Tympanic Membrane

Tympanic Membrane

Q. 1

Most common site of perforation of tympanic membrane in ASOM is

 A

Anterior superior quadrant

 B

Anterior inferior quadrant

 C

Posterior superior quadrant

 D

Posterior inferior quadrant

Q. 1

Most common site of perforation of tympanic membrane in ASOM is

 A

Anterior superior quadrant

 B

Anterior inferior quadrant

 C

Posterior superior quadrant

 D

Posterior inferior quadrant

Ans. B

Explanation:

Q. 2

 A patient presented with the following picture of Tympanic Membrane. Most Probable diagnosis (marked with arrow)

 A

Tubercular Otitis Media

 B

Syphilitic Otitis Media

 C

Pseudomonas infection

 D

Fungal Otitis Media

Q. 2

 A patient presented with the following picture of Tympanic Membrane. Most Probable diagnosis (marked with arrow)

 A

Tubercular Otitis Media

 B

Syphilitic Otitis Media

 C

Pseudomonas infection

 D

Fungal Otitis Media

Ans. A

Explanation:

 Tympanic membrane showing multiple perforations

  • Infection reaches the middle ear through eustachian tube.
  • The rare modes of infection are through hematogenous spread from tubercular focus in lung, tonsils, cervical lymph nodes; or due to ingestion of infected cow’s milk.
  • It usually affects children and young adults.

Q. 3

Rupture of an ear drum may occur at the noise level above :

 A

120 dB

 B

160 dB

 C

90 dB

 D

80 dB

Q. 3

Rupture of an ear drum may occur at the noise level above :

 A

120 dB

 B

160 dB

 C

90 dB

 D

80 dB

Ans. B

Explanation:

Q. 4

Use of nitrous oxide is contraindicated in all of the following surgeries, EXCEPT:

 A

Tympanic membrane grafting

 B

Pneumoencephalography

 C

Vitreoretinal surgery

 D

Exenteration operation

Q. 4

Use of nitrous oxide is contraindicated in all of the following surgeries, EXCEPT:

 A

Tympanic membrane grafting

 B

Pneumoencephalography

 C

Vitreoretinal surgery

 D

Exenteration operation

Ans. D

Explanation:

Conditions in which nitrous oxide might be hazardous include,

  • Air embolism
  • Pneumothorax
  • Acute intestinal obstruction
  • Intracranial air (tension pneumocephalus following dural closure or pneumoencephalography)
  • Pulmonary air cysts
  • Intraocular air bubbles
  • Tympanic membrane grafting

Ref: Morgan, Jr. G.E., Mikhail M.S., Murray M.J. (2006). Chapter 7. Inhalation Anesthetics. In G.E. Morgan, Jr., M.S. Mikhail, M.J. Murray (Eds), Clinical Anesthesiology, 4e.


Q. 5

The torture method involving simultaneous beating of both ears with palms of hand, resulting in rupture of tympanic membrane is called?

 A

Falanga

 B

Waterboarding

 C

Telefono

 D

Dunking

Q. 5

The torture method involving simultaneous beating of both ears with palms of hand, resulting in rupture of tympanic membrane is called?

 A

Falanga

 B

Waterboarding

 C

Telefono

 D

Dunking

Ans. C

Explanation:

Falanga involves beating on sole of feet. In dunking the victim is immersed in water.

In water boarding the victim is immobilised in a supine position with head inclined downwards and water is poured on the face.

Ref: Textbook of Forensic Medicine and Toxicology by V.V Pillay, 15th Edition, Page 118.

Q. 6

All of the following can be achieved by the use of siegel’s speculum during examination of the ear, EXCEPT:

 A

Magnification

 B

Removal of foreign body from the ear

 C

As applicator for the powdered antibiotic of ear

 D

Assessment of movement of the tympanic membrane

Q. 6

All of the following can be achieved by the use of siegel’s speculum during examination of the ear, EXCEPT:

 A

Magnification

 B

Removal of foreign body from the ear

 C

As applicator for the powdered antibiotic of ear

 D

Assessment of movement of the tympanic membrane

Ans. B

Explanation:

Siegel’s speculum has an eyepiece, which is a convex lens with a magnification of 2.5 times. The eyepiece is connected to an aural speculum. It is not used to remove foreign body from the ear.

Indications: It is used to provide a magnified view of ear drum, to test mobility of ear drum by varying the pressure of external canal, to suck out middle ear secretions in patients with chronic serous ottitis media and to instill ear drops into the middle ear.

Ref: Clinical Examination Techniques in Otology 2012 By Balasubramanian, Section 5; Essentials of Otolaryngology By Frank E. Lucente, 5th Edition, Page 121


Q. 7

A young man presents with an accident leading to loss of hearing in the right ear. On otoscopic examination, the tympanic membrane was intact. Pure tone audiometry shows an Air – Bone gap of 55 dB in the right ear with normal cochlear reserve. Which of the following will be the likely tympanometry finding?

 A

As type tympanogram

 B

Ad type tympanogram

 C

B type tympanogram

 D

C type tympanogram

Q. 7

A young man presents with an accident leading to loss of hearing in the right ear. On otoscopic examination, the tympanic membrane was intact. Pure tone audiometry shows an Air – Bone gap of 55 dB in the right ear with normal cochlear reserve. Which of the following will be the likely tympanometry finding?

 A

As type tympanogram

 B

Ad type tympanogram

 C

B type tympanogram

 D

C type tympanogram

Ans. B

Explanation:

The threshold of bone conduction is a measure of cochlear function in pure tone audiometry.

The difference in the thresholds of air and bone conduction (A-B) is a measure of the degree of conductive deafness.

Here this patient is having a normal cochlear function.

So A-B gap of 55 dB will be because of defect in air conduction.

Otoscopic examination showed an intact tympanic membrane means the ossicular discontinuity will be the reason for the hearing loss.

Therefore the tympanometry finding in this patient will be Ad type tympanogram.
 

Q. 8

A 31 year old female patient complaints of bilateral impairment of hearing for the past 5 years. On examination, tympanic membrane is normal and audiogram shows a bilateral conductive deafness. Impedance audiometry shows normal curve and acoustic reflexes are absent. All of the following constitute part of its treatment, EXCEPT:

 A

Gentamicin

 B

Hearing aid

 C

Stapedectomy

 D

Sodium fluoride

Q. 8

A 31 year old female patient complaints of bilateral impairment of hearing for the past 5 years. On examination, tympanic membrane is normal and audiogram shows a bilateral conductive deafness. Impedance audiometry shows normal curve and acoustic reflexes are absent. All of the following constitute part of its treatment, EXCEPT:

 A

Gentamicin

 B

Hearing aid

 C

Stapedectomy

 D

Sodium fluoride

Ans. A

Explanation:

The patient is showing features of otosclerosis.

It is a condition due to new spongy bone formation.

About 50% of the cases may have a positive family history and deafness starts between the age of 20-30 years.

Non surgical treatment of otosclerosis includes use of hearing aid and sodium fluoride.

Use of high doses of sodium fluoride is thought to increase the remineralization of otospongotic foci.

It has been reported to stabilize progressive inner ear hearing loss and tinnitus. Surgical treatment of choice is stapedectomy.
 

Q. 9

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. 9

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. 10

A young man is brought to the casualty with head trauma following a motor vehicle accident. He was unconscious. Hemotympanum without laceration of the tympanic membrane was evident. 
 
Assertion: Longitudinal fractures cause sensorineural hearing loss.
 
Reason: This fracture passes through the posterosuperior aspect of the external auditory canal, tympanic membrane, and the roof of the middle ear. These fractures commonly disrupt the ossicles.
 
 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 10

A young man is brought to the casualty with head trauma following a motor vehicle accident. He was unconscious. Hemotympanum without laceration of the tympanic membrane was evident. 
 
Assertion: Longitudinal fractures cause sensorineural hearing loss.
 
Reason: This fracture passes through the posterosuperior aspect of the external auditory canal, tympanic membrane, and the roof of the middle ear. These fractures commonly disrupt the ossicles.
 
 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. D

Explanation:

Longitudinal fractures cause conductive hearing loss. They are the most common fractures of the temporal bone. This fracture typically results from a direct blow to the temporal or parietal aspects of the head. Symptoms at presentation include conductive hearing loss, bloody otorrhea, and loss of consciousness. Fractures extending through the mastoid rather than ear canal can result in hemotympanum without laceration of the tympanic membrane.


Q. 11

A middle aged female presented with complaints of progressive deafness and tinnitus. On examination, deafness is conductive in nature. Otoscopy shows a red reflex through intact tympanic membrane. “Pulsation sign” is positive. 

 
Assertion: The possible diagnosis is glomus tumor, which is the most common benign neoplasm of middle ear.
 
Reason: When ear canal pressure is raised with Siegle’s speculum tumor pulsates vigorously and then blanches and the reverse happens when the pressure is released.
 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 11

A middle aged female presented with complaints of progressive deafness and tinnitus. On examination, deafness is conductive in nature. Otoscopy shows a red reflex through intact tympanic membrane. “Pulsation sign” is positive. 

 
Assertion: The possible diagnosis is glomus tumor, which is the most common benign neoplasm of middle ear.
 
Reason: When ear canal pressure is raised with Siegle’s speculum tumor pulsates vigorously and then blanches and the reverse happens when the pressure is released.
 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. A

Explanation:

Glomus tumour originates from the glomus bodies. It found in the dome of jugular bulb or on the promontory along the course of tympanic branch of IXth cranial nerve.


Q. 12

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. 12

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. 13

A 40 year old man presents to the general medicine clinic complaining of progressive hearing loss in his right ear. He says that over the past year, he has had difficulty hearing conversations in noisy places such as restaurants. In the past few months, he has experienced occasional ringing in his right ear. His hearing in his left ear has not been affected. He denies headache, vertigo, otalgia, facial pain, or weakness. He has no medical problems and does not take any medications. Otoscopic examination reveals pearly gray tympanic membranes bilaterally without any bulge or retraction. A Weber’s test is performed, and the patient reports hearing the vibration loudest in his left ear. Which of the following findings would MOST likely be observed in this patient?

 A

Air conduction equals bone conduction in his left ear

 B

Air conduction equals bone conduction in his right ear

 C

Air conduction is greater than bone conduction in his right ear

 D

Bone conduction is greater than air conduction in his left ear

Q. 13

A 40 year old man presents to the general medicine clinic complaining of progressive hearing loss in his right ear. He says that over the past year, he has had difficulty hearing conversations in noisy places such as restaurants. In the past few months, he has experienced occasional ringing in his right ear. His hearing in his left ear has not been affected. He denies headache, vertigo, otalgia, facial pain, or weakness. He has no medical problems and does not take any medications. Otoscopic examination reveals pearly gray tympanic membranes bilaterally without any bulge or retraction. A Weber’s test is performed, and the patient reports hearing the vibration loudest in his left ear. Which of the following findings would MOST likely be observed in this patient?

 A

Air conduction equals bone conduction in his left ear

 B

Air conduction equals bone conduction in his right ear

 C

Air conduction is greater than bone conduction in his right ear

 D

Bone conduction is greater than air conduction in his left ear

Ans. C

Explanation:

This patient has sensorineural deafness in his right ear due to his acoustic neuroma. In the normal ear, air conduction is greater than bone conduction. An ear with sensorineural deafness will still have air conduction greater than bone conduction, however both will be qualitatively decreased.

 

Q. 14

Most common site of perforation of tympanic membrane in acute suppurative otitis media is:

 A

Anterior superior quadrant

 B

Anterior inferior quadrant

 C

Posterior superior quadrant

 D

Posterior inferior quadrant

Q. 14

Most common site of perforation of tympanic membrane in acute suppurative otitis media is:

 A

Anterior superior quadrant

 B

Anterior inferior quadrant

 C

Posterior superior quadrant

 D

Posterior inferior quadrant

Ans. B

Explanation:

In acute suppurative otitis media, 85% of cases show a small perforation in antero-inferior quadrant of pars tensa.

Perforations in this location were associated with smooth margins, good drainage of pus, and a favorable clinical course.

Hence this area is termed as “perforation zone”.

Only 15% of perforations occurred in other locations, most typically the posterior-superior quadrant.


Q. 15

Which structure is attached to the center of the tympanic membrane?

 A

Footplate of the stapes

 B

Handle of the malleus

 C

Long process of the incus

 D

Tragus

Q. 15

Which structure is attached to the center of the tympanic membrane?

 A

Footplate of the stapes

 B

Handle of the malleus

 C

Long process of the incus

 D

Tragus

Ans. B

Explanation:

Q. 16

A man presented with pulsatile tinnitus and hearing loss. A vascular mass is seen behind the tympanic membrane. Diagnosis can be:

 A

Glomus Jugulare

 B

Ca mastoid

 C

Acoustic neuroma

 D

Angiofibroma

Q. 16

A man presented with pulsatile tinnitus and hearing loss. A vascular mass is seen behind the tympanic membrane. Diagnosis can be:

 A

Glomus Jugulare

 B

Ca mastoid

 C

Acoustic neuroma

 D

Angiofibroma

Ans. A

Explanation:

Glomus tumors arise either in the middle ear (glomus tympanicum) or in the jugular bulb with upward erosion into the hypotympanum (glomus jugulare).

They present clinically with pulsatile tinnitus and hearing loss. A vascular mass may be visible behind an intact tympanic membrane.

Large glomus jugulare tumors are often associated with multiple cranial neuropathies, especially involving nerves VII, IX, X, XI, and XII.

Treatment usually requires surgery, radiotherapy, or both.
 

Q. 17

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. 17

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. 18

The following structure represents all the 3 components of the embryonic disc-

 A

Tympanic membrane

 B

Retina

 C

Meninges

 D

None of the above

Q. 18

The following structure represents all the 3 components of the embryonic disc-

 A

Tympanic membrane

 B

Retina

 C

Meninges

 D

None of the above

Ans. A

Explanation:

A i.e. Tympanic membrane

Tympanic membrane derived from first pharyngeal membrane (which seperates 1st pharyngeal groove from 1st pharyngeal pouch) represents all three layers of embryonic disco. It develops from three sources. 1) External very thin skin is derived from ectoderm of 1st pharyngeal groove; 2) Medoderm of 1st & 2hd pharyngeal arches; 3) Internal lining is derived from endoderm of tubotympanic recess, (a derivative of 1st pharyngeal pouch).


Q. 19

Nerve supply of the tympanic membrane is by the

 A

Auriculotemporal

 B

Lesser occipital

 C

Greater occipital

 D

Parasympathetic ganglion

Q. 19

Nerve supply of the tympanic membrane is by the

 A

Auriculotemporal

 B

Lesser occipital

 C

Greater occipital

 D

Parasympathetic ganglion

Ans. A

Explanation:

A i.e. Aurico-temporal nerve


Q. 20

The treatment of traumatic rupture of tympanic membrane is-

 A

Aural packing

 B

Chloromycetin ear dorps

 C

Tympanoplasty

 D

No active treatment

Q. 20

The treatment of traumatic rupture of tympanic membrane is-

 A

Aural packing

 B

Chloromycetin ear dorps

 C

Tympanoplasty

 D

No active treatment

Ans. D

Explanation:

Ans. is ‘d’ i.e., No active treatment

T/T of traumatic rupture of tympanic membrane.

  • Systemic antibiotics and topical optic medications are not required unless suppurative otorrhoea is present.
  • Close follow up examination is necessary to ensure that Spontaneous healing occurs.
  • If the tympanic membrane does not heal within several months, surgical graft repair should be considered.

Q. 21

A 20 year old male come to causality with head injury. Examination reveals normal consciousness and blood in the tympanic membrane. Most likely cause is

 A

Extradural hemorrhage

 B

Subdural hemorrhage

 C

Intraventricular hemorrhage

 D

Basilar fracture

Q. 21

A 20 year old male come to causality with head injury. Examination reveals normal consciousness and blood in the tympanic membrane. Most likely cause is

 A

Extradural hemorrhage

 B

Subdural hemorrhage

 C

Intraventricular hemorrhage

 D

Basilar fracture

Ans. D

Explanation:

Ans. is ‘d’ i.e. basilar fracture 


Q. 22

What is the color of the normal tympanic membrane?

 A

Pearly white

 B

Gray

 C

Yellow

 D

Red

Q. 22

What is the color of the normal tympanic membrane?

 A

Pearly white

 B

Gray

 C

Yellow

 D

Red

Ans. A

Explanation:

Q. 23

The most mobile part of the tympanic membrane:

 A

Central

 B

Peripheral

 C

Both

 D

None of the above

Q. 23

The most mobile part of the tympanic membrane:

 A

Central

 B

Peripheral

 C

Both

 D

None of the above

Ans. B

Explanation:

   


Q. 24

Pars flaccida of the tympanic membrane is also called 

 A

Reissner’s membrane

 B

Shrapnell’s membrane

 C

Basilar membrane

 D

Secondary tympanic membrane

Q. 24

Pars flaccida of the tympanic membrane is also called 

 A

Reissner’s membrane

 B

Shrapnell’s membrane

 C

Basilar membrane

 D

Secondary tympanic membrane

Ans. B

Explanation:

 

Situated above the lateral process of malleus between the notch of Rivinus and the anterior and posterior malleal folds.

  • Reissner’s membrane – Separates scala media from scala vestibuli in the inner ear
  • Basilar membrane – Seen in scala media and supports the organ of corti
  • Secondary Tympanic Membrane – Closes the scala tympani at the site of round window 

Q. 25

The distance between tympanic membrane and medial wall of middle ear at the level of center is:

 A

3 mm

 B

4 mm

 C

6mm

 D

2 mm

Q. 25

The distance between tympanic membrane and medial wall of middle ear at the level of center is:

 A

3 mm

 B

4 mm

 C

6mm

 D

2 mm

Ans. D

Explanation:

Q. 26

Distance of promontory from tympanic membrane:

 A

2 mm

 B

5 mm

 C

6 mm

 D

7 mm

Q. 26

Distance of promontory from tympanic membrane:

 A

2 mm

 B

5 mm

 C

6 mm

 D

7 mm

Ans. A

Explanation:

Q. 27

Surface area of tympanic membrane:

 A

55 mm2

 B

70 mm2

 C

80 mm2

 D

90 mm2

Q. 27

Surface area of tympanic membrane:

 A

55 mm2

 B

70 mm2

 C

80 mm2

 D

90 mm2

Ans. D

Explanation:

Q. 28

The effective diameter of the tympanic membrane:

 A

25 mm2

 B

30 mm2

 C

40 mm2

 D

45 mm2

Q. 28

The effective diameter of the tympanic membrane:

 A

25 mm2

 B

30 mm2

 C

40 mm2

 D

45 mm2

Ans. D

Explanation:

 

Area of tympanic membrane is 90 mm2.

Effective area is 55 mrn2(approximately 2/3 of the total area).

Significance of large area of tympanic membrane – The area of tympanic is much larger than area of stapes footplate, which helps in converting sound of greater amplitude but lesser force to that of lesser amplitude and great force.


Q. 29

Lever ratio of tympanic membrane is:

 A

1.4-1

 B

1.3-1

 C

18.2-1

 D

1.5-1

Q. 29

Lever ratio of tympanic membrane is:

 A

1.4-1

 B

1.3-1

 C

18.2-1

 D

1.5-1

Ans. B

Explanation:

 

Lever-Action of Ossicles

Handle of malleus is 1.3 times longer than process of the incus which constitutes for the lever-action.

Area Ratio:The area ratio of tympanic membrane is 14:1

Lever ratio = 1.3: 1

= Their product is 18:1 i.e. the pressure exerted at oval window.

This helps in the transformer action of the middle ear (impedance matching mechanism) i.e. converting sound of greater amplitude  and less force to that of lesser amplitude but greater force.


Q. 30

Nerve supply of the tympanic membrane is by: 

 A

Auriculotemporal

 B

Lesser occipital

 C

Greater occipital

 D

Parasympathetic ganglion

Q. 30

Nerve supply of the tympanic membrane is by: 

 A

Auriculotemporal

 B

Lesser occipital

 C

Greater occipital

 D

Parasympathetic ganglion

Ans. A

Explanation:

Q. 31

After rupture of tympanic membrane, the hearing loss is:

 A

10-40 dB

 B

5-15 dB

 C

20 dB

 D

300 dB

Q. 31

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. 32

Post head injury, the patient had conductive deafness and on examination, tympanic membrane was normal and mobile. Likely diagnosis is:

 A

Distortion of ossicular chain

 B

Hemotympanum

 C

EAC sclerosis

 D

Otosclerosis

Q. 32

Post head injury, the patient had conductive deafness and on examination, tympanic membrane was normal and mobile. Likely diagnosis is:

 A

Distortion of ossicular chain

 B

Hemotympanum

 C

EAC sclerosis

 D

Otosclerosis

Ans. A

Explanation:

 

  • Fracture temporal bone (more commonly longitudinal) extending to external canal: tympanic membrane is frequently torn and inner ear is spared.
  • Blood or CSF in external and middle ear.
  • Damage to ossicle (most frequent being incudo-stapedial joint) resulting in more severe and permanent conductive deafness.
  • Aseptic necrosis of long process of incus can lead to late conductive deafness.

 

Tympanic membrane is normal and mobile: In hemotympanum – tympanic membrane will appear red/blue (due to presence of blood pigments) so it is ruled out. … Logan Tumer1Oth/ed p441 Otosclerosis and EAC sclerosis do not occur in case of head injury and hence they are ruled out


Q. 33

Chalky white tympanic membrane is seen in: 

 A

ASOM

 B

Otosclerosis

 C

Tympanosclerosis

 D

Cholesteatoma

Q. 33

Chalky white tympanic membrane is seen in: 

 A

ASOM

 B

Otosclerosis

 C

Tympanosclerosis

 D

Cholesteatoma

Ans. C

Explanation:

 

Keratosis Obturans (Primary canal cholesteatoma)

  • It is accumulation of a large plug of desquamated keratin in the external auditory meatus
  • Seen between 5 and 20 yrs of age (i.e. younger age as compared to cholestealoma which is seen in middle age)
  • May be U/L or Bilateral (occasionally)
  • It may be associated with bronchiectasis and chronic sinusitis.

Clinical Features

  • Pain in the ear (severe olatagia)
  • Hearing loss (of conductive type)
  • Tinnitus
  • Ear discharge – sometimes
  • Pearly white mass of keratin is visible in the ear canal
  • Tympanic membrane is thickened and chalky white in appearance
  • Ear canal is ballooned

Treatment

  • Removal by syringing / Instrumentation
  • Periodic checkup should be done to see reaccumulation
  • If it recurs – keratolytic agent – 2% salicylic acid in alcohol can be tried.

Q. 34

Features of moderately retracted tympanic membrane are all except:

 A

Handle of malleus appearance foreshortened

 B

Cone of light is absent or interrupted

 C

Lateral process of malleus becomes more prominent

 D

None

Q. 34

Features of moderately retracted tympanic membrane are all except:

 A

Handle of malleus appearance foreshortened

 B

Cone of light is absent or interrupted

 C

Lateral process of malleus becomes more prominent

 D

None

Ans. D

Explanation:

Q. 35

Dysfunction of tympanic membrane is characterized by all except:

 A

Normal ‘cone of light’

 B

Retracted TM

 C

Non prominent umbo 

 D

Prominent malleolar folds

Q. 35

Dysfunction of tympanic membrane is characterized by all except:

 A

Normal ‘cone of light’

 B

Retracted TM

 C

Non prominent umbo 

 D

Prominent malleolar folds

Ans. A

Explanation:

 

Retracted Tympanic Membrane

It is the result of negative intratympanic pressure when Eustachian tube is blocked


Characteristics

It appears dull and lusterless

Cone of light is absent or interrupted

Handel of malleus appears foreshortened

Lateral process of malleus becomes more prominent 

Anterior and posterior malleal folds become sickle shaped 

It is immobile or has limited mobility when tested with pneumatic otoscope or siegle’s speculum.

Features of Normal Tympanic Membrane

  • It is shiny and pearly grey in colour
  • Has concavity on its lateral surface
  • Cone of light seen in antero — inferior quadrant
  • It’s transparency varies
  • It is mobile when tested with pneumatic otoscope or siegle’s speculum.



Q. 36

Most common perforation site in tympanic membrane in ASOM:

 A

Antero-inferior

 B

Postero-inferior

 C

Antero-superior

 D

Postero-superior

Q. 36

Most common perforation site in tympanic membrane in ASOM:

 A

Antero-inferior

 B

Postero-inferior

 C

Antero-superior

 D

Postero-superior

Ans. A

Explanation:

Q. 37

Bluish tympanic membrane is seen in:

 A

Early ASOM

 B

Glue ear

 C

Cholesteatoma

 D

Cholesterol granuloma

Q. 37

Bluish tympanic membrane is seen in:

 A

Early ASOM

 B

Glue ear

 C

Cholesteatoma

 D

Cholesterol granuloma

Ans. B

Explanation:

 

In glue ear (serous otitis media) Tympanic membrane is dull opaque with loss of light reflex and appears yellow / grey / blue in colour.

  • Normal colour of tympanic membrane is pearly grey.
  • Congested membrane with prominent blood vessels (cartwheel sign) is seen in early stages of acute otitis media.
  • Bluish discoloration is seen in haemotympanum.
  • Flamingo pink color is seen in otosclerosis.



Q. 38

Perforation of tympanic membrane with destruction of tympanic annulus is called:

 A

Attic

 B

Marginal

 C

Subtotal

 D

Total

Q. 38

Perforation of tympanic membrane with destruction of tympanic annulus is called:

 A

Attic

 B

Marginal

 C

Subtotal

 D

Total

Ans. B

Explanation:

Q. 39

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. 39

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. 40

A-7 year child presenting with acute otitis media, does not respond to ampicillin. Examination reveals full and bulging tympanic membrane, the treatment of choice is: 

 A

Sytemic steroid

 B

Ciprofloxacin

 C

Myringotomy

 D

Cortical mastoidectomy

Q. 40

A-7 year child presenting with acute otitis media, does not respond to ampicillin. Examination reveals full and bulging tympanic membrane, the treatment of choice is: 

 A

Sytemic steroid

 B

Ciprofloxacin

 C

Myringotomy

 D

Cortical mastoidectomy

Ans. C

Explanation:

 

 

Indications of myringotomy in acute otitis media:

  • Drum is bulging + acute pain.
  • Incomplete resolution despite antibiotics when drum remains full with persistent conductive deafness.
  • Persistent effusion beyond 12 weeks.



Q. 41

A 3 year old child presents with fever and ear ache. On examination there is congested tympanic membrane with slight bulge. The treatment of choice is:

 A

Myringotomy with penicillin

 B

Myringotomy with grommet

 C

Only antibiotics

 D

Wait and watch

Q. 41

A 3 year old child presents with fever and ear ache. On examination there is congested tympanic membrane with slight bulge. The treatment of choice is:

 A

Myringotomy with penicillin

 B

Myringotomy with grommet

 C

Only antibiotics

 D

Wait and watch

Ans. A

Explanation:

 

Fever + earache + congested and bulging tympanic membrane in a four year old child points towards Acute suppurative otitis media as the diagnosis.

Antibiotics (Penicillin) form the mainstay of treatment of acute otitis media and should be administered in a child with Acute otitis media and once tympanic membrane is bulging, myringotomy should be done.

Grommet insertion is not indicated in Acute suppurative otitis media. It may be used in cases of myringotomy for serous or secretory otitis media.



Q. 42

Myringoplasty is plastic repair of:

 A

Middle ear

 B

Internal ear

 C

Eustachian tube

 D

Tympanic membrane

Q. 42

Myringoplasty is plastic repair of:

 A

Middle ear

 B

Internal ear

 C

Eustachian tube

 D

Tympanic membrane

Ans. D

Explanation:

Q. 43

Surgery on ear drum is done using:

 A

Operative microscope 

 B

Laser

 C

Direct vision

 D

Blindly

Q. 43

Surgery on ear drum is done using:

 A

Operative microscope 

 B

Laser

 C

Direct vision

 D

Blindly

Ans. A

Explanation:

Q. 44

Myringotomy is:

 A

Surgical opening in Eustachian tube

 B

Surgical opening in tympanic membrane

 C

Surgical opening in semicircular canal

 D

None

Q. 44

Myringotomy is:

 A

Surgical opening in Eustachian tube

 B

Surgical opening in tympanic membrane

 C

Surgical opening in semicircular canal

 D

None

Ans. B

Explanation:

Q. 45

What is tympanoplasty?

 A

Eradication of middle ear disease with reconstruction of tympanic membrane & ossicles

 B

Eradication of disease from internal ear

 C

Eradication of middle ear disease with repair of tympanic membrane only

 D

Eradication of middle ear disease with repair of ossicles only

Q. 45

What is tympanoplasty?

 A

Eradication of middle ear disease with reconstruction of tympanic membrane & ossicles

 B

Eradication of disease from internal ear

 C

Eradication of middle ear disease with repair of tympanic membrane only

 D

Eradication of middle ear disease with repair of ossicles only

Ans. A

Explanation:

 

Tympanoplasty (Tympanum = Middle ear)

It is an operation in which reconstructive procedure is limited to repair of tympanic membrane perforation.

Myringoplasty

It is an operation in which reconstructive procedure is limited to repair of tympanic membrane perforation.

Meatoplasty

Meatoplasty is an operation in which a crescent of conchal cartilage is excised to widen the meatus.


Q. 46

A 31 year old female patient complains of bilateral impairment of hearing for the 5 year. On examination, tympanic membrane is normal and audiogram shows a bilateral conductive deafness. Impedance audiometry shows As type of curve and acoustic reflexes are absent. All constitute part of treatment, except:

 A

Hearing aid

 B

Stapedectomy

 C

Sodium fluoride

 D

Gentamicin

Q. 46

A 31 year old female patient complains of bilateral impairment of hearing for the 5 year. On examination, tympanic membrane is normal and audiogram shows a bilateral conductive deafness. Impedance audiometry shows As type of curve and acoustic reflexes are absent. All constitute part of treatment, except:

 A

Hearing aid

 B

Stapedectomy

 C

Sodium fluoride

 D

Gentamicin

Ans. D

Explanation:

 

Gentamicin is used to treat Meniere’s disease.



Q. 47

Which of the following is a features of tympanic membrane perforation ?

 A

Tinnitus

 B

Vertigo

 C

Conductive deafness

 D

Fullness in ear

Q. 47

Which of the following is a features of tympanic membrane perforation ?

 A

Tinnitus

 B

Vertigo

 C

Conductive deafness

 D

Fullness in ear

Ans. C

Explanation:

Q. 48

Blue ear drum is seen in:   

 A

Tympanosclerosis

 B

Secretory otitis media

 C

Otosclerosis

 D

Myringitis bullosa

Q. 48

Blue ear drum is seen in:   

 A

Tympanosclerosis

 B

Secretory otitis media

 C

Otosclerosis

 D

Myringitis bullosa

Ans. B

Explanation:

Q. 49

A 31 year old female patient complains of bilateral impairment of hearing for the past 5 years. On examination, tympanic membrane is normal and audiogram shows a bilateral conductive deafness. Acoustic reflexes are absent. All constitute part of treatment EXCEPT:       

 A

Hearing aid

 B

Stapectomy

 C

Sodium fluoride

 D

Gentamycin

Q. 49

A 31 year old female patient complains of bilateral impairment of hearing for the past 5 years. On examination, tympanic membrane is normal and audiogram shows a bilateral conductive deafness. Acoustic reflexes are absent. All constitute part of treatment EXCEPT:       

 A

Hearing aid

 B

Stapectomy

 C

Sodium fluoride

 D

Gentamycin

Ans. D

Explanation:

 

There is no medical treatment that cures otosclerosis.

Sodium fluoride has been tried to hasten the maturity of active focus and arrest further cochlear loss, but controversies exist and this treatment is NOT recommended generally


Q. 50

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. 50

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. 51

Multiple perforation of tympanic membrane characteristic of ‑

 A

Tubercular Otitis Media

 B

Syphilitic Otitis Media

 C

Pseudomonas infection

 D

Fungal Otitis Media

Q. 51

Multiple perforation of tympanic membrane characteristic of ‑

 A

Tubercular Otitis Media

 B

Syphilitic Otitis Media

 C

Pseudomonas infection

 D

Fungal Otitis Media

Ans. A

Explanation:

Ans. is ‘a’ i.e., Tubercular otitis media

Tubercular otitis media

  • Tuberculosis of middle ear is a comparatively rare entity usually seen in association with or secondary to pulmonarytuberculosis, infection reaches the middle ear through eustachian tube.
  • The rare modes of infection are through hematogenous spread from tubercular focus in lung, tonsils, cervical lymph nodes; or due to ingestion of infected cow’s milk.
  • It usually affects children and young adults.

Clinical features

  • Generally, tuberculosis of middle ear is unilateral.
  • It is characterized by painless otorrhoea which fails to respond to the usual antimicrobial treatment. There is painless watery otorrhea.
  • Single or multiple perforation of tympanic membrane. There may be multiple perforations in the early stages, but they coalesce into a large tympanic membrane perforation accompanied by a pale granulation tissue.
  • Periauricular fistulae, lymphadenopathy and facial palsy are infrequent findings.
  • Late complications include facial paralysis, labyrinthitis, postauricular fistulae, subperiosteal abscess, petrous apicitis and intracranial extension of infection.

Q. 52

Conducting hearing loss with intact tympanic membrane ‑

 A

Presbycausis

 B

Meniere’s disease

 C

Glue ear

 D

Acoustic neuroma

Q. 52

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. 53

Patient with thin painless otorrhoea, multiple perforations of the tympanic membrane and failure to respond to antimicrobial treatment. What is the most probable causative organism ‑

 A

Mycobacterium tuberculosis

 B

Staphylococcus aureus

 C

Candida albicans

 D

Aspegillusfumigatus

Q. 53

Patient with thin painless otorrhoea, multiple perforations of the tympanic membrane and failure to respond to antimicrobial treatment. What is the most probable causative organism ‑

 A

Mycobacterium tuberculosis

 B

Staphylococcus aureus

 C

Candida albicans

 D

Aspegillusfumigatus

Ans. A

Explanation:

Ans. is ‘a’ i.e., Mycobacterium tuberculosis

Thin painless otorrhoea, multiple perforations of the tympanic membrane and failure to respond to antimicrobial treatment are the features of tubercular otitis media and it is caused by Mycobacterium tuberculosis.


Q. 54

Tympanoplasty deals with reconstruction of –

 A

Tympanic membrane

 B

Ossicular chain

 C

Both a and b

 D

None of the above

Q. 54

Tympanoplasty deals with reconstruction of –

 A

Tympanic membrane

 B

Ossicular chain

 C

Both a and b

 D

None of the above

Ans. C

Explanation:

Ans. is ‘c’ i.e., Both a and b

  • Tympanoplasty is the surgical operation performed for reconstruction of tympanic membrane and/or middle ear ossicles.
  • Myringoplasty is the reconstruction of tympanic membrane.
  • Ossiculoplasty is the reconstruction of ossicular chain.
  • Tympanoplasty = Myringoplasty ± ossiculoplasty

Q. 55

Painless discharge from ear and multiple tympanic membrane perforations are characteristic of ‑

 A

Tuberculous otitis media

 B

Fungal otitis media

 C

Serous otitis media

 D

Viral otitis media

Q. 55

Painless discharge from ear and multiple tympanic membrane perforations are characteristic of ‑

 A

Tuberculous otitis media

 B

Fungal otitis media

 C

Serous otitis media

 D

Viral otitis media

Ans. A

Explanation:

Ans. is ‘a’ i.e., Tubercular otitis media


Q. 56

Areas of spontaneously healed tympanic membrane are called ‑

 A

Dimeric

 B

Pontiac

 C

Both of the above

 D

None of the above

Q. 56

Areas of spontaneously healed tympanic membrane are called ‑

 A

Dimeric

 B

Pontiac

 C

Both of the above

 D

None of the above

Ans. A

Explanation:

 

When a tympanic membrane heals spontaneously without grafting, perforation is closed by squamous epithelium before fibrous elements develop.

The fibrous layer may be attenuated or even lacking.

The resultant tympanic membrane has an area that lacks the tensile strength, elasticity, blood supply and resistance to future perforation of a fully reconstructed tympanic membrane.

Such areas are called dimeric because the squamous epithelium lies against the mucous membrane without intermediate fibrous elements.



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