Mastoidectomy

Mastoidectomy

Q. 1 A 30 year old male is having Attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following will be the operation of choice?
 A Intact canal wall mastoidectomy
 B Simple mastoidectomy with Tympanoplasty 
 C Canal wall down mastoidectomy
 D Mastoidectomy with cavity obliteration
Q. 1 A 30 year old male is having Attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following will be the operation of choice?
 A Intact canal wall mastoidectomy
 B Simple mastoidectomy with Tympanoplasty 
 C Canal wall down mastoidectomy
 D Mastoidectomy with cavity obliteration
Ans. C

Explanation:

(CWD) Canal wall down is usually done is cases of Attic cholesteotoma with complications. The indications for a canal wall down procedure would be a large cholesteatonma involving the mastoid cavity, or a patient with chronic otitis media who has already failed a canal wall up procedure. There is a category of canal wall down procedures based on intracranial complications of chronic ottitis media, due to cholesteamoma, For etample brain  abscess or  meningitis from ear  disease  or even a sigmoid sinus thrombosis from ear disease these would merit a canal wall down procedure


Q. 2

Iatrogenic traumatic facial nerve palsy is most commonly caused du­ring:

 A

Myringoplasty

 B

Stapedectomy

 C

Mastoidectomy

 D

Ossiculoplasty

Q. 2

Iatrogenic traumatic facial nerve palsy is most commonly caused du­ring:

 A

Myringoplasty

 B

Stapedectomy

 C

Mastoidectomy

 D

Ossiculoplasty

Ans. C

Explanation:

Q. 3

Schwartz operation is:

 A

Cortical mastoidectomy

 B

Radical mastoidectomy

 C

Modified radical mastoidectomy

 D

Myringotomy

Q. 3

Schwartz operation is:

 A

Cortical mastoidectomy

 B

Radical mastoidectomy

 C

Modified radical mastoidectomy

 D

Myringotomy

Ans. A

Explanation:

Q. 4

Radical mastoidectomy is done for:

 A

ASOM

 B

CSOM

 C

Attico antro cholesteatoma

 D

Acute mastoiditis

Q. 4

Radical mastoidectomy is done for:

 A

ASOM

 B

CSOM

 C

Attico antro cholesteatoma

 D

Acute mastoiditis

Ans. C

Explanation:

Q. 5

A 30 year old male is having attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following would be the operation of choice?

 A

Intact canal wall mastoidectomy

 B

Canal wall down mastoidectomy

 C

Mastoidectomy with cavity obliteration

 D

Simple mastoidectomy with Tympanoplasty

Q. 5

A 30 year old male is having attic cholesteatoma of left ear with lateral sinus thrombophlebitis. Which of the following would be the operation of choice?

 A

Intact canal wall mastoidectomy

 B

Canal wall down mastoidectomy

 C

Mastoidectomy with cavity obliteration

 D

Simple mastoidectomy with Tympanoplasty

Ans. B

Explanation:

Canal wall down mastoidectomy is done in cases of attic cholesteatoma. In this procedure mastoid cavity is left open into the external auditory canal.

Since the patient in the question is suffering from attic cholesteatoma and secondary complications canal wall down mastoidectomy would be the treatment of choice.

Other indications of this procedure includes extensive chronic otits media, formation of a new attic retraction pocket with disease following a previously performed canal wall up procedure, lateral semicircular canal fistula in the only hearing ear.


Q. 6

Which of the following is an indication for cortical mastoidectomy?

 A

CSOM

 B

CSOM with brain abscess

 C

Coalescent mastoiditis

 D

Perforation of pars flascida

Q. 6

Which of the following is an indication for cortical mastoidectomy?

 A

CSOM

 B

CSOM with brain abscess

 C

Coalescent mastoiditis

 D

Perforation of pars flascida

Ans. C

Explanation:

Q. 7

Which of the following surgery is known as Schwartz operation?

 A

Cortical mastoidectomy

 B

Radical mastoidectomy

 C

Modified radical mastoidectomy

 D

Myringotomy

Q. 7

Which of the following surgery is known as Schwartz operation?

 A

Cortical mastoidectomy

 B

Radical mastoidectomy

 C

Modified radical mastoidectomy

 D

Myringotomy

Ans. A

Explanation:

Cortical mastoidectomy, known as simple or complete mastoidectomy or Schwartz operation, is complete exenteration of all accessible mastoid air cells and converting them into single cavity. Posterior meatal wall is left intact. Middle ear structures are not disturbed.

 
Indications:
1. Acute coalescent mastoiditis
2. Incompletely resolved acute otitis media with reservoir sign
3. Masked mastoiditis
4. As an initial step to perform,
  • Endolymphatic sac surgery
  • Decompression facial nerve
  • Translabyrinthine or retrolabyrinthine procedures for acoustic neuroma

Q. 8

All of the following are removed during modified radical mastoidectomy in a patient with cholesteatoma, EXCEPT:

 A

Incus and head of malleus removed

 B

Lateral attic wall removed

 C

Cochlea removed

 D

Posterior meatal wall removed

Q. 8

All of the following are removed during modified radical mastoidectomy in a patient with cholesteatoma, EXCEPT:

 A

Incus and head of malleus removed

 B

Lateral attic wall removed

 C

Cochlea removed

 D

Posterior meatal wall removed

Ans. C

Explanation:

Q. 9

What is the indication for radical mastoidectomy in an middle aged female?

 A

ASOM

 B

CSOM

 C

Cholesteatoma invading eustachian tube

 D

Acute mastoiditis

Q. 9

What is the indication for radical mastoidectomy in an middle aged female?

 A

ASOM

 B

CSOM

 C

Cholesteatoma invading eustachian tube

 D

Acute mastoiditis

Ans. C

Explanation:

Indications for radical mastoidectomy:
  • When all cholesteatoma cannot be safely removed, e.g., that invading eustachian tube, round window niche, perilabyrinthine or hypotympanic cells.
  • If previous attempts to eradicate chronic inflammatory disease or cholesteatoma have failed.
  • As an approach to petrous apex
  • Removal of glomus tumor
  • Carcinoma middle ear

Q. 10

Which of the following is the treatment of choice for atticoantral variety of chronic suppurative otitis media?

 A

Mastoidectomy

 B

Medical management

 C

Underlay myringoplasty

 D

Insertion of ventilation lube

Q. 10

Which of the following is the treatment of choice for atticoantral variety of chronic suppurative otitis media?

 A

Mastoidectomy

 B

Medical management

 C

Underlay myringoplasty

 D

Insertion of ventilation lube

Ans. A

Explanation:

Atticoantral type of CSOM involves the attic of the tympanic membrane and is often associated with cholesteatoma formation.

In this type, a retraction pocket develops in the pars flaccida and a cholesteatoma develops if the squamous epithelium cannot migrate out of this pocket.

It is associated with a number of complications and the surgery is the primary modality of treatment.

Surgical procedures indicated in this condition are atticotomy, mastoidectomy or combined approach tympanoplasty.

 
Tubotympanic type of CSOM involves the anteroinferior part of the middle ear cleft and is associated with a permanent central perforation. It is not associated with serious complications and it is called safe or benign CSOM.
 

Q. 11

Iatrogenic traumatic facial nerve palsy is MOST commonly produced during which of the following surgical procedure?

 A

Myringoplasty

 B

Stapedectomy

 C

Mastoidectomy

 D

Ossiculoplasty

Q. 11

Iatrogenic traumatic facial nerve palsy is MOST commonly produced during which of the following surgical procedure?

 A

Myringoplasty

 B

Stapedectomy

 C

Mastoidectomy

 D

Ossiculoplasty

Ans. C

Explanation:

 
Iatrogenic facial nerve trauma most often occurs during mastoidectomy. When injury occur to more than 50% of the neural diameter either primary reanastomosis or reconstruction using a nerve graft is done. 
 
Complications of mastoidectomy includes:
  • Infection
  • Labrynthitis ossificans
  • Mucosalization of the middle ear
  • Facial nerve injury
  • CSF leak
  • Encephalocele

Q. 12

The treatment of choice for atticoantral variety of chronic suppurative otitis media is:

 A

Mastoidectomy

 B

Medical management

 C

Underlay myringoplasty

 D

Insertion of ventilation tube

Q. 12

The treatment of choice for atticoantral variety of chronic suppurative otitis media is:

 A

Mastoidectomy

 B

Medical management

 C

Underlay myringoplasty

 D

Insertion of ventilation tube

Ans. A

Explanation:

Q. 13

Treatment of choice for Perforation in pars flaccida of the tympanic membrane with cholesteatoma is: 

 A

Myringoplasty

 B

 Modified Radical Mastoidectomy [MRM]

 C

Antibiotics

 D

Radical mastoidectomy

Q. 13

Treatment of choice for Perforation in pars flaccida of the tympanic membrane with cholesteatoma is: 

 A

Myringoplasty

 B

 Modified Radical Mastoidectomy [MRM]

 C

Antibiotics

 D

Radical mastoidectomy

Ans. B

Explanation:

Q. 14

Treatment of cholesteatoma with facial paresis in child is:

 A

Antibiotics to dry ear and then mastoidectomy

 B

Immediate mastoidectomy

 C

Observation

 D

Only antibiotic ear drops

Q. 14

Treatment of cholesteatoma with facial paresis in child is:

 A

Antibiotics to dry ear and then mastoidectomy

 B

Immediate mastoidectomy

 C

Observation

 D

Only antibiotic ear drops

Ans. B

Explanation:

Q. 15

Schwartz operation is also called as:

 A

Cortical mastoidectomy

 B

Radial mastoidectomy

 C

Fenestration operation

 D

All

Q. 15

Schwartz operation is also called as:

 A

Cortical mastoidectomy

 B

Radial mastoidectomy

 C

Fenestration operation

 D

All

Ans. A

Explanation:

Q. 16

Simple mastoidectomy is done in:

 A

Acute mastoiditis

 B

Cholesteatoma

 C

Coalescent mastoiditis

 D

Localized chronic otitis media

Q. 16

Simple mastoidectomy is done in:

 A

Acute mastoiditis

 B

Cholesteatoma

 C

Coalescent mastoiditis

 D

Localized chronic otitis media

Ans. C

Explanation:

Q. 17

Cortical mastoidectomy in indicated in:

 A

Cholesteatoma without complication

 B

Coalescent mastoiditis

 C

CSOM with brain abscess

 D

perforation in Pars flaccida

Q. 17

Cortical mastoidectomy in indicated in:

 A

Cholesteatoma without complication

 B

Coalescent mastoiditis

 C

CSOM with brain abscess

 D

perforation in Pars flaccida

Ans. B

Explanation:

 

Schwartz operation is another name for cortical/sample mastoidectomy


Q. 18

Radical mastoidectomy is done for:

 A

ASOM

 B

CSOM

 C

Atticoantral cholesteotoma

 D

Acute mastoiditis

Q. 18

Radical mastoidectomy is done for:

 A

ASOM

 B

CSOM

 C

Atticoantral cholesteotoma

 D

Acute mastoiditis

Ans. C

Explanation:

Q. 19

All of of the following steps are done in radical mastoidectomy except:

 A

Lowering of facial ridge

 B

Removal of middle ear mucosa and muscles

 C

Removal of all ossicles of eustachiean tube plate

 D

Maintainance of patency of eustachian tube

Q. 19

All of of the following steps are done in radical mastoidectomy except:

 A

Lowering of facial ridge

 B

Removal of middle ear mucosa and muscles

 C

Removal of all ossicles of eustachiean tube plate

 D

Maintainance of patency of eustachian tube

Ans. D

Explanation:

Q. 20

Radical mastoidectomy includes all except: 

 A

Closure of the auditory tube

 B

Ossicles removed

 C

Cochlea removed

 D

Exteriorisation of mastoid

Q. 20

Radical mastoidectomy includes all except: 

 A

Closure of the auditory tube

 B

Ossicles removed

 C

Cochlea removed

 D

Exteriorisation of mastoid

Ans. C

Explanation:

Q. 21

Modified radical mastoidectomy is indicated in all except:

 A

Safe SCOM

 B

Unsafe CSOM with atticoantral disease

 C

Coalescent mastoiditis

 D

Limited mastoid pathology

Q. 21

Modified radical mastoidectomy is indicated in all except:

 A

Safe SCOM

 B

Unsafe CSOM with atticoantral disease

 C

Coalescent mastoiditis

 D

Limited mastoid pathology

Ans. C

Explanation:

Q. 22

A -30-yead old male is having Attic cholesteatoma of left ear with lateral sinus thromboplebitis. Which of the following will be the operation of choice?

 A

Intact canal will be the operation of choice

 B

Simple mastoidectomy with Tympanoplasty

 C

Canal wall down mastoidectomy

 D

Mastodidectomy with cavity obliteration

Q. 22

A -30-yead old male is having Attic cholesteatoma of left ear with lateral sinus thromboplebitis. Which of the following will be the operation of choice?

 A

Intact canal will be the operation of choice

 B

Simple mastoidectomy with Tympanoplasty

 C

Canal wall down mastoidectomy

 D

Mastodidectomy with cavity obliteration

Ans. C

Explanation:

In Attic cholesteatoma, if it invades eustachian tube or perilabyrynthine tissue, then manage­ment is Radial Mastoidectomy. 


Q. 23

Communication between middle ear and Eustachian tube is obliterated in which surgery?

 A

Tympanoplasty

 B

Schwartz operation

 C

Modified radical mastoidectomy

 D

Radical mastoidectomy

Q. 23

Communication between middle ear and Eustachian tube is obliterated in which surgery?

 A

Tympanoplasty

 B

Schwartz operation

 C

Modified radical mastoidectomy

 D

Radical mastoidectomy

Ans. D

Explanation:

 

In radical mastoidectomy, the opening of Eustachian tube is closed by curetting its mucosa and plugging the opening with tensor tympani muscle or cartilage.


Q. 24

latrogenic traumatic facial nerve palsy is most commonly caused during:

 A

Myringoplasty

 B

Stapedectomy

 C

Mastoidectomy

 D

Ossiculoplasty

Q. 24

latrogenic traumatic facial nerve palsy is most commonly caused during:

 A

Myringoplasty

 B

Stapedectomy

 C

Mastoidectomy

 D

Ossiculoplasty

Ans. C

Explanation:

 

Other Operations where Facial Nerve may be Damaged

–         Stapedectomy

–         Removal of acoustic neuroma



Q. 25

Treatment of middle ear malignancy includes:

 A

Excision of petrous part of temporal bone

 B

Subcortical excision

 C

Modified radical mastoidectomy

 D

a and c

Q. 25

Treatment of middle ear malignancy includes:

 A

Excision of petrous part of temporal bone

 B

Subcortical excision

 C

Modified radical mastoidectomy

 D

a and c

Ans. D

Explanation:

 

Most common malignant tumor of middle ear and mastoid is squamous cell carcinoma.

Clinical Features

  • It affects age group 40-60 years
  • Slightly more common in females
  • Most important predisposing cause is long standing CSOM
  • Patient may present with chronic foul smelling blood stained discharge
  • Pain is severe and comes at night.
  • Facial palsy may be seen
  • 0/E – Friable, hemorrhagic granulation or polyp are present.
  • Diagnosis – made only on biopsy CT and angiography are done to see the extent of disease.

Metastasis occurs to cervical lymph nodes later.

Treatment of carcinoma of middle ear is combination of surgery followed by radiotherapy.

Surgery consists of radical mastoidectomy / subtotal or total petrosectomy depending on the extent of tumor.



Q. 26

Attico antral disease is treated by ‑

 A

Modified radical mastoidectomy

 B

Antibiotics

 C

Grommet insertion

 D

Synringing

Q. 26

Attico antral disease is treated by ‑

 A

Modified radical mastoidectomy

 B

Antibiotics

 C

Grommet insertion

 D

Synringing

Ans. A

Explanation:

Ans. is ‘a’ i.e., Modified radical mastoidectomy

Treatment of atticoantral disease

Since cholesteatoma is going to expand and destroy bone and mucous membrane, it has to be removed. Therefore, surgery is the mainstay of treatment. Primary aim is removal of disease by mastoidectomy to make ear safe followed by reconstruction of hearing at a later stage. Modified radical mastoidectomy is the surgery of choice.

Two types of surgical procedures (mastoidectomy) are done to deal with cholesteatoma.

1) Canal wall down procedures

  • These leave the mastoid cavity open into the external auditory canal so that the diseased area is fully exteriorized.
  • The commonly used procedures for atticoantral disease are atticotomy, modified radical mastoidectomy and rarely radical mastoidectomy.
  • Modified radical mastoidectomy is the procedure of choice.

2) Canal wall up procedures (cortical mastoidectomy)

  • Here disease is removed by combined approach through the meatus and mastoid but retaining the posterior bony meatus wall, thereby avoiding an open mastoid cavity.
  • For reconstruction of hearing mechanism myringoplasty or tympanoplasty can be done at the time of primary surgery or as a second stage procedure.

Q. 27

Treatment of middle ear papilloma is ‑

 A

Myringotomy and simple excision

 B

Myringectomy and simple excision

 C

Tympanomastoidectomy

 D

Local infiltration with podophyllin

Q. 27

Treatment of middle ear papilloma is ‑

 A

Myringotomy and simple excision

 B

Myringectomy and simple excision

 C

Tympanomastoidectomy

 D

Local infiltration with podophyllin

Ans. C

Explanation:

Ans. is ‘c’ i.e., Tympanomastoidectomy

Middle ear pappilomas

The middle ear papillomas are rare presentations and medical literature is mainly limited to case reports or case series.

These include aggressive pappilary tumors, schneiderian type of pappilomas and inverted pappilomas.

They are associated with hearing difficulty and vertigo and may be associated with Von Hippel Lindau syndrome.

They tend to be slowly growing, locally aggressive non metastasizing neoplasms

The approach for treatment of such pathology is usually radical and tympanomastoidectomy is considered the treatment of choice. This gives the best chance of cure.


Q. 28

A 12 year old presents with fever, unilateral post auricular pain, mastoid bulging displacing the pinna forward and outwards with loss of bony trabeculae. This patient has history of chronic persistent pus discharge from same ear. Treatment of choice is‑

 A

Antibiotics only

 B

Incision and drainage

 C

Antibiotics, incision and drainage

 D

Mastoidectomy with incision, drainage and antibiotics

Q. 28

A 12 year old presents with fever, unilateral post auricular pain, mastoid bulging displacing the pinna forward and outwards with loss of bony trabeculae. This patient has history of chronic persistent pus discharge from same ear. Treatment of choice is‑

 A

Antibiotics only

 B

Incision and drainage

 C

Antibiotics, incision and drainage

 D

Mastoidectomy with incision, drainage and antibiotics

Ans. D

Explanation:

 

The patient is presenting with features of postauricular subperiosteal abscess. Treatment for this is antibiotics along with drainage of abscess and cortical mastoidectomy.

This patient has developed this abscess as a complication of CSOM (History of chronic ear discharge) for which he requires meastoidectomy.



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