Otology Practice Questions

Q: All are true about transverse fracture of the temporal bone except?

Conductive deafness. Temporal bone fractures are traditionally classified as **Longitudinal** (80%) or **Transverse** (20%) based on their relationship to the long axis of the petrous bone. ### **Why "Conductive Deafness" is the Correct Answer (The Exception)** Transverse fractures typically run perpendicular to the petrous ridge, crossing the bony labyrinth (cochlea and vestibule) and the internal auditory canal. This results in **Sensorineural Hearing Loss (SNHL)** and severe vertigo due to direct damage to the inner ear structures. **Conductive deafness** is a hallmark of *longitudinal* fractures, where the fracture line involves the middle ear, causing ossicular disruption or tympanic membrane rupture. ### **Analysis of Other Options** * **A. Facial nerve commonly involved:** True. Facial nerve paralysis occurs in approximately **50%** of transverse fractures (compared to only 15-20% in longitudinal) because the fracture line often crosses the fallopian canal or internal auditory meatus. * **B. Sensorineural deafness:** True. As the fracture line transects the cochlea or the 8th cranial nerve, permanent SNHL is the expected outcome. * **D. These fractures are less common:** True. Transverse fractures account for only about **20%** of all temporal bone fractures and usually result from severe frontal or occipital blows. ### **High-Yield Clinical Pearls for NEET-PG** | Feature | Longitudinal Fracture (80%) | Transverse Fracture (20%) | | :--- | :--- | :--- | | **Force Direction** | Lateral (Temporal/Parietal) | Frontal or Occipital | | **Hearing Loss** | **Conductive** (Common) | **Sensorineural** (Common) | | **Facial Nerve** | Less common (15-20%) | **More common (50%)** | | **Otics Capsule** | Spared | **Involved** | | **Bleeding** | Bleeding from ear (common) | Hemotympanum (intact TM) | | **CSF Otorrhea** | More common | Less common |

Q: Bezold abscess is seen in:

Sternocleidomastoid Muscle. **Explanation:** **Bezold abscess** is a rare complication of acute coalescent mastoiditis. It occurs when the infection erodes through the thin inner cortical bone of the **mastoid tip** (medial to the attachment of the sternocleidomastoid muscle). 1. **Why Option A is Correct:** The pus tracks downwards from the mastoid tip into the **sheath of the Sternocleidomastoid (SCM) muscle**. Because the mastoid tip bone is thinner on its medial aspect, the infection escapes the bone and presents as a deep neck swelling in the upper part of the neck, obscured by the SCM muscle. 2. **Why Other Options are Incorrect:** * **Sternohyoid muscle (B):** This is an infrahyoid "strap" muscle of the neck. It is located too anteriorly and medially to be involved in mastoid tip infections. * **Sartorius muscle (C):** This is the longest muscle in the human body, located in the **thigh**. It has no anatomical relation to the temporal bone. * **Semimembranosus muscle (D):** This is one of the hamstring muscles located in the **posterior compartment of the thigh**. **Clinical Pearls for NEET-PG:** * **Luc’s Abscess:** Pus tracks through the external auditory canal wall (subperiosteal abscess). * **Citelli’s Abscess:** Pus tracks into the posterior belly of the digastric muscle, presenting in the digastric triangle. * **Clinical Presentation:** Patients with Bezold abscess often present with neck pain, fever, and a "torticollis" (wry neck) due to irritation of the SCM. * **Diagnosis:** Contrast-enhanced CT (CECT) is the gold standard to visualize the mastoiditis and the extent of the neck abscess.

Q: The Phlep sign is seen in which of the following conditions?

Glomus tumor. **Explanation:** The **Phelps sign** (often referred to as the Phlep sign in some Indian medical texts) is a characteristic radiological finding seen in **Glomus Jugulare** tumors. It refers to the **erosion of the bony septum** (the carotico-jugular crest) that separates the jugular bulb from the carotid canal. This sign is best visualized on a high-resolution CT scan of the temporal bone and helps differentiate a glomus tumor from a high-placed jugular bulb. **Analysis of Options:** * **Glomus Tumor (Correct):** These are highly vascular paragangliomas. The Phelps sign indicates the destructive nature of the tumor as it expands from the jugular bulb toward the carotid artery. * **Otosclerosis:** Characterized by the **Schwartze sign** (flamingo flush) on otoscopy and the **Carhart’s notch** at 2 kHz on audiometry. It involves bony remodeling, not large-scale erosion of the jugular crest. * **Meniere’s Disease:** A clinical diagnosis of endolymphatic hydrops. It does not present with bony erosive signs on imaging. * **Lateral Sinus Thrombosis:** A complication of CSOM characterized by the **Griesinger sign** (edema over the mastoid) and the **Delta sign** (empty triangle) on contrast CT, representing a thrombus in the sinus. **NEET-PG High-Yield Pearls for Glomus Tumor:** 1. **Brown’s Sign:** Pulsation of the tympanic membrane seen on otoscopy, which ceases with positive pressure (Siegle’s bulb). 2. **Aquino’s Sign:** Blanching of the tympanic mass upon carotid artery compression. 3. **Clinical Presentation:** Pulsatile tinnitus (most common symptom) and a "rising sun" appearance behind the intact eardrum. 4. **Investigation of Choice:** Contrast-enhanced MRI (shows "salt and pepper" appearance).

Q: The stapes foot plate covers which anatomical structure?

Oval window. **Explanation:** The middle ear functions as an impedance-matching mechanism, transmitting sound vibrations from the air to the fluid-filled cochlea. The **stapes**, the smallest bone in the human body, consists of a head, neck, two crura, and a **footplate**. The footplate is held in the **Oval Window** (Fenestra vestibuli) by the annular ligament. When the stapes vibrates, it pushes the footplate into the oval window, creating pressure waves in the perilymph of the scala vestibuli. **Analysis of Options:** * **A. Round Window (Fenestra Cochleae):** This is located postero-inferior to the oval window and is covered by the **secondary tympanic membrane**. It serves as a pressure release valve; as the stapes pushes into the oval window, the round window membrane bulges outward. * **C. Sinus Tympani:** This is a deep recession on the posterior wall of the tympanic cavity, medial to the pyramid and facial nerve canal. It is a clinically significant site as it is a common hiding spot for **cholesteatoma**. * **D. Pyramid:** This is a hollow conical projection on the posterior wall that houses the **stapedius muscle**. The tendon of the stapedius emerges from its apex to attach to the neck of the stapes. **High-Yield Clinical Pearls for NEET-PG:** * **Otosclerosis:** A condition characterized by pathological bone remodeling that fixes the stapes footplate in the oval window, leading to conductive hearing loss. * **Schwartze Sign:** A flamingo-pink flush seen on the promontory through the TM, indicative of active otosclerosis. * **Stapedectomy:** The surgical treatment for otosclerosis where the fixed footplate is bypassed or removed and replaced with a prosthesis.

Q: Greisinger's sign is suggestive of:

Acute mastoiditis with lateral sinus thrombosis. ### Explanation **Greisinger’s sign** is a classic clinical finding in **Lateral Sinus Thrombosis (LST)**, which is a serious extracranial complication of chronic or acute coalescent mastoiditis. #### 1. Why Option A is Correct The sign refers to **pitting edema and tenderness over the mastoid process**, specifically over the area of the mastoid emissary vein. * **Pathophysiology:** When the lateral (sigmoid) sinus becomes thrombosed, the retrograde pressure causes thrombosis or congestion of the **mastoid emissary vein**. This leads to localized edema and inflammatory changes in the soft tissues behind the mastoid. * In the context of the NEET-PG, this is a high-yield association with "Hectic Pick-fence" fever and the Griesinger sign. #### 2. Why Other Options are Incorrect * **Option B:** Maxillary cancer spreading to the nasal cavity presents with cheek swelling, epistaxis, or infraorbital anesthesia, but does not involve mastoid edema. * **Option C:** Rhinosporidiosis is a granulomatous fungal-like infection (caused by *Rhinosporidium seeberi*) characterized by leafy, strawberry-like nasal masses; it has no relation to venous thrombosis. * **Option D:** While LST can lead to internal jugular vein (IJV) thrombosis, the specific sign for IJV involvement is a palpable "cord-like" swelling in the neck, not mastoid edema. #### 3. Clinical Pearls for NEET-PG * **Tobey-Ayer Test / Queckenstedt’s Test:** Used during lumbar puncture to diagnose LST. Compression of the IJV on the affected side fails to show a rise in CSF pressure. * **Crowe-Beck Test:** Engorgement of retinal veins and conjunctiva upon compressing the IJV on the healthy side. * **Delta Sign (Empty Triangle Sign):** Seen on contrast-enhanced CT, representing a clot in the sigmoid sinus surrounded by dural enhancement. * **Treatment:** High-dose antibiotics, mastoidectomy, and potentially anticoagulants.

Q: A 30-year-old woman with a family history of hearing loss from her mother's side developed a hearing problem during pregnancy. The hearing loss is bilateral and slowly progressive. Pure tone audiometry shows an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

Otosclerosis. ### Explanation **1. Why Otosclerosis is the Correct Answer:** The clinical presentation is classic for **Otosclerosis**, a primary metabolic bone disease of the otic capsule. * **Epidemiology:** It typically affects young adults (20–30 years) and has a strong **autosomal dominant** inheritance with incomplete penetrance (family history). * **Pregnancy:** Hormonal changes during pregnancy are known to accelerate the progression of the disease. * **Audiometry:** The "apparent bone conduction loss at 2000 Hz" is the pathognomonic **Carhart’s Notch**. This is not a true sensorineural loss but a mechanical artifact caused by the loss of the stapes' resonance frequency (normally 2000 Hz) due to stapedial fixation. **2. Why Other Options are Incorrect:** * **Acoustic Neuroma:** This presents with unilateral sensorineural hearing loss and tinnitus, not bilateral conductive loss triggered by pregnancy. * **Otitis Media with Effusion (OME):** While it causes conductive hearing loss, it is usually associated with Eustachian tube dysfunction or URTI and would show a "B" type tympanogram, not Carhart’s notch. * **Sigmoid Sinus Thrombosis:** This is a complication of chronic suppurative otitis media (CSOM) presenting with "picket-fence" fever and headache, not progressive hearing loss. **3. High-Yield Clinical Pearls for NEET-PG:** * **Schwartz Sign:** A flamingo-pink flush seen on the promontory through the TM (indicates active disease/otospongiosis). * **Gelle’s Test:** Negative (indicates stapes fixation). * **Tympanometry:** Typically shows an **As type** curve (stiffened ossicular chain). * **Treatment of Choice:** **Stapedotomy** (with Teflon piston insertion). Sodium fluoride can be used to medically manage the active phase.

Q: Otomycosis is caused by which of the following organisms?

Both Candida and Aspergillus. **Explanation:** **Otomycosis** (also known as "Singapore Ear" or Tropical Ear) is a fungal infection of the external auditory canal. It is most commonly seen in hot, humid climates or in patients who frequently use topical antibiotic ear drops, which disrupt the normal bacterial flora. **Why Option C is Correct:** The etiology of Otomycosis is predominantly fungal, involving two main genera: 1. **Aspergillus:** This is the most common cause (80-90% of cases). Specifically, *Aspergillus niger* is classic for producing black, soot-like spores, while *Aspergillus fumigatus* produces pale blue or green spores. 2. **Candida:** *Candida albicans* is the second most frequent pathogen. It typically presents as a white, creamy, curd-like discharge. Since both organisms are primary causative agents, **Option C** is the most accurate choice. **Analysis of Incorrect Options:** * **Options A and B:** While both Candida and Aspergillus cause Otomycosis, selecting one over the other would be incomplete, as clinical studies show both are frequently isolated from infected ears. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Intense itching (pruritus), ear pain (otalgia), and a "wet newspaper" appearance of the debris in the canal. * **Characteristic Morphology:** On otoscopy, *A. niger* looks like a "conidial head" or a "wet piece of filter paper with black dots." * **Treatment:** The mainstay of treatment is **thorough aural toilet** (cleaning the debris) followed by topical antifungal agents like **Clotrimazole** (most common), Nystatin, or Povidone-iodine. * **Risk Factors:** Excessive moisture (swimming), immunocompromised states (Diabetes Mellitus), and prolonged use of topical steroids/antibiotics.

Question 1

All are true about transverse fracture of the temporal bone except?

Accepted Answer

Conductive deafness

Answer

Facial nerve commonly involved

Answer

Sensorineural deafness

Answer

These fractures are less common

Question 2

Bezold abscess is seen in:

Accepted Answer

Sternocleidomastoid Muscle

Answer

Sternohyoid muscle

Answer

Saorius muscle

Answer

Semimembranosus muscle

Question 3

The Phlep sign is seen in which of the following conditions?

Accepted Answer

Glomus tumor

Answer

Otosclerosis

Answer

Meniere's disease

Answer

Lateral sinus thrombosis

Question 4

The stapes foot plate covers which anatomical structure?

Accepted Answer

Oval window

Answer

Round window

Answer

Sinus tympani

Answer

Pyramid

Question 5

A 3-year-old girl ruptured her eardrum when she inserted a pencil into her external ear canal. She was urgently admitted to the emergency department. Physical examination revealed pain in her ear and a few drops of blood in the external auditory meatus. There was concern that there might possibly have been an injury to the nerve that principally innervates the external surface of the tympanic membrane. Which of the following tests is most likely to be performed during physical examination to check for injury to this nerve?

Accepted Answer

Check if there is paraesthesia at the TMJ.

Answer

Check the taste in the anterior two thirds of the tongue.

Answer

Check the sensation to the pharynx and palate.

Answer

Check for sensation in the larynx.

Question 6

Hypoacusis is caused by paralysis of which of the following muscles?

Accepted Answer

Tensor tympani

Answer

Mylohyoid

Answer

Tensor veli palatini

Answer

Macula densa

Question 7

Greisinger's sign is suggestive of:

Accepted Answer

Acute mastoiditis with lateral sinus thrombosis

Answer

Maxillary cancer with spread to nasal cavity

Answer

Rhinosporidiosis

Answer

Jugular vein thrombosis

Question 8

A 30-year-old woman with a family history of hearing loss from her mother's side developed a hearing problem during pregnancy. The hearing loss is bilateral and slowly progressive. Pure tone audiometry shows an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

Accepted Answer

Otosclerosis

Answer

Acoustic neuroma

Answer

Otitis media with effusion

Answer

Sigmoid sinus thrombosis

Question 9

Otomycosis is caused by which of the following organisms?

Accepted Answer

Both Candida and Aspergillus

Answer

Candida

Answer

Aspergillus

Answer

None of the above

Question 10

What is tympanoplasty?

Accepted Answer

Eradication of middle ear disease with reconstruction of the tympanic membrane and ossicles

Answer

Eradication of disease from the internal ear

Answer

Repair of the tympanic membrane only

Answer

Repair of the ossicle only

Otology — MCQs

Otology — MCQs

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