Complications of Otits Media

Complications of Otits Media

Q. 1

Commonest complication of CSOM is:

 A

Bezolds abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Q. 1

Commonest complication of CSOM is:

 A

Bezolds abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Ans. B

Explanation:

Q. 2

Commonest complication of CSOM is:

 A

Subperiosteal abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Q. 2

Commonest complication of CSOM is:

 A

Subperiosteal abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Ans. B

Explanation:

Q. 3

Gradenigo’s syndrome involves the following cranial nerves:

 A

IV, VII

 B

V, VI

 C

VI, DC

 D

VII, VIII

Q. 3

Gradenigo’s syndrome involves the following cranial nerves:

 A

IV, VII

 B

V, VI

 C

VI, DC

 D

VII, VIII

Ans. B

Explanation:

Q. 4

All of the following are features of Gradenigo’s syndrome?

 A

It causes diplopia

 B

It is characterized by retro-orbital pain

 C

It is associated with involvement of the Cranial nerves V and VI

 D

All of the above

Q. 4

All of the following are features of Gradenigo’s syndrome?

 A

It causes diplopia

 B

It is characterized by retro-orbital pain

 C

It is associated with involvement of the Cranial nerves V and VI

 D

All of the above

Ans. D

Explanation:

Clinical features of gardenigo syndrome consist of a triad of deep retro orbital pain, paralysis of ipsilateral laeral rectus muscle from the involvement of abducens nerve(diplopia) as it cross the petrous bone and otitic infection with purulent discharge. This syndrome is also associated with features such vertigo and hearing loss either from a concomitant bacterial labrynthitis or from involvement of eight cranial nerve in its bony canal.

Ref: Companion to Clinical Neurology By William Pryse-Phillips, 2nd Edition, Page 404


Q. 5

What is the COMMONEST complication of CSOM?

 A

Subperiosteal abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Q. 5

What is the COMMONEST complication of CSOM?

 A

Subperiosteal abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Ans. B

Explanation:

Mastoiditis is the most common complication of CSOM. Acute mastoiditis usually accompanies or follows acute suppurative otitis media.

Complications of otitis media are classified into two main groups:
A.Intratemporal:
  • Mastoiditis
  • Petrositis
  • Facial paralysis
  • Labyrinthitis
B.Intracranial:
  • Extradural abscess
  • Subdural abscess
  • Meningitis
  • Brain abscess
  • Lateral sinus thrombophlebitis

Q. 6

Which among the following is the COMMONEST complication of CSOM?

 A

Subperiosteal abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Q. 6

Which among the following is the COMMONEST complication of CSOM?

 A

Subperiosteal abscess

 B

Mastoiditis

 C

Brain abscess

 D

Meningitis

Ans. B

Explanation:

Mastoiditis is the most common complication of otitis media. Mastoiditis refers to inflammation of the air cells in the mastoid process.
 
Patients usually presents with fever and local pain. The classic triad consists of:
  • Prominent auricle with retro orbital swelling
  • Tenderness over the mastoid
  • Otorrhea
It is best diagnosed using CT scan. It shows clouding of the mastoid air cells and middle ear spaces. It can also demonstrate erosion of the mastoid bone structure.
 

Q. 7

Gradenigo’s syndrome involves all of the following cranial nerves, except:

 A

IV

 B

V

 C

VI

 D

VII

Q. 7

Gradenigo’s syndrome involves all of the following cranial nerves, except:

 A

IV

 B

V

 C

VI

 D

VII

Ans. D

Explanation:

Gradenigo’s syndrome is characterized by pain in the face (from irritation of the trigeminal nerve) retroorbital pain,AOM, and ipsilateral abducens nerve paresis.

The syndrome is produced by disease of the tip of the petrous bone and most often occurs as a rare complication of otitis media with mastoiditis or petrous bone tumors.
 
 

 


Q. 8

Gradenigo’s syndrome involves all of the following cranial nerves, EXCEPT:

 A

IV

 B

V

 C

VI

 D

VII

Q. 8

Gradenigo’s syndrome involves all of the following cranial nerves, EXCEPT:

 A

IV

 B

V

 C

VI

 D

VII

Ans. A

Explanation:

Gradenigo’s syndrome is characterized by facial pain, particularly in the first division of the trigeminal nerve and diplopia due to sixth cranial nerve palsy. It is associated with disease at the apex of the petrous temporal bone where the abducens nerve is closely related to the trigeminal nerve. Facial nerve palsy and deafness (VIII nerve palsy) is also considered to be a part of this syndrome.

 
Causes includes:
  • Inflammation (petrositis, possibly spreading from a local infection such as otitis or mastoiditis)
  • Tumors ( cholesteatoma, chordoma, meningioma, nasopharyngeal carcinoma, metastatic disease)
  • Skull base fracture

Q. 9

The most common complication of chronic suppurative otitis media is:

 A

Meningitis

 B

Intracerebral abscess

 C

Cholesteatoma

 D

Conductive deafness

Q. 9

The most common complication of chronic suppurative otitis media is:

 A

Meningitis

 B

Intracerebral abscess

 C

Cholesteatoma

 D

Conductive deafness

Ans. B

Explanation:

Q. 10

Commonest complication of CSOM is:

 A

Sub periosteal abscess 

 B

Mastoiditis

 C

Brain absess

 D

Meningitis

Q. 10

Commonest complication of CSOM is:

 A

Sub periosteal abscess 

 B

Mastoiditis

 C

Brain absess

 D

Meningitis

Ans. C

Explanation:

 



Q. 11

Extracranial complications of CSOM:

 A

Epidural abscess

 B

Facial nerve plasy

 C

Hearing loss

 D

All

Q. 11

Extracranial complications of CSOM:

 A

Epidural abscess

 B

Facial nerve plasy

 C

Hearing loss

 D

All

Ans. B

Explanation:

Q. 12

Extracranial complications of CSOM:

 A

Labyrinthitis

 B

Otitic hyrocephalus

 C

Bezold’s abscess

 D

a and c

Q. 12

Extracranial complications of CSOM:

 A

Labyrinthitis

 B

Otitic hyrocephalus

 C

Bezold’s abscess

 D

a and c

Ans. D

Explanation:

 

Extra cranial complications of CSOM are:

  • Petrositis (gradenigo syndrome)
  • Labyrinthitis
  • Osteomyelitis of temporal bone
  • Septicemia / pyaemia
  • Otogenic Tetanus.
  • F. Facial nerve palsy
  • Acute Mastoiditis: – Postaural sub periosteal abscess

– Zygomatic abscess

-Luc’s abscess

-Citelli abscess

–  Bezold abscess


Q. 13

Acute mastoiditis is characterized by all except: 

 A

Clouding of air cells

 B

Obliteration of retroauricular sulcus

 C

Deafness

 D

Outward and downward deviation of the pinna

Q. 13

Acute mastoiditis is characterized by all except: 

 A

Clouding of air cells

 B

Obliteration of retroauricular sulcus

 C

Deafness

 D

Outward and downward deviation of the pinna

Ans. B

Explanation:

Q. 14

Essential radiological feature of acute mastoiditis is:

 A

Temporal bone pneumatisation

 B

Clouding of air cells of mastoid

 C

Rarefaction and tuning of petrous bone

 D

Thickening of temporal bone

Q. 14

Essential radiological feature of acute mastoiditis is:

 A

Temporal bone pneumatisation

 B

Clouding of air cells of mastoid

 C

Rarefaction and tuning of petrous bone

 D

Thickening of temporal bone

Ans. B

Explanation:

Q. 15

In Mastoiditis tenderness is/are present at:

 A

Tragus

 B

Concha

 C

Mastoid tip

 D

All

Q. 15

In Mastoiditis tenderness is/are present at:

 A

Tragus

 B

Concha

 C

Mastoid tip

 D

All

Ans. C

Explanation:

Q. 16

All are true for Gradenigo’s syndrome except:

 A

It is associated with jugular vein tenderness

 B

It is caused by an abscess in the petrous apex

 C

It leads to involvement of the Cranial nerves V and VI.

 D

It is characterized by retro-orbital pain

Q. 16

All are true for Gradenigo’s syndrome except:

 A

It is associated with jugular vein tenderness

 B

It is caused by an abscess in the petrous apex

 C

It leads to involvement of the Cranial nerves V and VI.

 D

It is characterized by retro-orbital pain

Ans. A

Explanation:

Q. 17

Gradenigo’s syndrome characterised by all except:

 A

Retroorbital pain

 B

Profuse discharge from the ear

 C

VII nerve palsy

 D

Diplopia

Q. 17

Gradenigo’s syndrome characterised by all except:

 A

Retroorbital pain

 B

Profuse discharge from the ear

 C

VII nerve palsy

 D

Diplopia

Ans. C

Explanation:

Q. 18

Most common nerve to be damaged in CSOM is

 A

III

 B

VII

 C

IV

 D

VI

Q. 18

Most common nerve to be damaged in CSOM is

 A

III

 B

VII

 C

IV

 D

VI

Ans. B

Explanation:

 

Facial nerve is the M/C nerve to be damaged in CSOM.



Q. 19

All of the following are included in Gradenigo’s triad EXCEPT:    

 A

Abducent nerve palsy

 B

Retro-orbital pain

 C

Aural discharge

 D

Palatal palsy

Q. 19

All of the following are included in Gradenigo’s triad EXCEPT:    

 A

Abducent nerve palsy

 B

Retro-orbital pain

 C

Aural discharge

 D

Palatal palsy

Ans. D

Explanation:

 

Gradenigo’s syndrome/ Gradenigo-Lannois syndrome/ Petrous apicitis

  • It is a complication of otitis media and mastoiditis involving the apex of the petrous temporal bone.
  • It was first described by Giuseppe Gradenigo in 1904 when he reported a triad of symptoms consisting of periorbital unilateral pain related to trigeminal nerve involvement, diplopia due to sixth nerve palsy and persistent otorrhea, associated with bacterial otitis media with apex involvement of the petrous part of the temporal bone (petrositis).

Q. 20

Gradenigo syndrome is characterized by all except ‑

 A

Diplopia

 B

Retro-orbital pain

 C

Persistent ear discharge

 D

Vertigo

Q. 20

Gradenigo syndrome is characterized by all except ‑

 A

Diplopia

 B

Retro-orbital pain

 C

Persistent ear discharge

 D

Vertigo

Ans. D

Explanation:

Ans. is d i.e., Vertigo

Infection of mastoid and middle ear may be complicated by the spread of infection within the temporal bone into petrous apex. Petrositis is an extension of infection from middle ear and mastoid to the petrous part of the temporal bone.

Gradenigo’s syndrome is the classical presentation and consists of a triad of : –

  • External rectus palsy (VIth nerve/abducent nerve palsy) causing diplopia.
  • Deep seated orbital or retroorbital pain (Vth nerve involvement).
  • Persistent ear discharge due to ipsilateral acute or chronic otitis media.

Associated symptoms of otitis media are also present e.g., conductive deafness. Other symptoms are fever, head­ache, vomiting, and sometimes neck rigidity. Some patient may get facial paralysis and recurrent vertigo due to involvement of facial and statoacoustic nerves.


Q. 21

All are true for gradenigo’s syndrome except ‑

 A

Associated with intermittent ear discharge

 B

Associated with conductive hearing loss

 C

Causes diplopia

 D

Leads to retro orbital pain

Q. 21

All are true for gradenigo’s syndrome except ‑

 A

Associated with intermittent ear discharge

 B

Associated with conductive hearing loss

 C

Causes diplopia

 D

Leads to retro orbital pain

Ans. A

Explanation:

Ans. is ‘a’ i.e., Associated with intermittent ear discharge


Q. 22

In a patient with CSOM, labrynthine fistula most commnonly involves ‑

 A

Superior SCC

 B

Lateral SCC

 C

Posterior SCC

 D

Utricle

Q. 22

In a patient with CSOM, labrynthine fistula most commnonly involves ‑

 A

Superior SCC

 B

Lateral SCC

 C

Posterior SCC

 D

Utricle

Ans. B

Explanation:

Ans. is ‘b’ i.e., Lateral SCC

  • Labrynthine fistula is almost exclusively reported in association with chronic otitis media and cholesteatoma.
  • The most commonly affected canal is lateral (horizontal) semicircular canal, but involvement of the posterior and superior canals as well as other regions of labyrinth have been reported.
  • The incidence of labrynthine fistula in chronic otitis media is approximately 10%.



Q. 23

Most common cranial nerve involved in CSOM is ‑

 A

V

 B

VII

 C

IX

 D

XI

Q. 23

Most common cranial nerve involved in CSOM is ‑

 A

V

 B

VII

 C

IX

 D

XI

Ans. B

Explanation:

Ans. is ‘b’ i.e., VII


Q. 24

Gradenigo’s syndrome consists of the following except ‑

 A

Retro-orbital pain

 B

Persistent ear discharge

 C

External rectus palsy

 D

Convulsions

Q. 24

Gradenigo’s syndrome consists of the following except ‑

 A

Retro-orbital pain

 B

Persistent ear discharge

 C

External rectus palsy

 D

Convulsions

Ans. D

Explanation:

Ans. is ‘d’ i.e., Convulsions

Infection of mastoid and middle ear may be complicated by the spread of infection within the temporal bone into petrous apex. Petrositis is an extension of infection from middle ear and mastoid to the petrous part of the temporal bone. Gradenigo’s syndrome is the classical presentation and consists of a triad of : –

i)  External rectus palsy (VIth nerve/abducent nerve palsy) causing diplopia.

ii) Deep seated orbital or retroorbital pain (Vth nerve involvement).

iii) Persistent ear discharge due to ipsilateral acute or chronic otitis media.

 Associated symptoms of otitis media are also present e.g., conductive deafness. Other symptoms are fever, headache, vomiting, and sometimes neck rigidity. Some patient may get facial paralysis and recurrent vertigo due to involvement of facial and statoacoustic nerves.



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