Severe pain on swallowing, a muffled voice and trismus have developed over 3 days in a college student who had tonsillitis last week. The left soft palate bulges, the uvula is pushed to the right and the left tonsil is displaced down and medially. He is febrile at 38.6 °C and drinking little. Besides IV antibiotics and fluids, what is the most appropriate treatment?

Aspirate or incise at the maximal bulge

Oral antibiotics, review in a week

External drainage through the neck

Ten days after recovering from pneumococcal meningitis treated with ceftriaxone and dexamethasone, a toddler of 20 months no longer turns to his name or to loud sounds. ABR shows no response at 90 dB nHL in either ear, and OAEs are absent. CT of the temporal bones is normal, but a high-resolution T2-weighted MRI shows early loss of the normal fluid signal in the basal turn of both cochleae. The parents ask whether they can wait 6 months with hearing aids to see if his hearing comes back. What is the most appropriate management?

Urgent bilateral cochlear implantation

Hearing aids for 6 months, then review

High-dose steroids and a repeat ABR

ENT emergencies, foreign bodies and hearing screening

29 NEET-PG practice questions on ENT emergencies, foreign bodies and hearing screening, part of ENT. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
MRI of the internal acoustic canals in a child with profound congenital deafness, who has gained nothing from hearing aids, shows normal cochleae on both sides but absent cochlear nerves within narrow canals. Which device can give this child hearing sensation?
1. ACochlear implant
2. BBone-anchored hearing aid
3. CAuditory brainstem implant
4. DMiddle ear implant
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Answer: C · Auditory brainstem implant
A cochlear implant stimulates the spiral ganglion and cochlear nerve, so it cannot work if the nerve is absent. An auditory brainstem implant places electrodes on the cochlear nucleus in the lateral recess of the fourth ventricle, bypassing the cochlea and the nerve. It is also used in neurofibromatosis type 2 after removal of bilateral vestibular schwannomas. Key point: Absent cochlear nerves: auditory brainstem implant, not a cochlear implant.
- A: A cochlear implant needs an intact cochlear nerve.
- B: Bone conduction still needs a working cochlea and nerve.
- D: A middle ear implant amplifies sound but still needs the nerve.
Question 2 · Medium
Statements about cochlear implants in India: 1. Children with prelingual deafness do best when implanted early, ideally before 2 years. 2. The implant needs a functioning cochlear nerve. 3. Children can receive implants under the government ADIP scheme. 4. The implant gives normal hearing at once without auditory training. Which are true?
1. A1, 2 and 3 only
2. B2 and 4 only
3. C1, 2, 3 and 4
4. D1 and 4 only
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Answer: A · 1, 2 and 3 only
Early implantation in prelingual deafness uses the critical period for language, and the device depends on an intact cochlear nerve. The Assistance to Disabled Persons (ADIP) scheme of the Government of India funds cochlear implants for young children. Sound through an implant is different from natural hearing, so months of auditory-verbal therapy and mapping are needed. Key point: Cochlear implant success needs early implantation, an intact cochlear nerve and long auditory rehabilitation.
- B: Statement 4 is false, and 1 and 3 are true.
- C: Statement 4 is false, so not all four are true.
- D: Statement 4 is false; rehabilitation is essential.
Question 3 · Easy
Lateral soft-tissue X-ray of the neck in a febrile, drooling child shows a 'thumb sign'. Which organism is classically responsible?
1. AHaemophilus influenzae type b
2. BStreptococcus pneumoniae
3. CParainfluenza virus
4. DRespiratory syncytial virus
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Answer: A · Haemophilus influenzae type b
The thumb sign is a swollen epiglottis on a lateral neck film, seen in acute epiglottitis (supraglottitis), classically caused by Haemophilus influenzae type b. The disease has become uncommon where Hib vaccine is given, as in the Indian pentavalent vaccine. Croup from parainfluenza virus gives a 'steeple sign' on the AP film instead. Key point: Thumb sign means acute epiglottitis, classically from Hib.
- B: Pneumococcus can cause epiglottitis but is not the classical organism.
- C: Parainfluenza virus causes croup with the steeple sign.
- D: RSV causes bronchiolitis in infants.
Question 4 · Medium
Severe pain on swallowing, a muffled voice and trismus have developed over 3 days in a college student who had tonsillitis last week. The left soft palate bulges, the uvula is pushed to the right and the left tonsil is displaced down and medially. He is febrile at 38.6 °C and drinking little. Besides IV antibiotics and fluids, what is the most appropriate treatment?
1. AOral antibiotics, review in a week
2. BAspirate or incise at the maximal bulge
3. CEmergency tracheostomy
4. DExternal drainage through the neck
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Answer: B · Aspirate or incise at the maximal bulge
This is a peritonsillar abscess (quinsy). Pus is let out by needle aspiration or incision at the point of maximum bulge, usually where a line along the base of the uvula meets a line along the anterior pillar. IV antibiotics and fluids are added, and interval tonsillectomy is offered after about 6 weeks, especially after a second episode. Key point: Quinsy: drain by aspiration or incision at the point of maximum bulge, with IV antibiotics.
- A: Oral antibiotics alone do not drain an established abscess in a dehydrated patient.
- C: The airway is not threatened, so tracheostomy is not indicated.
- D: External drainage is for parapharyngeal abscess, not quinsy.
Question 5 · Hard
Ten days after recovering from pneumococcal meningitis treated with ceftriaxone and dexamethasone, a toddler of 20 months no longer turns to his name or to loud sounds. ABR shows no response at 90 dB nHL in either ear, and OAEs are absent. CT of the temporal bones is normal, but a high-resolution T2-weighted MRI shows early loss of the normal fluid signal in the basal turn of both cochleae. The parents ask whether they can wait 6 months with hearing aids to see if his hearing comes back. What is the most appropriate management?
1. AWait one year for recovery
2. BUrgent bilateral cochlear implantation
3. CHearing aids for 6 months, then review
4. DHigh-dose steroids and a repeat ABR
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Answer: B · Urgent bilateral cochlear implantation
Profound deafness after bacterial meningitis is followed by labyrinthitis ossificans: fibrosis and then new bone fill the cochlea, starting in the basal turn, within weeks to months. Loss of fluid signal on MRI shows fibrosis has begun before bone is visible on CT, so implantation must be done urgently, before the scala tympani closes and electrode insertion becomes impossible. Aids will not help profound loss. Key point: Post-meningitic profound deafness: implant urgently, before cochlear ossification blocks insertion.
- A: Recovery from profound post-meningitic loss is very unlikely, and the window for implantation closes.
- C: Waiting allows ossification and makes implantation difficult or impossible.
- D: Steroids do not reverse established post-meningitic profound loss.
Question 6 · Medium
Statements about foreign bodies in the ear canal: 1. A vegetable seed should not be syringed, because it swells with water. 2. Syringing is contraindicated when the drum is known to be perforated. 3. A smooth round bead is best grasped with crocodile forceps. 4. A button battery in the ear needs urgent removal. Which are correct?
1. A1, 2, 3 and 4
2. B1 and 3 only
3. C1, 2 and 4 only
4. D2 and 3 only
Answer and explanation in LearnFree account
Question 7 · Medium
At 2 a.m. in the casualty, a construction labourer is in distress with a loud buzzing and severe pain in the right ear; he says something crawled in while he slept at the site. Otoscopy shows a moving insect deep in the canal, and the drum cannot be seen. What should be done first?
1. APack the canal with an antibiotic wick
2. BInstil oil or lignocaine to kill it
3. CSyringe the ear at once with warm water
4. DGrasp the moving insect with forceps
Answer and explanation in LearnFree account
Question 8 · Medium
Chest X-ray taken in expiration in a child who choked while eating groundnuts 2 days ago: the right lung is hyperlucent and larger than the left, the mediastinum moves to the left on expiration, and the right hemidiaphragm is flat. Breath sounds are reduced on the right, with a localised wheeze. SpO2 is 95% on room air. What is the definitive management?
1. AChest physiotherapy and postural drainage
2. BNebulised salbutamol and steroids
3. CBack blows and abdominal thrusts now
4. DRigid bronchoscopy and removal
Answer and explanation in LearnFree account
Question 9 · Medium
Swelling under the chin and both sides of the jaw, with a woody, tender, non-fluctuant floor of the mouth and the tongue pushed up and back, has developed over 2 days in a diabetic labourer. He had a painful lower third molar last week and is now drooling. Which space is involved, and what is the usual source?
1. AParapharyngeal space, from the tonsil
2. BPeritonsillar space, from tonsillitis
3. CRetropharyngeal space, from lymph nodes
4. DSubmandibular space, from a lower molar
Answer and explanation in LearnFree account
Question 10 · Medium
X-ray of a crying child who swallowed a coin an hour ago: on the AP view a round radio-opaque disc lies face-on at the level of C6, and on the lateral view it is seen edge-on behind the air column of the trachea. The child swallows saliva with difficulty but has no stridor or cough. Where is the coin?
1. AOesophagus, at the cricopharyngeus
2. BOesophagus, at the lower sphincter
3. COesophagus, at the aortic arch
4. DTrachea, just below the glottis
Answer and explanation in LearnFree account
Question 11 · Medium
As the medical officer of a PHC, you review children referred by the Rashtriya Bal Swasthya Karyakram (RBSK) mobile health team. A baby of 4 months does not startle to loud sounds and has failed an OAE screen twice. Under RBSK, where should this child be referred for confirmation and management?
1. AThe sub-centre ANM for a repeat screen
2. BThe anganwadi centre for stimulation
3. CA private hearing-aid dealer
4. DDistrict Early Intervention Centre
Answer and explanation in LearnFree account
Question 12 · Medium
Statements about the National Programme for Prevention and Control of Deafness (NPPCD): 1. It aims to prevent avoidable hearing loss due to disease or injury. 2. It supports early identification, diagnosis and treatment of ear problems causing hearing loss. 3. It includes training of health workers and provision of hearing aids. 4. It is limited to children under 5 years. Which of these are correct?
1. A1, 2 and 3 only
2. B1, 2, 3 and 4
3. C2, 3 and 4 only
4. D1 and 4 only
Answer and explanation in LearnFree account
Question 13 · Hard
X-ray of the neck and chest, taken in casualty 90 minutes after a toddler of 2 years was seen putting something shiny in his mouth: a round, radio-opaque 20 mm disc at the level of the thoracic inlet, with a double-ring ('halo') outline on the AP view and a step-off at its edge on the lateral view. He is drooling a little but breathing comfortably, with SpO2 98% on room air. The nearest endoscopy theatre is 40 minutes away. His mother says he ate a full meal 3 hours ago and asks whether he can be watched overnight, as with a coin. How should he be managed?
1. AA laxative and a repeat X-ray in 12 hours
2. BRemoval after 6 hours of fasting
3. CObservation; most coins pass in 24 hours
4. DEndoscopic removal within 2 hours
Answer and explanation in LearnFree account
Question 14 · Hard
In the casualty at night, a man with Ludwig angina from a lower molar abscess develops inspiratory stridor and cannot lie flat. Mouth opening is 15 mm, the floor of the mouth is board-hard and the tongue is pressed against the palate. SpO2 is 91% on a face mask. IV antibiotics and dexamethasone were started 2 hours ago with no improvement. The anaesthetist judges direct laryngoscopy impossible, no fibreoptic scope is available tonight, and the ENT surgeon is at the bedside. What is the safest way to secure his airway?
1. ANeedle cricothyroidotomy with jet ventilation
2. BAwake tracheostomy under local anaesthesia
3. CRapid sequence induction and laryngoscopy
4. DBlind nasal intubation under heavy sedation
Answer and explanation in LearnFree account
Question 15 · Medium
Bleeding from both nostrils and down the throat has continued for an hour in an elderly man with BP 190/110 mmHg who takes aspirin. After suction there is no bleeding point in Little's area, and a well-placed anterior pack has not stopped blood trickling into the pharynx. Haemoglobin is 11.4 g/dL. What is the most appropriate next step?
1. ACautery of Little's area
2. BPinching the soft nose for 10 minutes
3. CExternal carotid artery ligation
4. DPosterior nasal pack or balloon
Answer and explanation in LearnFree account
Question 16 · Easy
Bilateral profound sensorineural hearing loss, confirmed by ABR, in a child of 14 months who has gained nothing from a 3-month trial of well-fitted hearing aids. MRI shows normal cochleae and cochlear nerves. What is the best management to develop spoken language?
1. ASign language with no device
2. BBone-anchored hearing aids
3. CMore powerful hearing aids
4. DCochlear implantation
Answer and explanation in LearnFree account
Question 17 · Easy
In a well baby born at a district hospital without risk factors, which test is used for the first-stage hearing screen before discharge?
1. ABehavioural observation audiometry
2. BPure tone audiometry
3. COtoacoustic emissions
4. DTympanometry
Answer and explanation in LearnFree account
Question 18 · Hard
A preterm baby born at 30 weeks spent 3 weeks in the NICU on a ventilator, received amikacin for sepsis, and needed an exchange transfusion for a serum bilirubin of 24 mg/dL. Before discharge the nurse records 'OAE pass, both ears' and suggests that no further hearing test is needed. The paediatric resident is unsure and asks the ENT team. The baby is now feeding well and gaining weight, and the parents live far from the district hospital. Which hearing screen should this baby have before discharge?
1. AA repeat OAE at 6 months of age
2. BNo further test, as the OAE has passed
3. CAutomated ABR, though the OAE has passed
4. DPure tone audiometry at 3 years
Answer and explanation in LearnFree account
Question 19 · Medium
Under the Joint Committee on Infant Hearing benchmarks, by what ages should a baby be screened, diagnosed and started on intervention?
1. A3, 6 and 12 months
2. B1, 3 and 6 months
3. C1, 6 and 12 months
4. D6, 12 and 18 months
Answer and explanation in LearnFree account
Question 20 · Medium
Pure tone audiometry at a district hospital: average hearing threshold 42 dB in the better ear and 58 dB in the worse ear, in a retired teacher who struggles to follow conversation in a group. According to the WHO World Report on Hearing (2021), how is his hearing loss graded?
1. ASevere hearing loss
2. BMild hearing loss
3. CModerately severe hearing loss
4. DModerate hearing loss
Answer and explanation in LearnFree account
Question 21 · Medium
Foul-smelling, blood-stained discharge from the left nostril only for 3 weeks in a nursery-school child has not improved with oral amoxicillin. After suction, anterior rhinoscopy shows a greyish round object between the septum and the inferior turbinate; the right side is clear. The child is frightened but sits still on the mother's lap. What is the most appropriate next step?
1. AA longer course of antibiotics
2. BGrasp it with crocodile forceps
3. CSyringe the nose with warm saline
4. DRemove it with a blunt hook passed behind it
Answer and explanation in LearnFree account
Question 22 · Easy
Two days after a punch to the nose in a college fight, a youth has complete blockage of both nostrils. Anterior rhinoscopy shows a smooth, soft, fluctuant swelling on both sides of the septum. What should be done?
1. AClosed reduction of the nasal bones
2. BOral antibiotics and steroids only
3. CIncise, drain and pack both sides
4. DDecongestant drops and review
Answer and explanation in LearnFree account
Question 23 · Hard
On the third day after he felt a sharp pain on swallowing a mouthful of fish curry, a man who wears upper dentures has worsening pain in the neck and behind the sternum, pain on swallowing, a temperature of 38.9 °C and a pulse of 118/min. There is crepitus over the left side of the neck. He tried to push the bone down at home by swallowing balls of rice. A lateral neck X-ray shows air in the prevertebral soft tissue, and his total leucocyte count is 18,600/mm3. BP is 110/70 mmHg. What is the most appropriate next step?
1. ARigid oesophagoscopy at once to find the bone
2. BFlexible endoscopy, then a soft diet
3. COral antibiotics and a review in 48 hours
4. DContrast CT neck and chest, nil by mouth, IV antibiotics
Answer and explanation in LearnFree account
Question 24 · Medium
Lateral soft-tissue X-ray of the neck in a febrile infant of 10 months who refuses feeds, drools, holds the neck stiffly and breathes noisily: the prevertebral soft tissue at C2 measures 14 mm (normal under 7 mm in a child) with an air-fluid level, and the cervical lordosis is lost. Which condition and treatment fit best?
1. AAcute retropharyngeal abscess; drainage through the mouth
2. BCold retropharyngeal abscess; drainage via the neck
3. CCroup; nebulised adrenaline
4. DAcute epiglottitis; intubation in theatre
Answer and explanation in LearnFree account
Question 25 · Medium
Risk indicators for permanent childhood hearing loss: 1. NICU stay of more than 5 days. 2. Congenital cytomegalovirus infection. 3. Hyperbilirubinaemia needing exchange transfusion. 4. Physiological jaundice that settles by day 7 without treatment. Which of these call for audiological monitoring?
1. A1 and 4 only
2. B1, 2, 3 and 4
3. C2 and 4 only
4. D1, 2 and 3 only
Answer and explanation in LearnFree account

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ENT emergencies, foreign bodies and hearing screening

MRI of the internal acoustic canals in a child with profound congenital deafness, who has gained nothing from hearing aids, shows normal cochleae on both sides but absent cochlear nerves within narrow canals. Which device can give this child hearing sensation?

Lateral soft-tissue X-ray of the neck in a febrile, drooling child shows a 'thumb sign'. Which organism is classically responsible?

At 2 a.m. in the casualty, a construction labourer is in distress with a loud buzzing and severe pain in the right ear; he says something crawled in while he slept at the site. Otoscopy shows a moving insect deep in the canal, and the drum cannot be seen. What should be done first?

As the medical officer of a PHC, you review children referred by the Rashtriya Bal Swasthya Karyakram (RBSK) mobile health team. A baby of 4 months does not startle to loud sounds and has failed an OAE screen twice. Under RBSK, where should this child be referred for confirmation and management?

Bilateral profound sensorineural hearing loss, confirmed by ABR, in a child of 14 months who has gained nothing from a 3-month trial of well-fitted hearing aids. MRI shows normal cochleae and cochlear nerves. What is the best management to develop spoken language?

In a well baby born at a district hospital without risk factors, which test is used for the first-stage hearing screen before discharge?

Under the Joint Committee on Infant Hearing benchmarks, by what ages should a baby be screened, diagnosed and started on intervention?

Pure tone audiometry at a district hospital: average hearing threshold 42 dB in the better ear and 58 dB in the worse ear, in a retired teacher who struggles to follow conversation in a group. According to the WHO World Report on Hearing (2021), how is his hearing loss graded?

Two days after a punch to the nose in a college fight, a youth has complete blockage of both nostrils. Anterior rhinoscopy shows a smooth, soft, fluctuant swelling on both sides of the septum. What should be done?

Risk indicators for permanent childhood hearing loss: 1. NICU stay of more than 5 days. 2. Congenital cytomegalovirus infection. 3. Hyperbilirubinaemia needing exchange transfusion. 4. Physiological jaundice that settles by day 7 without treatment. Which of these call for audiological monitoring?