NEET-PG 2024 — ENT

Q: A patient presents with conductive hearing loss, pulsatile tinnitus and a positive Phelps sign. Using the CT scan provided, identify the condition.

Glomus jugulare. ***Glomus jugulare*** - This diagnosis aligns with the presence of **conductive hearing loss**, **pulsatile tinnitus**, and a **positive Phelps sign**, which indicate a highly vascular tumor in the jugular foramen. - While exact details of the CT scan are difficult to discern from the provided image, the clinical context strongly points towards a **glomus jugulare tumor**, known for its characteristic bone erosion around the jugular bulb seen on imaging. *Glomus tympanicum* - This typically presents with **pulsatile tinnitus** and **conductive hearing loss**, but is usually observed as a red mass behind an intact tympanic membrane, arising from the **promontory** within the middle ear space. - It would not typically cause a **Phelps sign**, which specifically relates to erosion of the jugular foramen region. *Acoustic neuroma* - An acoustic neuroma (vestibular schwannoma) causes **sensorineural hearing loss**, often unilateral, not conductive, along with **tinnitus** (usually non-pulsatile) and **balance issues**. - It arises from the vestibular nerve within the **internal auditory canal** and cerebellopontine angle, and does not cause a Phelps sign. *Otosclerosis* - Otosclerosis is characterized by **conductive hearing loss** due to abnormal bone growth fixing the stapes in the oval window, but it does not cause **pulsatile tinnitus** or involve a **positive Phelps sign**. - The disease involves the **otic capsule** and typically does not present with a tumorous mass visible on CT in the jugular foramen area.

11 Questions — Page 2 of 2

Q11

A patient presents with conductive hearing loss, pulsatile tinnitus and a positive Phelps sign. Using the CT scan provided, identify the condition.