A 14-year-old boy from a rural district has had scanty, foul-smelling left ear discharge for years. Otoscopy shows an attic perforation with white flakes. For 5 days he has had fever with rigors that rises and falls several times a day. There is oedema and tenderness over the posterior part of the left mastoid, and tenderness along the left jugular vein. Which complication is most likely?

Petrositis (Gradenigo syndrome)

A 47-year-old man from Nagaland has had a blocked feeling and reduced hearing in the right ear for 2 months. The right drum is retracted and dull with fluid behind it, and the tympanogram is type B on the right and normal on the left. He has a painless, firm node in the upper right neck. What is the next best step?

Nasopharyngeal endoscopy with biopsy

A 6-year-old girl has had fever and right earache for 2 days. Today her mother noticed that the right side of her face does not move. The right drum is red, bulging and intact, there is no mastoid swelling, and she has no previous ear disease. CT shows no bone erosion or cholesteatoma. What is the best management?

Myringotomy with IV antibiotics

Urgent canal wall down mastoidectomy

Oral acyclovir and steroids only

Facial nerve decompression via the middle fossa

Otitis media and its complications

35 NEET-PG practice questions on Otitis media and its complications, 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 · Hard
A 14-year-old boy from a rural district has had scanty, foul-smelling left ear discharge for years. Otoscopy shows an attic perforation with white flakes. For 5 days he has had fever with rigors that rises and falls several times a day. There is oedema and tenderness over the posterior part of the left mastoid, and tenderness along the left jugular vein. Which complication is most likely?
1. ALateral sinus thrombophlebitis
2. BPetrositis (Gradenigo syndrome)
3. COtogenic meningitis
4. DTemporal lobe abscess
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Answer: A · Lateral sinus thrombophlebitis
An attic perforation with white flakes is unsafe (squamosal) CSOM with cholesteatoma, which erodes bone and spreads infection inwards. Hectic 'picket-fence' fever with rigors from septic emboli, Griesinger sign (oedema over the mastoid emissary vein) and tenderness along the jugular vein point to thrombophlebitis of the lateral (sigmoid) sinus. Contrast CT or MR venography shows the thrombus (empty delta sign). Treatment is IV antibiotics and urgent mastoid exploration with removal of disease and exposure of the sinus.
- B: Gradenigo syndrome is discharge, retro-orbital pain and sixth nerve palsy.
- C: Meningitis gives headache, neck rigidity and Kernig sign rather than hectic fever with Griesinger sign.
- D: A temporal lobe abscess presents with headache, drowsiness and focal signs such as aphasia.
Question 2 · Medium
A 13-year-old boy recovering from acute otitis media of the left ear has had a worsening headache, vomiting and blurred vision for 10 days. He is alert, with bilateral papilloedema and a left lateral rectus palsy, but no retro-orbital pain, neck stiffness or focal limb signs. Contrast MRI shows no abscess and a normal petrous apex, but shows thrombosis of the left lateral sinus. CSF opening pressure is high, with normal cells, protein and sugar. What is the diagnosis?
1. AOtitic hydrocephalus
2. BOtogenic meningitis
3. CGradenigo syndrome
4. DTemporal lobe abscess
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Answer: A · Otitic hydrocephalus
Raised intracranial pressure with papilloedema, sometimes a false-localising sixth nerve palsy, and normal CSF apart from the high pressure after otitis media is otitic hydrocephalus. It is associated with lateral sinus thrombosis, which impairs venous drainage and CSF absorption. Treatment includes antibiotics for the ear, measures to lower ICP such as acetazolamide or repeated lumbar puncture, and monitoring of vision. Failing vision may need a CSF shunt or optic nerve decompression.
- B: Meningitis gives neck stiffness and pus cells in the CSF.
- C: Gradenigo syndrome adds retro-orbital pain and needs petrous apex disease.
- D: An abscess would show on MRI and usually causes drowsiness or focal signs.
Question 3 · Easy
A 40-year-old woman with long-standing left squamosal CSOM has a conductive hearing loss larger than her small attic perforation would explain. At surgery, cholesteatoma is found in the attic. Which part of the ossicular chain is most commonly eroded in this disease?
1. AHead and neck of the malleus
2. BLong process of the incus
3. CHandle of the malleus
4. DFootplate of the stapes
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Answer: B · Long process of the incus
The long process of the incus has the poorest blood supply of the ossicles and lies in the path of disease spreading from the attic, so it is the part most often eroded by cholesteatoma or chronic inflammation. Its loss breaks the incudostapedial joint and causes a large conductive loss. Sometimes the cholesteatoma itself bridges the gap and hearing is better than expected. Ossicular reconstruction is planned at the same or a later stage.
- A: The malleus head is bulkier and is eroded later than the incus long process.
- C: The malleus handle is embedded in the drum and is usually spared early.
- D: The footplate is the most resistant part of the chain and is rarely eroded.
Question 4 · Medium
A 47-year-old man from Nagaland has had a blocked feeling and reduced hearing in the right ear for 2 months. The right drum is retracted and dull with fluid behind it, and the tympanogram is type B on the right and normal on the left. He has a painless, firm node in the upper right neck. What is the next best step?
1. ARepeat tympanogram in 3 months
2. BNasopharyngeal endoscopy with biopsy
3. CRight myringotomy and grommet
4. DNasal steroid spray and review
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Answer: B · Nasopharyngeal endoscopy with biopsy
Unilateral middle-ear effusion in an adult must be taken as nasopharyngeal carcinoma until proved otherwise, because a tumour in the fossa of Rosenmuller can block the Eustachian tube. A neck node makes it even more likely, and the disease is commoner in north-east India. Endoscopic examination of the nasopharynx with biopsy is the next step, followed by imaging for staging. A grommet alone would relieve symptoms but delay the diagnosis.
- A: Observation is for childhood glue ear, not adult unilateral effusion.
- C: A grommet treats the effusion but misses a possible tumour.
- D: Steroid spray and waiting delays diagnosis of a likely cancer.
Question 5 · Hard
A 6-year-old girl has had fever and right earache for 2 days. Today her mother noticed that the right side of her face does not move. The right drum is red, bulging and intact, there is no mastoid swelling, and she has no previous ear disease. CT shows no bone erosion or cholesteatoma. What is the best management?
1. AUrgent canal wall down mastoidectomy
2. BOral acyclovir and steroids only
3. CFacial nerve decompression via the middle fossa
4. DMyringotomy with IV antibiotics
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Answer: D · Myringotomy with IV antibiotics
Facial palsy at the start of acute otitis media is usually due to a congenitally dehiscent fallopian canal in the middle ear, letting inflammation reach the nerve. Myringotomy drains the middle ear and gives pus for culture, IV antibiotics treat the infection, and steroids are often added; recovery is usually complete. Mastoid exploration is needed only if there is mastoiditis or no recovery. In contrast, facial palsy in chronic disease with cholesteatoma needs urgent surgery.
- A: Mastoidectomy is for palsy caused by cholesteatoma, which CT has excluded.
- B: Antivirals and steroids alone suit Bell palsy and ignore the middle-ear pus.
- C: Nerve decompression is not first-line in acute otitis media.
Question 6 · Hard
During a cortical mastoidectomy for acute mastoiditis in a 9-year-old, the surgeon drills through MacEwen's triangle, opens some pus-filled superficial air cells and finds a bony plate, believing it to be the medial wall of the antrum. Pus keeps welling up from deeper cells, and the antrum has not been reached. Which structure has misled the surgeon?
1. AThe sinodural angle
2. BKorner's (petrosquamous) septum
3. CThe digastric ridge
4. DTrautmann's triangle
Answer and explanation in LearnFree account
Question 7 · Medium
A 4-year-old girl's teacher says she does not respond when called. She has no ear pain or discharge and snores at night. Both drums are dull, retracted and amber with air bubbles, and the tympanograms are flat (type B) on both sides. Pure tone audiometry shows a bilateral conductive loss. The findings persist after 3 months of watchful waiting. What is the next best step?
1. ALong-term oral antibiotics and decongestants
2. BMyringoplasty on both sides
3. CMyringotomy with grommet insertion
4. DCanal wall down mastoidectomy
Answer and explanation in LearnFree account
Question 8 · Medium
A 28-year-old woman with a cholesteatoma in the left ear says she feels giddy whenever she cleans the ear with a finger. Pressing the tragus firmly to raise the pressure in the canal produces vertigo and nystagmus. Which part of the labyrinth is most likely eroded?
1. ALateral semicircular canal
2. BPosterior semicircular canal
3. CCochlear promontory
4. DSuperior semicircular canal
Answer and explanation in LearnFree account
Question 9 · Easy
A 3-year-old boy is brought to a PHC with fever and crying from right ear pain for one day, after a cold. He is not allergic to any drug. Otoscopy shows a red, bulging right tympanic membrane with loss of the light reflex. What is the first-line oral antibiotic?
1. AMetronidazole
2. BAmoxicillin
3. CCiprofloxacin
4. DDoxycycline
Answer and explanation in LearnFree account
Question 10 · Medium
A 35-year-old auto driver has had scanty, foul-smelling discharge from the right ear for 10 years. Over the last 2 weeks, his right eye does not close fully and the right corner of his mouth droops. Otoscopy shows an attic perforation with cholesteatoma and granulations. What is the next best step?
1. AOral steroids and observe
2. BNerve conduction studies first
3. CAntibiotic drops for 6 weeks
4. DUrgent mastoid exploration
Answer and explanation in LearnFree account
Question 11 · Medium
A 22-year-old man with squamosal CSOM of the right ear has had headache and vomiting for a week. He is drowsy but obeys commands. He has coarse nystagmus, past-pointing and intention tremor in the right arm, inability to perform rapid alternating movements with the right hand, and he falls to the right. Where is the lesion most likely?
1. ARight cerebellar hemisphere
2. BRight frontal lobe white matter
3. CRight temporal lobe
4. DLeft cerebellar hemisphere
Answer and explanation in LearnFree account
Question 12 · Hard
A 14-year-old girl with right ear discharge for 6 weeks after acute otitis media develops deep pain behind the right eye and double vision on looking to the right. Contrast MRI shows enhancement and fluid in the right petrous apex. The ENT resident lists four statements: 1. The diplopia is due to the abducens nerve in Dorello's canal. 2. The retro-orbital pain arises from irritation of the trigeminal ganglion. 3. Facial palsy is part of the classic triad. 4. The cause is the lateral sinus thrombosis. Which statements are correct?
1. A2 and 4 only
2. B1, 2 and 3 only
3. C1 and 2 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 13 · Medium
A 19-year-old student has severe left ear pain for 3 days and a swelling behind the ear. Pain is much worse when the tragus is pressed or the pinna is pulled. The retroauricular groove is preserved, a tender red swelling narrows the outer canal, the drum seen past it is normal, and hearing is near normal. What is the most likely diagnosis?
1. AMasked (latent) mastoiditis
2. BAcute coalescent mastoiditis
3. CFurunculosis of the external canal
4. DSubperiosteal mastoid abscess
Answer and explanation in LearnFree account
Question 14 · Easy
A 48-year-old man with untreated foul ear discharge for many years develops fever and a painful, firm swelling in the upper part of the neck, below the mastoid tip and deep to the sternocleidomastoid muscle. His head is held tilted to the affected side. What is this abscess called?
1. AZygomatic abscess
2. BBezold abscess
3. CLuc abscess
4. DCitelli abscess
Answer and explanation in LearnFree account
Question 15 · Medium
A 10-year-old girl had acute otitis media treated with a 3-day course of an oral antibiotic two months ago. Since then she has had dull ache behind the ear and reduced hearing, without fever. The drum is intact but thick and dull, there is mild mastoid tenderness, and CT shows clouding of the mastoid air cells with breakdown of the bony partitions. What is the most likely diagnosis?
1. AMasked (latent) mastoiditis
2. BCongenital cholesteatoma
3. CChronic otitis media with effusion
4. DMalignant otitis externa
Answer and explanation in LearnFree account
Question 16 · Medium
A 16-year-old boy with cholesteatoma is listed for canal wall down mastoidectomy. While taking consent, the resident plans to tell the family four things: 1. The main aim is to remove disease and make the ear safe and dry. 2. Hearing may not improve and can sometimes become worse. 3. Weakness of the face is a recognised, though uncommon, risk. 4. If surgery is declined, regular drops can cure the cholesteatoma. Which statements are appropriate to tell them?
1. A1, 2, 3 and 4
2. B1 and 3 only
3. C1, 2 and 3 only
4. D2, 3 and 4 only
Answer and explanation in LearnFree account
Question 17 · Hard
A 34-year-old woman had canal wall up mastoidectomy for attic cholesteatoma 14 months ago. She is well, the ear is dry and the reconstructed drum looks normal. HRCT shows a small soft-tissue opacity in the attic that could be scar, granulation tissue or residual disease. Which investigation best tells these apart without surgery?
1. APure tone audiometry with impedance testing
2. BRepeat HRCT of the temporal bone
3. CContrast CT with bone windows
4. DNon-echo-planar diffusion-weighted MRI
Answer and explanation in LearnFree account
Question 18 · Easy
In chronic suppurative otitis media, which site in the brain is most commonly involved by an otogenic abscess?
1. ATemporal lobe
2. BBrainstem
3. CCerebellar hemisphere
4. DFrontal lobe
Answer and explanation in LearnFree account
Question 19 · Medium
A 24-year-old clerk had intermittent mucoid discharge from the right ear for years. The ear has now been dry for 4 months. There is a medium central perforation, the middle-ear mucosa is healthy, and audiometry shows a 25 dB conductive loss in that ear. The Eustachian tube is patent. What is the most appropriate treatment?
1. ALong-term antibiotic ear drops
2. BA hearing aid and no surgery
3. CMyringoplasty with temporalis fascia
4. DCanal wall down mastoidectomy
Answer and explanation in LearnFree account
Question 20 · Medium
A 45-year-old man has profuse greenish discharge through a central perforation of the right drum. Culture of the pus grows a Gram-negative, oxidase-positive, non-lactose-fermenting bacillus that produces a blue-green pigment and a fruity smell. After aural toilet, which topical drug is the best choice?
1. ACiprofloxacin ear drops
2. BGentamicin ear drops
3. CClotrimazole ear drops
4. DNeomycin-polymyxin drops
Answer and explanation in LearnFree account
Question 21 · Medium
A 5-year-old boy is found during a school health check to have a white, pearly, round mass behind the anterosuperior quadrant of an intact left tympanic membrane. He has never had ear discharge, surgery or a known perforation. The right ear is normal. What is the most likely diagnosis?
1. AGlomus tympanicum tumour
2. BTympanosclerotic plaque
3. CCongenital cholesteatoma
4. DPrimary acquired cholesteatoma
Answer and explanation in LearnFree account
Question 22 · Hard
A 25-year-old man from Bihar with squamosal CSOM of the left ear is admitted with headache, vomiting and confusion for 1 week. He is drowsy, has nominal aphasia, pulse 56/min, BP 150/90 mmHg and papilloedema. Contrast MRI shows a 4 cm ring-enhancing lesion in the left temporal lobe with surrounding oedema and a tegmen defect. What is the best management plan?
1. ALumbar puncture first to identify the organism
2. BOral antibiotics and a repeat MRI in 6 weeks
3. CCanal wall down mastoidectomy alone, today
4. DNeurosurgical drainage with IV antibiotics; mastoid surgery later
Answer and explanation in LearnFree account
Question 23 · Medium
A 27-year-old woman from Varanasi has had painless discharge from the left ear for 3 months, not helped by two courses of antibiotic drops. She has lost much of her hearing on that side. Otoscopy shows several perforations in the drum with pale granulations in the middle ear, and she now has mild left facial weakness. Her sister was treated for pulmonary TB last year. Which investigation is most useful next?
1. ABiopsy of granulations for histology and CBNAAT
2. BContrast MRI of the brain
3. CTuberculin skin test alone
4. DPus culture for Pseudomonas sensitivity
Answer and explanation in LearnFree account
Question 24 · Medium
A 42-year-old man has had foul ear discharge for 15 years and now hears poorly on that side. CT shows cholesteatoma filling the attic, aditus, antrum and a sclerotic mastoid, with eroded ossicles. He lives in a remote village and is unlikely to come back for regular follow-up. Which operation suits him best?
1. ACanal wall down mastoidectomy
2. BCortical mastoidectomy
3. CMyringoplasty alone
4. DMyringotomy with grommet
Answer and explanation in LearnFree account
Question 25 · Medium
A 7-year-old boy from Ranchi had a painful discharging ear for three weeks, treated irregularly with tablets from a local shop. He now has fever, a tender, fluctuant swelling behind the ear that has pushed the pinna forward and downward, and sagging of the posterosuperior wall of the deep canal. What is the next best step after starting IV antibiotics?
1. ACanal wall down mastoidectomy
2. BOral antibiotics at home
3. CMyringoplasty
4. DCortical mastoidectomy
Answer and explanation in LearnFree account

10 more Otitis media and its complications questions

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Otitis media and its complications

A 40-year-old woman with long-standing left squamosal CSOM has a conductive hearing loss larger than her small attic perforation would explain. At surgery, cholesteatoma is found in the attic. Which part of the ossicular chain is most commonly eroded in this disease?

A 28-year-old woman with a cholesteatoma in the left ear says she feels giddy whenever she cleans the ear with a finger. Pressing the tragus firmly to raise the pressure in the canal produces vertigo and nystagmus. Which part of the labyrinth is most likely eroded?

A 3-year-old boy is brought to a PHC with fever and crying from right ear pain for one day, after a cold. He is not allergic to any drug. Otoscopy shows a red, bulging right tympanic membrane with loss of the light reflex. What is the first-line oral antibiotic?

A 35-year-old auto driver has had scanty, foul-smelling discharge from the right ear for 10 years. Over the last 2 weeks, his right eye does not close fully and the right corner of his mouth droops. Otoscopy shows an attic perforation with cholesteatoma and granulations. What is the next best step?

A 48-year-old man with untreated foul ear discharge for many years develops fever and a painful, firm swelling in the upper part of the neck, below the mastoid tip and deep to the sternocleidomastoid muscle. His head is held tilted to the affected side. What is this abscess called?

In chronic suppurative otitis media, which site in the brain is most commonly involved by an otogenic abscess?

A 5-year-old boy is found during a school health check to have a white, pearly, round mass behind the anterosuperior quadrant of an intact left tympanic membrane. He has never had ear discharge, surgery or a known perforation. The right ear is normal. What is the most likely diagnosis?