Conductive Hearing Loss

Conductive Hearing Loss

Q. 1 Which condition causes the maximum hearing loss?
 A Ossicular disruption with intact tymnpanic membrane
 B Disruption of melleus and incus as well tympanic membrane
 C Partial fixation of the stapes footplate 
 D Otitis media with effusion
Q. 1 Which condition causes the maximum hearing loss?
 A Ossicular disruption with intact tymnpanic membrane
 B Disruption of melleus and incus as well tympanic membrane
 C Partial fixation of the stapes footplate 
 D Otitis media with effusion
Ans. A

Explanation:

Average Hearing loss seen in different lesions of conductive apparatus:

Complete obstruction of ear canal = 30dB Perforation of tympanic membrane (it varies and is directly proportional to the size of perforation) =

10-40 dB

Ossicular interruption with intact drum = 54 Db

Closure of oval window = 60 Db


Q. 2

A teacher slapped a 6th standard student after which she suffered from 25% hearing loss in left ear. This was corrected after a surgery. Which type of injury is this?

 A

Simple

 B

Simple

 C

Dangerous

 D

Serious

Q. 2

A teacher slapped a 6th standard student after which she suffered from 25% hearing loss in left ear. This was corrected after a surgery. Which type of injury is this?

 A

Simple

 B

Simple

 C

Dangerous

 D

Serious

Ans. B

Explanation:

Grievous [Ref: Reddy 29/e, p 261-263; Parikh 6/e, p 4.59-4.60; Dhingra ENT 5/e, p 44]

  • Permanent privation of the hearing of either ear comes under grievous injury 496
  • Reddy says — “The possibility of correction of any of the injuries mentioned under grievous injuries through surgery should not be a factor while assessing such injury.” So even if the hearing loss is correctable through surgery, then also it will fall under grievous injury.
  • Grievous injury ?

Section 320 IPC defines following injuries as grievous:

1)     Emasculation (cutting of the penis, castration, or causing loss of power of erection due to spinal injury).

2)     Permanent privation of the sight of either eye.

3)     Permanent privation of the hearing of either ear.

4)     Privation of any member (part, organ, limb) or joint

5)     Destruction or permanent impairing of powers of any member or joint

6)     Permanent disfiguration of head or face

7)     Fracture or dislocation of a bone or a tooth.

8)     Any hurt which endangers life, or which causes the sufferer to be, during the period of twenty days in severe bodily pain or unable to follow his daily routine (a simple stay in hospital for 20 days does not constitute grievous injury) Also know

  • Simple injury – It is neither extensive nor serious, and which would heal rapidly without leaving any permaennt deformity or disfiguration.
  • Dangerous injury – It is a variety of grievous injury which poses an immediate danger to life. The injury is fatal in the absence of surgical aid.
  • About 25% hearing loss

We had same doubts about the percentage of hearing loss – “what percentage of hearing loss would qualify for grievous injury?”. So we consulted a lawyer and he told that any percentage of hearing loss would be taken as grieveous injury.


Q. 3

A teacher slapped a 6th standard student after which she suffered from 25% hearing loss in one ear. This was corrected by surgery. Which type of injury was this?

 A

Simple

 B

Grievous

 C

Dangerous

 D

Serious

Q. 3

A teacher slapped a 6th standard student after which she suffered from 25% hearing loss in one ear. This was corrected by surgery. Which type of injury was this?

 A

Simple

 B

Grievous

 C

Dangerous

 D

Serious

Ans. B

Explanation:

Section 320, I.P.C defines following injuries as grievous:

1) Emasculation
2) Permanent privation of the sight of either eye
3) Permanent privation of the hearing of either ear
4) Privation of any member or joint
5) Destruction or permanent impairing of power of any member or joint
6) Permanent disfiguration of head or face
7) Fracture or dislocation of a bone or a tooth
8) Any hurt which endangers life, or which causes the sufferer to be in severe bodily pain, or unable to follow his daily routine for a period of twenty days
 
Ref: The Essentials of Forensic Medicine and Toxicology, 27th edition, Page 256.

Q. 4

Which of the following conditions is associated with maximum hearing loss?

 A

Otitis media with effusion

 B

Partial fixation of the stapes footplate

 C

Ossicular disruption with intact tympanic membrane

 D

Disruption of malleus and incus as well tympanic membrane

Q. 4

Which of the following conditions is associated with maximum hearing loss?

 A

Otitis media with effusion

 B

Partial fixation of the stapes footplate

 C

Ossicular disruption with intact tympanic membrane

 D

Disruption of malleus and incus as well tympanic membrane

Ans. C

Explanation:

Maximum hearing loss occur when there is ossicular interruption with intact tympanic membrane (54dB).

Ossicular interruption with perforation result in 38dB hearing loss, hearing loss in ottitis media with effusion averages about 26-30 dB.

Partial or complete fixation of the stapes results in conductive hearing loss that ranges from 5dB to 60dB.


Q. 5

Which of the following causes maximum hearing loss?

 A

Complete obstruction of ear canal

 B

Perforation of tympanic membrane

 C

Ossicular interruption with intact tympanic membrane

 D

Ossicular interruption with perforation

Q. 5

Which of the following causes maximum hearing loss?

 A

Complete obstruction of ear canal

 B

Perforation of tympanic membrane

 C

Ossicular interruption with intact tympanic membrane

 D

Ossicular interruption with perforation

Ans. C

Explanation:

Average hearing loss in different lesions:

  • Complete obstruction of ear canal = 30db
  • Perforation of tympanic membrane = 10-40 db
  • Ossicular interruption with intact tympanic membrane= 54db
  • Ossicular interruption with perforation = 38db
  • Closure of oval window can cause 60 db hearing loss

Q. 6

A 30-year old woman with family history of hearing loss from her mother’s side developed hearing problem during pregnancy. Hearing loss is bilateral, slowly progressive, with bilateral tinnitus that bothers her at night. Pure tone audiometry shows conductive hearing loss with an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

 A

Otosclerosis

 B

Acoustic neuroma

 C

Otitis media with effusion

 D

Sigmoid sinus thrombosis

Q. 6

A 30-year old woman with family history of hearing loss from her mother’s side developed hearing problem during pregnancy. Hearing loss is bilateral, slowly progressive, with bilateral tinnitus that bothers her at night. Pure tone audiometry shows conductive hearing loss with an apparent bone conduction hearing loss at 2000 Hz. What is the most likely diagnosis?

 A

Otosclerosis

 B

Acoustic neuroma

 C

Otitis media with effusion

 D

Sigmoid sinus thrombosis

Ans. A

Explanation:

Otosclerosis is characterized by abnormal removal of mature dense otic capsule bone by osteoclasts, and replacement with the woven bone of greater thickness, cellularity, and vascularity.

When disease involves the annular ligament of the oval window and stapes footplate, a conductive hearing loss (CHL) occurs which is slowly progressive, usually bilateral and asymmetric. 

The hallmark of bone conduction thresholds in otosclerosis is the Carhart notch which is as a result from the disruption of normal ossicular resonance, approximately at 2000 Hz. One of the earliest signs of otosclerosis is an abnormal acoustic reflex.
 
Hormonal influences during pregnancy might cause a more rapid progression in women, bringing them to clinical attention.
 

Q. 7

Tympanogram of a 70 year old male with hearing loss and tinnitus revealed a type B wave. On examination he has a conductive type of deafness and a dull tympanic membrane on the right side. Lympadenopathy was present in the posterior triangle of neck. The most likely diagnosis is:

 A

Middle ear tumor

 B

Nasopharyngeal malignancy

 C

Acoustic neuroma

 D

T.B of middle ear

Q. 7

Tympanogram of a 70 year old male with hearing loss and tinnitus revealed a type B wave. On examination he has a conductive type of deafness and a dull tympanic membrane on the right side. Lympadenopathy was present in the posterior triangle of neck. The most likely diagnosis is:

 A

Middle ear tumor

 B

Nasopharyngeal malignancy

 C

Acoustic neuroma

 D

T.B of middle ear

Ans. B

Explanation:

The presence of conductive type of hearing loss, dull tympanic membrane and type B tympanogram suggests the presence of middle ear cavity or serous otitis media.

Serous otitis media in an older individual should raise the suspicion of nasopharyngeal malignancy. The presence of enlarged lymph nodes adds to the suspicion.


Q. 8

A teacher slapped a student after which she suffered from 25% hearing loss. This was corrected after a surgery. What kind of injury is this?

 A

Serious

 B

Grevious

 C

Dangerous

 D

Simple

Q. 8

A teacher slapped a student after which she suffered from 25% hearing loss. This was corrected after a surgery. What kind of injury is this?

 A

Serious

 B

Grevious

 C

Dangerous

 D

Simple

Ans. B

Explanation:

B i.e. Grevious


Q. 9

After rupture of tympanic membrane, the hearing loss is:

 A

10-40 dB

 B

5-15 dB

 C

20 dB

 D

300 dB

Q. 9

After rupture of tympanic membrane, the hearing loss is:

 A

10-40 dB

 B

5-15 dB

 C

20 dB

 D

300 dB

Ans. A

Explanation:

Q. 10

Which of the following conditions causes maximum hearing loss ?

 A

Ossicular disruption with intact tympanic membrane

 B

Disruption of malleus and incus with intact tympanic membrane

 C

Partial fixation of the stapes footplate

 D

All

Q. 10

Which of the following conditions causes maximum hearing loss ?

 A

Ossicular disruption with intact tympanic membrane

 B

Disruption of malleus and incus with intact tympanic membrane

 C

Partial fixation of the stapes footplate

 D

All

Ans. A

Explanation:

Q. 11

In a patient, audiogram shows hearing loss of 54 dB. Most probably it is due to:

 A

Ossicular disruption with intact TM

 B

Ossicular disruption with TM perforation

 C

Complete fixation of stapes footplate

 D

Otitis media with effusion

Q. 11

In a patient, audiogram shows hearing loss of 54 dB. Most probably it is due to:

 A

Ossicular disruption with intact TM

 B

Ossicular disruption with TM perforation

 C

Complete fixation of stapes footplate

 D

Otitis media with effusion

Ans. A

Explanation:

Q. 12

Commonest cause of hearing loss in children is:

 A

CSOM

 B

ASOM

 C

Acoustic – neuroma

 D

Chronic secretory otitis media

Q. 12

Commonest cause of hearing loss in children is:

 A

CSOM

 B

ASOM

 C

Acoustic – neuroma

 D

Chronic secretory otitis media

Ans. D

Explanation:

Q. 13

Conductive hearing loss is seen in all of the following except:

 A

Otosclerosis

 B

Otitis media with effusion

 C

Endolymphatic hydrops 

 D

Suppurative otitis media

Q. 13

Conductive hearing loss is seen in all of the following except:

 A

Otosclerosis

 B

Otitis media with effusion

 C

Endolymphatic hydrops 

 D

Suppurative otitis media

Ans. C

Explanation:

 

Endolymphatic hydrops i.e menieres disease leads to SNHL and not conductive hearing loss.



Q. 14

Threshhold for moderate hearing loss is:

 A

26-40dB

 B

0-25dB

 C

41-55dB

 D

More than 91 dB

Q. 14

Threshhold for moderate hearing loss is:

 A

26-40dB

 B

0-25dB

 C

41-55dB

 D

More than 91 dB

Ans. C

Explanation:

Q. 15

Lady has B/L hearing loss since 4 years which worsened during pregnancy.Type of impedance audiometry graph will be:

 A

Ad

 B

As

 C

B

 D

C

Q. 15

Lady has B/L hearing loss since 4 years which worsened during pregnancy.Type of impedance audiometry graph will be:

 A

Ad

 B

As

 C

B

 D

C

Ans. B

Explanation:

Q. 16

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

 A

Otosclerosis

 B

Acoustic neuroma

 C

Otitis media with effusion

 D

Sigmoid sinus thrombosis

Q. 16

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

 A

Otosclerosis

 B

Acoustic neuroma

 C

Otitis media with effusion

 D

Sigmoid sinus thrombosis

Ans. A

Explanation:

Q. 17

A 70 year old man presented with left sided conductive hearing loss, o/e TM intact and Type B curve on tympano­gram. Next step is:

 A

Myrinogotomy and grommet insertion

 B

Conservative management

 C

Type 3 tympanoplasty

 D

Endoscopic examination to look for nasopharyngeal causes

Q. 17

A 70 year old man presented with left sided conductive hearing loss, o/e TM intact and Type B curve on tympano­gram. Next step is:

 A

Myrinogotomy and grommet insertion

 B

Conservative management

 C

Type 3 tympanoplasty

 D

Endoscopic examination to look for nasopharyngeal causes

Ans. D

Explanation:

Q. 18

A 35 years old pregnant female complaining of hearing loss, which aggravated during pregnancy, was sent for tympanometry. Which of the following graph will be seen?

 A

As

 B

Ad

 C

B

 D

C

Q. 18

A 35 years old pregnant female complaining of hearing loss, which aggravated during pregnancy, was sent for tympanometry. Which of the following graph will be seen?

 A

As

 B

Ad

 C

B

 D

C

Ans. A

Explanation:

 

A 35 years old pregnant female complained of hearing loss, which was aggravated during pregnancy. This patient is most probably suffering from otosclerosis, which is more common in females and aggravated during pregnancy. Type As tympanogram is seen in otosclerosis


Q. 19

41-55 dB of hearing loss is categorized as _________

 A

Mild

 B

Moderate

 C

Moderately severe

 D

Severe

Q. 19

41-55 dB of hearing loss is categorized as _________

 A

Mild

 B

Moderate

 C

Moderately severe

 D

Severe

Ans. B

Explanation:

Q. 20

Unilateral conductive hearing loss in a patient with history of head injury. On examination, tympanic membrane is normal and mobile. The cause for deafness could be 

 A

Collection of fluid in the middle ear

 B

Otosclerosis

 C

Dislocation of the incudostapedial joint

 D

ASOM

Q. 20

Unilateral conductive hearing loss in a patient with history of head injury. On examination, tympanic membrane is normal and mobile. The cause for deafness could be 

 A

Collection of fluid in the middle ear

 B

Otosclerosis

 C

Dislocation of the incudostapedial joint

 D

ASOM

Ans. C

Explanation:

 

Acquired causes of conductive hearing loss include:

  • Perforation of tympanic membrane
  • Fluid in the middle ear-acute otitis media, serous otitis media, hemotympanum
  • Mass in the middle ear (benign/malignant)
  • Disruption of ossicles-trauma to ossicular chain, CSOM, cholesteatoma
  • Fixation of ossicles-otosclerosis, tympanosclerosis
  • Eustachian tube blockage

Q. 21

Conducting hearing loss with intact tympanic membrane ‑

 A

Presbycausis

 B

Meniere’s disease

 C

Glue ear

 D

Acoustic neuroma

Q. 21

Conducting hearing loss with intact tympanic membrane ‑

 A

Presbycausis

 B

Meniere’s disease

 C

Glue ear

 D

Acoustic neuroma

Ans. C

Explanation:

Ans. is ‘c’ i.e., Glue ear

Among the given options, only glue ear (serous otitis media) is a cause of conductive deafness.


Q. 22

When the patient fails to understand normal speech, but can understand shouted or amplified speech the hearing loss, is termed ‑

 A

Mild hearing loss

 B

Moderate hearing loss

 C

Severe hearing loss

 D

Profound hearing loss

Q. 22

When the patient fails to understand normal speech, but can understand shouted or amplified speech the hearing loss, is termed ‑

 A

Mild hearing loss

 B

Moderate hearing loss

 C

Severe hearing loss

 D

Profound hearing loss

Ans. C

Explanation:

Ans. is ‘c’ i.e., Severe hearing loss



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