Ear (Otology) MCQs
1. Regarding cholesteatoma, which of the following is true?
A. It consists of squamous epithelium.
B. It is a malignant tumour.
C. It should be left untreated.
D. It may metastasise to distant sites.
E. It is mainly treated medically.
2. Tympanic membrane develops from:
A. Ectoderm.
B. Endoderm.
C. Mesoderm.
D. A, B and C.
E. A and C.
3. Stapes footplate covers:
A. Round window.
B. Oval window.
C. Sinus tympani.
D. Aditus ad antrum.
E. Choclear aqueduct.
4. The auricle attains 90-95% of adult size by:
A. 5-6 years.
B. Birth.
C. 9-12 years.
D. 11-15 years.
E. 13-18 years.
5. Communication between middle ear and Eustachian tube is obliterated surgically in
A. Cortical mastoidectomy.
B. Radical mastoidectomy.
C. Myrigoplasty.
D. Modified radical mastoidectomy.
E. Bondyʼs mastoidectomy.
6. Treatment of choice for glue ear which presented for 6 months is
A. Conservative.
B. Adenoidectomy.
C. Myringotomy with ventilation tube insertion.
D. Myringotomy with cold knife.
E. Myringotomy with diode laser.
7. The cough response caused while cleaning the ear canal is mediated by stimulation of:
A. The 5th cranial nerve.
B. Innervation of external ear canal by C1 and C2.
C. Branches of the 7th cranial nerve.
D. The 8th cranial nerve.
E. The 10th cranial nerve.
8. Which of the following is a cause of sensorineural hearing loss:
A. Prespyacusis.
B. Tympanosclerosis.
C. Otosclerosis.
D. Longitudinal fracture of the temporal bone.
E. Cholesteatoma.
9. Which is the investigation of choice in assessing hearing loss in neonates?
A. Impedance audiometry.
B. Behavioral audiometry.
C. Free field audiometry.
D. Brain-stem evoked response audiometry.
E. Pure tone audiometry.
10. Use of Siegelʼs speculum during ear examination provides all except:
A. Magnification.
B. Visualization.
C. Assessment of movement of the tympanic membrane.
D. Removal of foreign body.
E. As applicator for the powdered antibiotic to ear.
11. All are true for Gradenigoʼs syndrome except
A. It is associated with conductive hearing loss.
B. It is seen in petrositis.
C. It leads to involvement of the 5th and 6th cranial nerves.
D. It is characterized by retro-orbital pain.
E. Otalgia.
12. In right middle ear pathology, Weberʼs test will be
A. Lateralized to right side.
B. Positive.
C. Lateralized to left side.
D. Centralized.
E. Normal.
13. Which of the following is not a typical feature of malignant otitis externa?
A. Mitotic figures are high.
B. Caused by Pseudomonas aeruginosa.
C. Patient are usually immune compromised.
D. Presence of granulation tissue.
E. Patients are usually old.
14. Otoacoustic emissions are produced by:
A. Inner hair cells.
B. Basilar membrane.
C. Auditory nerve.
D. Outer hair cells.
E. Utricle.
15. Speech frequencies include:
A. 500 1000 2000 Hz.
B. 125 250 2000 Hz.
C. 250 500 1000 Hz.
D. 1000 2000 3000Hz.
E. 2000 3000 4000Hz.
16. Decreased bone conduction in an audiogram indicates:
A. Glue ear.
B. Tympanic membrane perforation.
C. Damage to cochlea.
D. Ossicular dislocation.
E. Ossicular fixation.
17. Traumatic perforation differ from infective perforation of the ear drum in the:
A. Size of perforation.
B. Shape of perforation.
C. Number of perforations.
D. Site of perforation.
E. None of the above.
18. Caloric test determines function of:
A. Posterior semicircular canal.
B. Saccule.
C. Utricle.
D. Lateral semicircular canal.
E. Superior semicircular canal.
19. Treatment of dry traumatic rupture of tympanic membrane is:
A. Antibiotic ear drops.
B. Ear pack soaked with antibiotic.
C. Myringoplasty.
D. Protection of ear against water.
E. Systemic antibiotics.
20. All are true about ear wax except:
A. pH is acidic in normal healthy canals.
B. Contains a bactericidal enzyme.
C. Is a combination of secretions of sebaceous and apocrine glands.
D. Needs to be removed periodically.
E. Secreted from outer third of external auditory canal.
21. Type B tympanogram is found in:
A. Normal person.
B. Tympanosclerosis.
C. Otosclerosis.
D. Secretary otitis media.
E. Disconnection of the ossicles.
22. Which of the following is not an extracranial complication of chronic
suppurative otitis media:
A. Sigmoid sinus thrombosis.
B. Facial nerve palsy.
C. Squamous cell carcinoma.
D. Labyrinthitis.
E. Hearing loss.
23. Unilateral referred otalgia is due to all of the following except:
A. Peritonsillar abscess.
B. Ulcer oral tongue.
C. Allergic rhinitis.
D. Tempromandibular joint dysfunction.
E. Cancer of pyriform fossa.
24. Obliteration of postauricular sulcus is found in:-
A. Acute mastoiditis.
B. Acute petrositis.
C. Malignant otitis externa.
D. Otomycosis.
E. Gradingoʼs syndrome.
25. The augmentation power of the sound wave by the tympanic membrane is:-
A. 14 times.
B. 1.4 times.
C. 18 times.
D. 17 times.
E. 22 times.
26. Aim of mastoid surgery in CSOM which should receive first priority is:
A. Making the ear dry.
B. Rendering the ear safe.
C. Improvement in hearing.
D. Preservation of hearing.
E. Eradication of infection.
27. Most common cause for bilateral conductive deafness in a child is:
A. Otitis media with effusion.
B. Otosclerosis.
C. Acute otitis media.
D. Congenital cholesteatoma.
E. Chronic suppurative otitis media.
28. A child aged 3 years presented with severe sensorineural deafness, he was prescribed hearing aids but showed no improvement. What is the next line of management?
A. Fenestration.
B. Stapes mobilization.
C. Cochlear implant.
D. Conservative.
E. Mastoidectomy.
29. The most common cause of peripheral episodic vertigo is:
A. Benign paroxysmal positional vertigo.
B. Meniereʼs disease.
C. Acoustic neuroma.
D. Vascular occlusion of labyrinthine artery.
E. Labyrinthitis.
30. A fifty year old male diabetic patient has developed itching in his ears. On otoscopy there is debris with black specks in external auditory canal. The treatment of choice in this case is:-
A. Otosporin ear drops.
B. Gentamicin ear drops.
C. Salicylic acid in spirit drops.
D. Repeated suction toilet with antifungal drops.
E. Oral anti-fungal drugs.
31. Adenoidectomy is indicated in all of the following conditions except:
A. Otitis media with effusion.
B. Nasal obstruction due to adenoidal hyperplasia.
C. Allergic rhinitis in children.
D. Recurrent otitis media in children.
E. Sleep apnea syndrome.
32. Complications of mumps include all except:
A. Unilateral sensorineural hearing loss.
B. Pancreatitis.
C. Palatal paralysis.
D. Orchitis.
E. Bilateral sensorineural hearing loss.
33. External auditory canal extends from …… to tympanic membrane.
A. Attic.
B. Lobule.
C. Isthmus.
D. Concha.
E. Umbo.
34. All of the following regarding pure tone audiometry is true except:
A. Is an objective test.
B. It uses specific tones to give place specific responses.
C. Is used to determine the type of deafness.
D. Is used to determine the severity of deafness.
E. Is used to determine the side of deafness.
35. Tympanic membrane moves with respiration in:
A. Patulous Eustachian tube.
B. Eustachian tube dysfunction.
C. Otosclerosis.
D. Secretary otitis media.
E. Disconnection of the ossicles.
36. Loss of stapedial reflex indicates all of the following except:
A. Severe sensorineural hearing loss.
B. Profound sensorineural hearing loss.
C. Mild sensorineural hearing loss.
D. Facial nerve paralysis.
E. Conductive hearing loss.
37. External auditory canal has……constriction/s:
A. 1.
B. 3.
C. 2.
D. 4.
E. No constriction.
38. Ototoxic drugs involves all of the following except:
A. Gentamicin.
B. Aspirin.
C. Fruesamide.
D. Paracetamol.
E. Cisplatin.
39. A 50 year old male patient presented with otalgia, on examination both external auditory canal and tympanic membrane are normal, all of the following might be the sites of origin of his pain except:
A. Neck.
B. Pharynx.
C. Brain.
D. Eye.
E. Nose
40. A nine months old baby has put a plastic bead in his ear. On otoscopy, it is present in deeper portion of meatus and totally occluding the meatus. The best way to remove this bead is:
A. Remove it with foreign body hook.
B. Remove it with crocodile forceps.
C. Remove it with suction.
D. Remove it with ear syringing.
E. Remove it under general anesthesia using microscope.
41. A two year child is very slow in developing language. On otoscopy he has dull ear drum. Investigation of choice is:
A. Pure tone audiogram.
B. X-ray mastoids.
C. Tympanogram.
D. Serum bilirubin.
E. Nystagmogram.
42. A 10 year old boy has had ear problems for many years. He has a fever and you also notice that his mastoid bone is warm and tender to touch. Which of the following is the best course of action?
A. Refer routinely to ENT.
B. Prescribe topical eardrops.
C. Reassure.
D. Prescribe antibiotics.
E. Refer urgently to ENT.
43. If the patient can hear a whispered voice 30 cm away from the ear, the patient has:
A. Normal hearing.
B. Sensorineural hearing loss.
C. Conductive hearing loss.
D. Congenital hearing loss.
E. Mixed hearing loss.
44. All of the following tuning fork tests are used to detect organic hearing loss except:
A. Stenger test.
B. Weber test.
C. ABC test.
D. Rinne test.
E. Modified ABC test.
45. Fistula test is positive in:
A. Acute mastoiditis.
B. Erosion in the basal turn of cochlea.
C. Erosion of the lateral canal.
D. Acute petrositis.
E. Adhesive otitis media.
46. Before bone conduction audiometry masking is done:
A. To prevent cross hearing.
B. To diminish hearing acuity.
C. To increase hearing acuity.
D. To assess speech discrimination.
E. To prevent hair sensation.
47. A blue drum is seen in:
A. Cochlear otosclerosis.
B. Presbycusis.
C. Vestibular schwannoma.
D. High jugular bulb.
E. Glue ear.
48. The cone of light in the tympanic membrane points:
A. Posteroinferiorly.
B. Superiorly.
C. Anteroinferiorly.
D. Posteriorly.
E. Centrally.
49. Ear syringing is contraindicated in patients with:
A. Impacted wax.
B. Otomycosis.
C. Previous history suggesting skull fracture.
D. Presence of foreign body.
E. None of the above.
50. Keratosis obturans is commonly associated with:
A. Bronchiectasis.
B. Appendicitis.
C. Dextrocardia.
D. Renal failure.
E. Diabetes mellitus.
ANSWERS
1. A
Cholesteatoma is a destructive and expanding growth consisting of keratinizing
squamous epithelium in the middle ear and/or mastoid process. Although these
are not strictly speaking tumours or cancers they can still cause significant
problems because of their erosive and expansile properties resulting in the
destruction of the ossicles as well as their possible spread through the base of the
skull into the brain. They are also often infected and result in chronically draining
ears. It must be treated surgically unless the patient refuse the surgery or elderly
with significant medical problems.
2. D
Development of the ear, the complex organ of hearing and balance, involves all 3
embryonic germ layers
1. ECTODERM is the origin of the internal and external ears
2. ENDODERM takes part in the formation of the middle ear
3. MESODERM plays a role in the formation of all 3 parts of the ear.
Regarding the tympanic membrane, the outer squamous layer is derived
from ectoderm and the inner layer from endoderm while the middle
connective tissue layer is derived from mesoderm.
3. B
The footplate of the stapes helps with hearing. The stapes bone notifies the oval
window when movement occurs. The stapes footplate proceeds into the oval
window, sending the round window membrane out, allowing for the fluid in the
cochlea to move, which leads to the cochlear inner hair cells’ movement, and
finally, hearing.
4. A
The auricle (pinna) attains 90-95% of adult size by5-6 years. Due to this fact
otoplasty only performed around the age 6 years onward.
5. B
A Mastoidectomy is a procedure performed to remove the mastoid air cells. This
can be done as part of treatment for mastoiditis, chronic suppurative otitis media
or Cholesteatoma. In addition, it is sometimes performed as part of other
procedures (cochlear implant) or for access to the middle ear. There are
classically 5 different types of Mastoidectomy:
1. Radical Mastoidectomy - Removal of posterior and superior canal wall,
meatoplasty and exteriorisation of middle ear.
2. Canal Wall Down Mastoidectomy - Removal of posterior and superior
canal wall, meatoplasty. Tympanic membrane left in place.
3. Canal Wall Up Mastoidectomy - Posterior and superior canal wall are kept
intact. A facial recess approach is taken.
4. Cortical Mastoidectomy (Also known as schwartze procedure) - Removal
of Mastoid air cells is undertaken without affecting the middle ear. This is
typically done for mastoiditis
5. Modified Radical Mastoidectomy - This is confusing because it is
typically described as a radical mastoidectomy while maintaining the
posterior and superior canal wall which reminds the reader of the Canal
Wall Up Mastoidectomy. However, the difference is historical. Modified
radical mastoidectomy typically refers to Bondy’s procedure which
involves treating disease affecting only the epitympanum. Diseased areas
as well as portions of the adjacent superior and posterior canal are simply
exteriorised without affecting the uninvolved middle ear.
6. C
The best treatment for glue ear is consume time by watchful technique. In most
children, episodes of glue ear get better without active treatment. For this reason,
Otolaryngologist may simply recommend regular appointments for up to three
months so they can check the ears. If he finds a fluid in the space behind the ear
drum for more than three months, the beast treatment option is myringotomy with
ventilation tube (Grommets) insertion.
7. E
The auricular branch of the vagus nerve is often termed the Alderman's nerve or
Arnold’s nerve. The latter name is an eponym for Friedrich Arnold. It supplies
sensory innervation to the skin of the ear canal. In a small portion of individuals,
the auricular nerve is the afferent limb of the Ear-Cough or Arnold Reflex.
Physical stimulation of the external acoustic meatus innervated by the auricular
nerve elicits a cough, much like the other cough reflexes associated with the vagus
nerve. Rarely, on introduction of speculum in the external ear, patients have
experienced syncope due to the stimulation of the auricular branch of the vagus
nerve.
8. A
Prespyacusis is hearing loss occurring in old age individuals due progressive
degeneration in the auditory system with ageing, which leads to hearing impairment
in the affected individual as with all sensory systems in the human body.
Presbyacusis is defined as the lessening of the acuteness of hearing that characterizes
old age. Tympanosclerosis, otosclerosis, longitudinal fracture of the temporal bone
and cholesteatoma are the causes of conductive deafness.
9. D
The brainstem auditory evoked response (BAER) has proved useful in determining
the hearing threshold in neonates and even very young uncooperative patients. but
although still a research tool for the investigation of cochlear function, the use of evoked
otoacoustic emissions (OAEs) has now found a place in clinical practice in the screening
of neonates and high-risk infants for hearing loss. Evoked OAEs are quick, easy to test
and do not require an anaesthetic, in contrast to electrical evoked response audiometry.
The sensitivity and specificity of the test is sufficiently good that there are widespread
recommendations that all newborn infants are screened for hearing loss by OAE prior to
discharge from hospital.
10. D
A siegel’s pneumatic speculum has an eye piece which has a magnification of 4-5 times.
It is a convex lens. The eye piece is connected to an aural speculum. A bulb with a rubber
tube is provided to insufflate air via the aural speculum .The advantages of this aural
speculum is that it provides a magnified view of the ear drum, the pressure of the external
canal can be varied by pressing the bulb thereby the mobility of ear drum can be tested.
Since it provides adequate suction effect, it can be used to suck out middle ear secretions
in patients with CSOM. Ear drops or powder can be applied into the middle ear by using
this speculum. Ear is first filled with ear drops or powder and a snugly fitting siegel's
speculum is applied to the external canal. Pressure in the external canal is varied by
pressing and releasing the rubber bulb, this displaces the ear drops into the middle ear
cavity. A siegel's pneumatic speculum has an ability in detecting a fistula in inner ear
(fistula is due to an erosion in bony labyrinth with an intact endosteum) ) by applying
pressure in the middle ear there will be irritation of the labyrinth leading to nausea
,vomiting, vertigo and nystagmus and the result is said to be positive fistula test.
Sometimes a fistula present but the test is negative ,this occur in dead labyrinth and the
result is said to be false negative.
11. A
The syndrome, first described by Gradenigo in 1907, consists of the clinical triad of acute
otitis media, unilateral pain in regions innervated by the first and second branch of the
trigeminal nerve, and ipsilateral abducens nerve paralysis. These cranial nerve
dysfunctions are caused by osteitis of the petrous apex (petrous apicitis) and are very rare
complications of otitis media, especially since the widespread use of antibiotics.
12. A
The Weber test is a quick screening test for hearing. It can detect unilateral (one-
sided) conductive hearing loss (middle ear hearing loss) and unilateral sensorineural
hearing loss (inner ear hearing loss). The test is named after Ernst Heinrich Weber
(1795–1878).
A patient with a unilateral conductive hearing loss would hear the tuning fork loudest in
the affected ear. This finding is because the conduction problem of the middle ear (incus,
malleus, stapes, and Eustachian tube) masks the ambient noise of the room, while the
well-functioning inner ear (cochlea with its basilar membrane) picks the sound up via the
bones of the skull, causing it to be perceived as a louder sound in the affected ear.
Another theory, however, is based on the occlusion effect described by Tonndorf et al. in
1966. Lower frequency sounds (as made by the 256 Hz fork) that are transferred through
the bone to the ear canal escape from the canal. If an occlusion is present, the sound
cannot escape and appears louder on the ear with the conductive hearing loss.
13. A
Malignant (necrotizing) otitis externa (MOE) was first described as a case of
progressive Pseudomonas osteomyelitis in the temporal bone of elderly patient who had
diabetes nearly a half century ago.
Any condition causing immunosuppression, including HIV/AIDS, chemotherapy-
induced aplasia, refractory anemia, chronic leukemia, lymphoma, splenectomy,
neoplasia, and renal transplantation, may predispose a patient to MOE.
MOE should be suspected in all immunocompramized patients who have otitis externa
that does not improve with appropriate therapy. MOE have typical granulation tissue
along the floor of the external auditory canal (EAC).
Although its name is malignant but it is not neoplastic condition and the mitotic figures
remain normal ,the name (malignant) describes the aggressiveness and prognosis of the
condition.
14. D
An otoacoustic emission (OAE) is a sound which is generated from the outer hair
cells within the inner ear. Having been predicted by Thomas Gold in 1948, its existence
was first demonstrated experimentally by David Kemp in 1978 and otoacoustic emissions
have since been shown to arise through a number of different cellular and mechanical
causes within the inner ear. Studies have shown that OAEs disappear after the inner ear
has been damaged, so OAEs are often used in the laboratory and the clinic as a measure
of inner ear health. Using modern computing technology and signal averaging
techniques, outer hair cell vibrations can be detected in the external auditory meatus as
otoacoustic emissions (OAEs).It represents an objective measure of cochlear function.
Acoustically evoked OAEs are almost never found in ears with a hearing level worse than
40 dB.
15. A
Human ears can hear sound frequencies from 20-20000 Hz, But most of our speech
lies in range of 500-2000Hz.
16. C
Bone conduction decreases in sensorineural hearing loss and not in conductive
hearing loss, all the above conditions cause condutive hearing loss except cochlear
damage which causes sensorineural hearing loss.
In sensorineural hearing loss both air and bone conduction curves are decreased and the
difference between them <15 dB.
17. B
A perforated eardrum or punctured eardrum is a rupture or perforation (hole) of the
eardrum which can occur as a result of otitis media (ear infection), trauma (e.g. by trying
to clean the ear with sharp instruments), explosion, loud noise or surgery (accidental
creation of a rupture). Flying with a severe cold can also cause perforation due to changes
in air pressure and blocked Eustachian tubes resulting from the cold. This is especially
true on landing.
Perforation of the eardrum leads to conductive hearing loss, which is usually
temporary. Other symptoms may include tinnitus, earache or a discharge of mucus.
Traumatic eardrum perforation usually has an irregular shape while infective
perforation has regular shape.
18. D
The caloric reflex test (sometimes termed 'vestibular caloric stimulation') is a test of
the vestibulo-ocular reflex that involves irrigating cold or warm water or air into the
external auditory canal.
Ice cold or warm water or air is irrigated into the external auditory canal, usually using
a syringe. The temperature difference between the body and the injected water creates a
convective current in the endolymph of the nearby horizontal semicircular canal. Hot and
cold water produce currents in opposite directions and therefore a horizontal nystagmus
in opposite directions. In patients with an intact brainstem: If the water is warm (44°C or
above) endolymph in the ipsilateral horizontal canal rises, causing an increased rate of
firing in the vestibular afferent nerve. This situation mimics a head turn to the ipsilateral
side. Both eyes will turn toward the contralateral ear, with horizontal nystagmus to the
ipsilateral ear.
If the water is cold, relative to body temperature (30°C or below), the endolymph falls
within the semicircular canal, decreasing the rate of vestibular afferent firing. The eyes
then turn toward the ipsilateral ear, with horizontal nystagmus (quick horizontal eye
movements) to the contralateral ear.
19. D
When a fresh eardrum perforation is immediately confirmed, it is important to
instruct the patient to keep contaminated or soapy water out of the ear canal and to avoid
blowing the nose and elevation changes, all of which can serve to either create an
infection or maintain an open perforation.
20. D
Earwax, also known by the medical term cerumen, is a yellowish waxy substance
secreted in the ear canal of humans and other mammals. It protects the skin of the human
ear canal, assists in cleaning and lubrication, and also provides some protection from
bacteria, fungi, insects and water. Excess or impacted cerumen can press against the
eardrum and/or occlude (block) the external auditory canal or hearing aids, potentially
hindering hearing.
Cerumen is produced in the outer third of the cartilaginous portion of the ear canal. It is
a mixture of viscous secretions from sebaceous glands and less-viscous ones from
modified apocrine sweat glands. The primary components of earwax are shed layers of
skin, with 60% of the earwax consisting of keratin, 12–20% saturated and unsaturated
long-chain fatty acids, alcohols, squalene and 6–9% cholesterol.
21. D
Normal person: Type A tympanogram
Tympanosclerosis: Type As tympanogram
Otosclerosis: Type As tympanogram
Secretary otitis media: Type B tympanogram
Disconnection of the ossicles: Type Ad tympanogram
22. A
Types of intracranial complications of chronic suppuration otitis media:
1. Extradural abscess
2. Subdural abscess
3. Meningitis
4. Brain abscess
5. Lateral sinus thrombophlebitis.
6. Otitic hydrocephalus
Types of extracranial complications of chronic suppuration otitis media:
1. Mastoiditis
2. Petrositis
3. Labyrinthitis
4. Facial paralysis
5. Mastoid abscesses.
6. Squamous cell carcinoma of the ear.
23. C
Otalgia or an earache is pain in the ear. Primary otalgia is ear pain that originates
inside the ear. Referred otalgia is ear pain that originates from outside the ear.
Otalgia is not always associated with ear disease. It may be caused by several other
conditions, such as impacted teeth, sinus disease, inflamed tonsils, infections in the
nose and pharynx, throat cancer, and occasionally as a sensory aura that precedes a
migraine.
Allergic rhinitis is usually not associated with pain unless there is an infection of the
paranasal sinuses.
24. A
Acute mastoiditis symptoms may include:
1. Fever, irritability, and lethargy.
2. Swelling of the ear lobe.
3. Redness and tenderness behind the ear with obliteration of postauricular
sulcus.
4. Drainage from the ear.
5. Bulging and drooping of the ear.
One of the signs is obliteration of the postauricular sulcus which
differentiate it from otits externa in which this sulcus become widened.
25. A
The ratio of the functioning area of the tympanic membrane to the area of the
footplate is 14:1.
26. B
The primary goal of surgery for CSOM is make the ear safe (less complications
especially the intracranial complications).
27. A
Otitis media with effusion is the most common cause of bilateral conductive
deafness in children.
Otosclerosis is a cause of bilateral conductive deafness but in young adult and is
rare in children.
Acute otitis media is common in young children, might cause a unilateral or
bilateral and not causing persistent deafness unless it progress to chronic state.
Congenital cholesteatoma is rare cause of conductive deafness and mostly
unilateral.
Chronic suppurative otitis media: might cause unilateral or bilateral conductive
deafness but allover is less in occurrence than Otitis media with effusion.
28. C
Cochlear implant is the final solution for such child and should be done before the
brain loses the neural plasticity at age of 6-8 years.
29. A
All are causes of peripheral episodic vertigo but benign paroxysmal positional
vertigo is the most common cause.
30. D
Meticulous and regular aural toilet paying particular attention to the anteroinferior
meatal recess plus antifungal ear drops is the best option for otomycosis.
31. C
Indications for Adenoidectomy
1. Nasal obstruction.
2. Otitis media with effusion (glue car).
3. Recurrent acute otitis media.
4. Chronic rhinosinusitis.
5. Sleep apnea syndrome.
32. C
Complications of mumps are potentially serious, but rare. Most mumps
complications involve inflammation and swelling in some part of the body, such as:
1. Testicles. Orchitis.
2. Pancreas. Pancreatitis.
3. Ovaries and breasts. oophoritis or mastitis. Fertility is rarely affected.
4. Brain. Encephalitis
5. Membranes and fluid around the brain and spinal cord. Meningitis.
Other complications
6. Hearing loss. In rare cases, mumps can cause hearing loss, usually permanent, in
one or both ears.
7. Miscarriage
33. D
34. A
Pure tone audiometry (PTA) is the key hearing test used to identify hearing threshold
levels of an individual, enabling determination of the degree, type and configuration of a
hearing loss. Thus, providing the basis for diagnosis and management. PTA is a
subjective, behavioural measurement of hearing threshold, as it relies on patient response
to pure tone stimuli. Therefore, PTA is used on adults and children old enough to
cooperate with the test procedure. As with most clinical tests, calibration of the test
environment, the equipment and the stimuli to ISO standards is needed before testing
proceeds. PTA only measures thresholds, rather than other aspects of hearing such as
sound localization. However, there are benefits of using PTA over other forms of hearing
test, such as click auditory brainstem response. PTA provides ear specific thresholds, and
uses frequency specific pure tones to give place specific responses, so that the
configuration of a hearing loss can be identified. As PTA uses both air and bone
conduction audiometry, the type of loss can also be identified via the air-bone gap.
35. A
Patulous Eustachian tube, also known as patent Eustachian tube, is the name of a
physical disorder where the Eustachian tube, which is normally closed, instead stays
intermittently open. When this occurs, the patient experiences autophony, the hearing of
self-generated sounds.
Upon examination of a suspected case of patulous Eustachian tube, a doctor can directly
view the tympanic membrane with a light and observe that it vibrates with every breath
taken by the patient.
36. C
The acoustic reflex (also known as the stapedius reflex, attenuation reflex, or auditory
reflex) is an involuntary muscle contraction that occurs in the middle ear of mammals in
response to high-intensity sound stimuli.
When presented with a high-intensity sound stimulus, the stapedius and tensor tympani
muscles of the ossicles contract. The stapedius stiffens the ossicular chain by pulling the
stapes (stirrup) of the middle ear away from the oval window of the cochlea and the
tensor tympani muscle stiffens the ossicular chain by loading the eardrum when it pulls
the malleus (hammer) in toward the middle ear. The reflex decreases the transmission of
vibrational energy to the cochlea, where it is converted into electrical impulses to be
processed by the brain. The acoustic reflex normally occurs only at relatively high
intensities; activation for quieter sounds can indicate ear dysfunction. The pathway
involved in the acoustic reflex is complex and can involve the ossicular chain (malleus,
incus and stapes), the cochlea (organ of hearing), the auditory nerve, brain stem, facial
nerve and other components. Consequently, the absence of an acoustic reflex, by itself,
may not be conclusive in identifying the source of the problem.
37. C
The external auditory canal, an inch in length, extends from the concha to the eardrum
& consist of two parts. The outer one third is made of cartilage & called cartilaginous
part. The inner two thirds is made of bone & called the bony part. During its course, it
describes a sigmoid course. Its outer third goes medially, forwards & slightly upwards. Its
middle third courses medially, backwards, & slightly upwards. Its inner third traverses
medially, forwards & downwards. The cross-section of the canal is oval with its long axis
directed downwards & backwards & measures 9-10mm. This is, however, reduced
considerably at the isthmus, a point which is half a centimeter from the ear drum. And
also at the junction of the cartilaginous & bony parts.
38. D
Ototoxicity is the quality of being toxic to the ear (oto-), specifically the cochlea or
auditory nerve and sometimes the vestibular system; it is commonly medication-induced.
Ototoxic drugs include antibiotics such as gentamicin, loop diuretics such as furosemide
and platinum-based chemotherapy agents such as cisplatin. A number of nonsteroidal
anti-inflammatory drugs (NSAIDS) have also been shown to be ototoxic. This can result
in sensorineural hearing loss, dysequilibrium, or both. Either may be reversible and
temporary, or irreversible and permanent.
39. C
The brain has no pain receptors.
40. E
You should remove it under general anesthesia using microscope to avoid acute
complications of ear foreign body removal include canal abrasions, bleeding,
infection, and perforation of the tympanic membrane.
41. C
Pure tone audiogram cannot performed in such age.
This child has secretory otitis media and Type B tympanogram may reveal fluid in
the middle ear.
X-ray mastoids, serum bilirubin and nystagmogram are useless investigations for
such child.
42. E
Mastoid abscess remains a recognized complication of otitis media despite the advent
of antibiotics and need to refer urgently to ENT department.
43. A
The easiest & best method of performing monaural free-field voice testing is by
using a whispered voice, conversational voice & then the loud voice at 60cm & then
15cm. The non-test ear is masked by a tragal rub unless a loud voice is required(use the
Barany noise box).
If the patient can hear a whispered voice 60cm away from the ear, the pure tone
thresholds are likely to be less than 30dB(normal hearing). Patients who can hear a
whisper at 15cm or a conversational voice at 60cm or 15cm are likely to have thresholds
in the range of 30-70dB hearing loss(mild to moderate impairment). Those patients who
can only hear a loud voice are likely to have thresholds greater than 70dB hearing loss
(severe/profound impairment).
44. A
A Stenger test for non-organic hearing loss. If two identical tuning forks are used & one
is presented to each ear of normal subject, he can only perceive the nearer of the two
forks. If the examiner holds the two forks behind the blind folded patient & places one
fork about 25cm from the good ear, the patient will say he hears the sound. Next the other
fork is brought to about 8 cm from the ear under test. A patieni with true deafness will
still hear the fork placed 25cm from his good ear, but the patient with non-organic
deafness will deny that he hears any sound at all.
45. C
46. A
There are many different mechanisms of masking, one being suppression. This is when
there is a reduction of a response to a signal due to the presence of another. This happens
because the original neural activity caused by the first signal is reduced by the neural
activity of the other sound.
47. D
High jugular bulb is defined as that showing an abnormally high position in the
tympanic cavity. A high jugular bulb can be seen through the eardrum in some instances.
When the eardrum is not translucent, however, it is impossible to detect a high jugular
bulb by otoscopic examination alone.
48. C
A cone of light can be seen radiating from the tip of the malleus to the periphery in the
antero-inferior quadrant.
49. C
Syringing is contraindicated following recent injury or in patients who have had a
perforated ear drum. It is also contraindicated if there is a history of recent otitis externa
or otitis media, previous middle ear/mastoid surgery, and if it is the only hearing ear. In
these cases the patient should not be syringed and should be referred for dewaxing under
direct vision.
50. A