was negative in the right ear. What is the possible diagnosis?
Which device is depicted below?
Identify the device shown in the image below:
A 72-year-old man presents to his primary care physician with progressively worsening hearing loss. He states that his trouble with hearing began approximately 7-8 years ago. He is able to hear when someone is speaking to him; however, he has difficulty with understanding what is being said, especially when there is background noise. In addition to his current symptoms, he reports a steady ringing in both ears, and at times experiences dizziness. Medical history is significant for three prior episodes of acute otitis media. Family history is notable for his father being diagnosed with cholesteatoma. His temperature is 98.6°F (37°C), blood pressure is 138/88 mmHg, pulse is 74/min, and respirations are 13/min. On physical exam, when a tuning fork is placed in the middle of the patient's forehead, sound is appreciated equally on both ears. When a tuning fork is placed by the external auditory canal and subsequently on the mastoid process, air conduction is greater than bone conduction. Which of the following is most likely the cause of this patient's symptoms?
The following test is useful for diagnosis of all except:
Sudden Sensorineural Hearing Loss Indian Medical PG Practice Questions and MCQs
Question 1: A 25-year-old woman presents with episodes of dizziness, tinnitus, and hearing loss in the right ear. What is the most likely diagnosis?
- A. Labyrinthitis
- B. Ménière's disease (Correct Answer)
- C. Acoustic neuroma
- D. Benign paroxysmal positional vertigo
Explanation: ***Ménière's disease*** - This condition is characterized by a classic triad of **episodic vertigo (dizziness)**, fluctuating **sensorineural hearing loss**, and **tinnitus**, often accompanied by aural fullness, typically affecting one ear. - The symptoms arise from an accumulation of **endolymph** in the inner ear, leading to increased pressure and dysfunction. *Labyrinthitis* - **Labyrinthitis** is an inflammation of the inner ear, usually viral, causing sudden, severe **vertigo** potentially with hearing loss and tinnitus. - Unlike Meniere's disease, **hearing loss** and **tinnitus** in labyrinthitis are usually constant rather than episodic or fluctuating. *Acoustic neuroma* - An **acoustic neuroma** (vestibular schwannoma) is a benign tumor on the eighth cranial nerve, often causing **gradual, progressive unilateral hearing loss**, tinnitus, and **balance issues**, but typically not episodic severe dizziness. - While it can cause hearing loss and tinnitus, the **episodic nature of vertigo** is less common than in Ménière's disease. *Benign paroxysmal positional vertigo* - **BPPV** is characterized by sudden, **brief episodes of vertigo** triggered by specific head movements, caused by dislodged **otoconia** in the semicircular canals. - Critically, BPPV does **not** typically cause associated **hearing loss or tinnitus**, which are prominent symptoms in the presented case.
Question 2: Differential diagnosis of Meniere's disease includes all except -
- A. Acoustic neuroma
- B. Suppurative otitis media (Correct Answer)
- C. CNS disease
- D. Labyrinthitis
Explanation: ***Suppurative otitis media*** - **Suppurative otitis media** is an **infection of the middle ear** causing pus formation, earache, and hearing loss, which is distinctly different from the inner ear disorder seen in Meniere's disease. - Its clinical presentation, including visible **tympanic membrane perforation** and **otorrhea**, does not mimic the classic Meniere's triad of episodic vertigo, tinnitus, and fluctuating hearing loss. *Acoustic neuroma* - This is a **benign tumor** on the **vestibulocochlear nerve** that can cause progressive unilateral hearing loss, tinnitus, and balance issues, similar in some ways to Meniere's. - However, the hearing loss is typically **slowly progressive** and not fluctuating episodically like in Meniere's disease. *CNS disease* - Various **central nervous system (CNS) conditions**, such as **migraine-associated vertigo** or **vertebrobasilar insufficiency**, can present with dizziness, balance problems, and even tinnitus. - Unlike Meniere's, these conditions often have additional **neurological deficits** and typically lack the classic triad of episodic vertigo, fluctuating hearing loss, and aural fullness. *Labyrinthitis* - **Labyrinthitis** is an **inflammation of the inner ear** that causes sudden, severe vertigo, nausea, and hearing loss, which can initially resemble a Meniere's attack. - However, labyrinthitis is usually **self-limiting**, resolves over weeks, and does not involve the recurrent, fluctuating symptoms and aural fullness characteristic of Meniere's disease.
Question 3: A female patient presents with mild conductive hearing loss (CHL) and tinnitus. Based on the pure tone audiometry (PTA) shown in the image, what is the most likely diagnosis?
- A. Ménière's disease
- B. Otosclerosis (Correct Answer)
- C. Ototoxicity
- D. Noise-Induced Hearing Loss (NIHL)
Explanation: ***Otosclerosis*** - The audiogram shows a **conductive hearing loss** with a notable **Carhart notch** (bone conduction dip at 2000 Hz), which is characteristic of otosclerosis. - The patient's symptoms of **mild CHL** and **tinnitus** are consistent with the presentation of otosclerosis, a condition involving abnormal bone growth in the middle ear. *Ménière's disease* - This condition primarily causes **sensorineural hearing loss**, often fluctuating and affecting low frequencies initially, along with **vertigo, tinnitus, and aural fullness**. - The audiogram indicates **conductive hearing loss**, not sensorineural, and **vertigo** is not mentioned as a primary symptom. *Ototoxicity* - Ototoxicity typically results in **sensorineural hearing loss**, often bilateral and affecting high frequencies first. - The audiogram demonstrates **conductive hearing loss**, and there is no information about exposure to ototoxic medications. *Noise-Induced Hearing Loss (NIHL)* - NIHL is characterized by **sensorineural hearing loss**, typically with a **notch at 3000-6000 Hz** (most commonly 4000 Hz notch) on the audiogram. - The audiogram reflects **conductive hearing loss**, and the specific pattern does not match that of NIHL.
Question 4: Which of the following statements concerning sensorineural hearing loss in children with bacterial meningitis are TRUE?
- A. It occurs rarely (less than 5% of cases)
- B. Its onset often is late in the clinical course, after discontinuation of antimicrobial therapy
- C. Prompt institution of antimicrobial therapy appears not to influence the incidence (Correct Answer)
- D. It occurs more commonly when Haemophilus influenza type B rather than Streptococcus pneumoniae is the causative organism of the meningitis
Explanation: ***Prompt institution of antimicrobial therapy appears not to influence the incidence*** - While prompt antibiotic therapy is crucial for overall outcomes in **bacterial meningitis**, studies have shown it does not consistently reduce the risk or incidence of **sensorineural hearing loss**. - **Hearing loss** often results from direct damage to the cochlea or auditory nerve by inflammatory mediators and bacterial toxins early in the disease process, which may occur before antibiotics can fully mitigate the damage. *It occurs rarely (less than 5% of cases)* - **Sensorineural hearing loss** is a common and significant complication of **bacterial meningitis**, occurring in approximately **10-30%** of pediatric cases, not rarely. - This high incidence makes it a leading cause of acquired **hearing impairment** in children. *Its onset often is late in the clinical course, after discontinuation of antimicrobial therapy* - The onset of **sensorineural hearing loss** typically occurs **early** in the disease course, often during the acute phase of meningitis. - It results from direct damage to the **cochlea** or auditory nerve due to intense inflammation and the toxic effects of bacteria. *It occurs more commonly when Haemophilus influenza type B rather than Streptococcus pneumoniae is the causative organism of the meningitis* - Historically, **Haemophilus influenzae type B (Hib)** was a major cause of hearing loss following meningitis, but the introduction of the Hib vaccine has significantly reduced its incidence. - Currently, **Streptococcus pneumoniae (pneumococcus)** is more commonly associated with **sensorineural hearing loss** in bacterial meningitis cases.
Question 5: A child aged 3 yrs, presented with severe sensorineural deafness was prescribed hearing aids, but showed no improvement. What is the next line of management:
- A. Conservative
- B. Fenestration surgery
- C. Stapes mobilisation
- D. Cochlear implant (Correct Answer)
Explanation: ***Cochlear implant*** - For **severe sensorineural deafness** where conventional hearing aids provide no benefit, a cochlear implant is the most effective next step for restoring hearing. - A cochlear implant directly stimulates the **auditory nerve**, bypassing damaged hair cells in the cochlea, which is crucial for severe sensorineural hearing loss. - In children aged **12 months to 5 years**, early cochlear implantation is critical for optimal **speech and language development**. *Conservative* - This typically refers to observation or non-invasive treatments like hearing aids, which have already failed in this case. - Continuing a conservative approach would delay effective intervention for severe deafness, potentially impacting the child's **speech and language development**. *Fenestration surgery* - This is a surgical procedure primarily used for some types of **conductive hearing loss**, especially **otosclerosis**, by creating an opening in the bony labyrinth. - It is not indicated for **sensorineural deafness**, as the problem lies with the inner ear or auditory nerve, not the sound conduction pathway. *Stapes mobilisation* - This procedure aims to restore mobility to the **stapes bone** in cases of **otosclerosis**, a form of conductive hearing loss where the stapes becomes fixed. - It is not appropriate for **sensorineural hearing loss**, where the primary issue is damage to the inner ear's sensory cells or the auditory nerve.
Question 6: Rinne's test was negative in the right ear. What is the possible diagnosis?
- A. Profound hearing loss right ear, left ear normal
- B. 40 dB CHL in both ears
- C. 40 dB SNHL in left ear, right ear normal
- D. 40 dB CHL right ear, left normal (Correct Answer)
Explanation: ***40 dB CHL right ear, left normal*** - A **negative Rinne's test** indicates that **bone conduction is better than air conduction**, which is characteristic of a **conductive hearing loss (CHL)** in the tested ear. - For Rinne's test to be negative, the conductive hearing loss usually needs to be at least **25-30 dB**, making **40 dB CHL** a plausible diagnosis. - This correctly identifies the **right ear** as the affected ear with conductive pathology. *40 dB SNHL in left ear, right ear normal* - A **negative Rinne's test** in the **right ear** means the issue is in the right ear, not the left. - **Sensorineural hearing loss (SNHL)** typically results in a **positive Rinne's test** (air conduction better than bone conduction) as both air and bone conduction are equally reduced. - This option incorrectly identifies the left ear and wrong type of hearing loss. *40 dB CHL in both ears* - While a negative Rinne's test indicates CHL, it specifically points to the ear being tested (the **right ear** in this case). - There is no information from a unilateral Rinne's test to suggest CHL in the **left ear** as well. - This represents over-interpretation of a unilateral test finding. *Profound hearing loss right ear, left ear normal* - A **profound hearing loss** (particularly severe SNHL) in the right ear could result in a false-negative Rinne's test where bone conduction is picked up by the contralateral ear. - However, a negative Rinne's test without additional context more specifically indicates **moderate conductive hearing loss (40 dB CHL)** rather than profound loss. - The term "profound" is also imprecise without specifying the type of hearing loss.
Question 7: Which device is depicted below?
- A. Cochlear implant (Correct Answer)
- B. Auditory brainstem implant (ABI)
- C. Bone anchored hearing aid (BAHA)
- D. Hearing aid
Explanation: ***Cochlear implant*** - A cochlear implant is an **electronic medical device that replaces the function of a damaged inner ear (cochlea)** and provides sound signals directly to the brain - On imaging (X-ray, CT, or skull radiograph), it appears as a **characteristic circular receiver-stimulator device** under the skin behind the ear with an **electrode array extending into the cochlea** - The **internal receiver has a distinctive appearance** with visible magnets and electrode contacts, making it easily identifiable on radiographic images - Used for patients with **severe to profound sensorineural hearing loss** who do not benefit from conventional hearing aids *Auditory brainstem implant (ABI)* - An ABI **bypasses both the cochlea and auditory nerve**, directly stimulating the **cochlear nucleus in the brainstem** - On imaging, the electrode array would be located at the **cerebellopontine angle** near the brainstem, not in the cochlea - Reserved for patients with **absent or non-functional auditory nerves** (e.g., bilateral vestibular schwannomas, neurofibromatosis type 2) *Bone anchored hearing aid (BAHA)* - A BAHA consists of a **titanium implant osseointegrated into the skull bone** behind the ear with an external sound processor - On X-ray, only the **small titanium fixture/abutment** would be visible in the mastoid bone, without any cochlear or intracranial components - Works by **bone conduction**, transmitting sound vibrations directly to the inner ear, bypassing the outer and middle ear - Used for **conductive hearing loss, mixed hearing loss, or single-sided deafness** *Hearing aid* - A conventional hearing aid is a **completely external electronic device** that amplifies sound - It would **not be visible on X-ray or CT imaging** as it contains no implanted components - Simply amplifies sound for individuals with mild to moderate hearing loss
Question 8: Identify the device shown in the image below:
- A. Cochlear implant (Correct Answer)
- B. Transcranial magnetic stimulation
- C. Vagus nerve stimulation
- D. Deep brain stimulation
Explanation: ***Cochlear implant*** - The image displays the external components of a **cochlear implant**: a **speech processor** worn behind the ear connected to an external transmitter that sends signals to an implanted receiver. - This device is designed to provide a sense of sound to individuals with **severe-to-profound hearing loss** by directly stimulating the auditory nerve. *Transcranial magnetic stimulation* - This therapy involves a **coil placed on the scalp** that delivers magnetic pulses to stimulate nerve cells in the brain, typically for depression or migraines. - It does not involve ear-worn components or internal surgical implants of the type seen in the image. *Vagus nerve stimulation* - This involves a device surgically implanted under the skin in the chest, with wires connected to the **vagus nerve** in the neck. - It is used to treat epilepsy and depression and does not have external components positioned around the ear or on the head as depicted. *Deep brain stimulation* - This neurosurgical procedure involves implanting electrodes into specific areas of the brain, connected to a pulse generator (similar to a pacemaker) implanted in the chest. - It is primarily used for movement disorders like Parkinson's disease and does not feature external ear-worn components visible in the image.
Question 9: A 72-year-old man presents to his primary care physician with progressively worsening hearing loss. He states that his trouble with hearing began approximately 7-8 years ago. He is able to hear when someone is speaking to him; however, he has difficulty with understanding what is being said, especially when there is background noise. In addition to his current symptoms, he reports a steady ringing in both ears, and at times experiences dizziness. Medical history is significant for three prior episodes of acute otitis media. Family history is notable for his father being diagnosed with cholesteatoma. His temperature is 98.6°F (37°C), blood pressure is 138/88 mmHg, pulse is 74/min, and respirations are 13/min. On physical exam, when a tuning fork is placed in the middle of the patient's forehead, sound is appreciated equally on both ears. When a tuning fork is placed by the external auditory canal and subsequently on the mastoid process, air conduction is greater than bone conduction. Which of the following is most likely the cause of this patient's symptoms?
- A. Stapedial abnormal bone growth
- B. Endolymphatic hydrops
- C. Cochlear hair cell degeneration (Correct Answer)
- D. Accumulation of desquamated keratin debris
Explanation: ***Cochlear hair cell degeneration*** - The patient's **progressive, bilateral hearing loss** over several years, difficulty understanding speech in noise, and **tinnitus** are classic symptoms of **presbycusis**, which results from age-related **degeneration of cochlear hair cells**. - The **normal Weber test** (no lateralization) and **Rinne test** (air conduction > bone conduction) indicate a **sensorineural hearing loss**, consistent with cochlear pathology rather than conductive issues. *Stapedial abnormal bone growth* - This condition (**otosclerosis**) causes **conductive hearing loss** due to fixation of the stapes, which would present with an **abnormal Rinne test** (bone conduction > air conduction) in the affected ear. - While it can cause progressive hearing loss and tinnitus, the normal Rinne test contradicts this diagnosis. *Endolymphatic hydrops* - This is the underlying pathology of **Ménière's disease**, which typically presents with episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural fullness. - The patient's dizziness is non-episodic, and the absence of fluctuating hearing loss and aural fullness makes Ménière's less likely. *Accumulation of desquamated keratin debris* - This describes a **cholesteatoma**, which typically causes **conductive hearing loss** and often presents with otorrhea, earache, and possibly vestibular symptoms. - The normal Rinne test (indicating sensorineural loss) and lack of otorrhea or earache make cholesteatoma unlikely, despite a family history.
Question 10: The following test is useful for diagnosis of all except:
- A. Ossicular discontinuity
- B. Otosclerosis
- C. Serous otitis media
- D. Postmeningitis deafness (Correct Answer)
Explanation: ***Postmeningitis deafness*** - The image illustrates a **tympanometer**, which primarily assesses the function of the **middle ear** and **eardrum mobility** within the context of air pressure changes. - **Postmeningitis deafness** typically results from **sensorineural hearing loss** due to damage to the **cochlea** or **auditory nerve**, which is a condition of the inner ear and cannot be directly diagnosed by tympanometry. *Ossicular discontinuity* - This condition involves a break or separation in the **ossicular chain**, leading to excessive mobility of the tympanic membrane. - Tympanometry in **ossicular discontinuity** typically shows a **Type Ad tympanogram**, characterized by abnormally high compliance due to the lack of resistance from the damaged ossicles. *Otosclerosis* - **Otosclerosis** involves abnormal bone growth around the **stapes** footplate, leading to its fixation and reduced mobility. - Tympanometry in otosclerosis typically yields a **Type As tympanogram**, indicating abnormally low compliance or a shallow peak. *Serous otitis media* - Also known as **otitis media with effusion**, this condition involves the accumulation of fluid in the middle ear without signs of acute infection. - Tympanometry in **serous otitis media** typically presents with a **Type B tympanogram**, characterized by a flat curve due to reduced or absent eardrum mobility caused by the fluid.
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