Ext Ear Disease .. TM ... AOM.. SOM... CSOM ... UNSAFE CSOM

Question 1

Causative org of foll conditions.

1. Cauliflower ear
2. Perichondritis
3. furuncle
4. malignant otitis externa
5. Base of skull osteomyelitis
6. Bullous myringopathy
7. Ramsay hunt syndrome

Answer 1

1. Trauma
2. Pseudomonas
3. Staph
4. Pseudomonas
5. Pseudomonas
6. strep pneumonia, influenza virus, mycoplasma
7. VZV

Question 2

Tx of fibrous cauliflower ear

Answer 2

No rx required..

Rx only for cosmetic problem

Question 3

Test for early diagnosis of malignant otitis externa ?

Test for resolution confirmation of infection ?

Answer 3

1. Bone scan ( technitium 99 )
2. ESR ( mc used )
   Gallium/ indium

Question 4

Severe pain in ear which increases with jaw movement
Tragus sign positive

What is dx ?
What is rx for ur dx ?

Answer 4

Dx.. fruncle / folliculitis

Rx.. coamoxiclav ( staph)

Question 5

Elderly diabetic patient with ear pain..
On examination granulation is seen with necrosis …
Bx taken – came negative for mitotic bodies

State your dx and complications related to this dx.

Answer 5

Malignant otitis externa

Cx… 1. Osteomyelitis of base of skull ( thru fissure of santorini)
2. CN 7(mc) 9,10,11 involvement

Question 6

Otomycosis causative org and app ?

Answer 6

1. Aspergillus niger ( wet paper app)

2. Candida (cotton wool appearance)

Question 7

In Ramsay hunt synd there is activation of ________ organism in ______.

Answer 7

1. VZV

2. Geniculate ganglion

Question 8

Ear wax composition

Answer 8

Ceruminous secretion + desquamated epithelium

Question 9

what are Contraindication for wax removal ?

Answer 9

1. TM PERFORATION
2. Battery stuck as a foreign body
3. Vegetative foreign body

Question 10

Mx of traumatic TM PERFORATION ?

Answer 10

Keep the ear dry
If any infection give antibiotics (local and systemic)
TM heals by 3 months

Question 11

Which layer of TM does not heal ?

Answer 11

Fibrous layer

Question 12

Tympanosclerosis occurs following ______

Answer 12

1. SOM
2. CSOM
3. TM PERFORATION HEALING

Question 13

TM is adherent to promontory

State the stage of sabe pars tensa retraction

Answer 13

Stage 4

Adhesive otitis media

Question 14

Sickling of maleolar folds seen in _____

Answer 14

Stage 1 of TM retraction

Question 15

MC organism to cause Acute otitis media ?

Answer 15

Strep pneumoniae

Question 16

Why eustachian tube is infected in
A) children
B) adult

Answer 16

A) ET is wider and smaller

B) FORCEFULL SNEEZING IN PHARYNGITIS OR SINUSITIS

Question 17

3 year old child brought with severe pain in right ear with H/O sore throat. He will be having all except

A.. Hyperemic TM ( CART WHEEL SIGN)
B.. Bulging of TM
C… Tx is Tymoanoplasty
D… AB is preferred course.

Answer 17

C

Tymoanoplasty is done is safe CSOM where there is ossicular dislocation along with TM PERFORATION.

Ab is preferred when there is less / minimal bulging and no imminent danger of perforation.

Question 18

Light house sign characteristics of

Answer 18

Acute otitis media

Aka light house sign

Question 19

Types of incision in myringotomy

Answer 19

Radial and curvilinear

Curvilinear is preferred in postero inferior quadrant.

Question 20

Postero superiro incision in myringotomy in contraindicated due to risk to damage to following structure

Answer 20

Chorda tympani
Facial nerve
Incudostapedial joint
Oval window

Question 21

Acute necrotising otitis media

Caused by _______

Answer 21

B hemolytic streptococcus

Question 22

1. Subtotal perforation occurs in ANOM
2. Annulus is eroded in Marginal perforation

True or false

Answer 22

1. False

2. True

Question 23

Causes of SEROUS OTITIS MEDIA

Answer 23

SOM - STERILE FLUID COLLECTION

CAUSES

DECREASE DRAINAGE -

1. Bilateral hypertrophy of adenoid
2. ET dysfunction in cleft palate
3. Unilateral nasopharyngeal carcinoma

Increase production
1. Allergic conditions

Question 24

State dx

25 year old male presented with

1. DULL TM
2. NON BULGING TM
3. PROMINENT LATERAL PROCESS OF MALEUS
4. B TYPE Of TYMPANOGRAM

Answer 24

SEROUS OTITIS MEDIA

Fluid is collected but not under pressure and non infected .

Retracted tm features like shortened malleus, prominent lateral process, come light distortion can be seen.

No infection means no hyperemia means dull TM

Question 25

Tx of SEROUS OTITIS MEDIA

Answer 25

1. Antiallergins 2. Decongestant 3. Steroidal nasal spray ! ! 3 months of tx if no response ! √ Surgery 1. adenoidectomy + myringotomy 2. Grommet insertion

Question 26

Incision for grommet insertion is made on ?

Answer 26

1. Radial incision on anteroinferior part | 2. Incision on anterosuperior part ( bear can technique)

Question 27

T tube grommet stays in ear for how long

Answer 27

2 years

Question 28

Long term grommet indication

Answer 28

1. Adhesive otitis media | 2. Atelectasis

Question 29

Tx of safe csom

Answer 29

Antibiotics × 6 weeks When ear is dry Sx----. Mryingoplasty. } . }. Tymoanoplasty Ossiculoplasty }

Question 30

Most common ossicle to get necrosed

Answer 30

Lenticular process of incus

Question 31

Which grafts are used for repairing TM

Answer 31

1. Temporalis fascia 2. Perichondrium of ear 3. Fat

Question 32

State and define types of Tymoanoplasty

Answer 32

Type 1... Graft over malleus ( simple myringoplasty) Type 2.... Graft over incus Type 3....Graft over stapes head ( myringostapediopexy) Type 4... Maintain phase difference Type 5... Fenestration operation

Question 33

Types of myringoplasty Which is preferred

Answer 33

Underlay ( preferred) Graft under malleus and *under annulus* Overlay Graft under malleus and *over annulus*

Question 34

Unsafe csom can spread to

Answer 34

Medially inner ear Superiorly brain Posteriorly mastoid Further posteriorly sigmoid sinus

Question 35

What is cholesteatoma

Answer 35

It the the keratin flakes due to startified squamous keritinizing epithelium Normally present only in EAC Abnormal in middle ear or temporal bone - cholesteatoma

Question 36

Keratin accumulation in EAC

Answer 36

Keratosis obturans

Question 37

1° cholesteatoma is due to 2° cholesteatoma is due to

Answer 37

1° retraction of pars flaccida in prussak space / attic 2° marginal perforation of TM

Question 38

Explain Haberman theory Wittmack theory Sade theory Ruedis theory

Answer 38

Haberman - 2° cholesteatoma Wittmack - 1 cholesteatoma Sade theory - due to repeated infection of ET --> metaplasia Ruedis theory - due to basal cell hyperplasia of TM

Question 39

Management of UNSAFE CSOM

Answer 39

Surgery 1. Canal intact surgery 2. Canal wall down surgery - Radical mastoidectomy - modified radical M....

Question 40

Which type of incision in MRM for tx of UNSAFE CSOM

Answer 40

Wilde's incision | Post auricular incision

Question 41

Boundaries of trautmam triangle

Answer 41

Anteriorly by inner ear Superiorly by superior. Petrosal sinus Posteriorly by sigmoid sinus

Question 42

Discharge from the ear is when cleaned reappear again This sign is called ______ and it is suggestive of ______

Answer 42

Reservoir sign | Suggestive of mastoiditis

Question 43

Superior spread of infection from mastoiditis results in ?

Answer 43

Zygomatic abscess

Question 44

Which of the foll is not a complications of mastoiditis 1. Lucs abscess 2. Post auricular abscess 3. Bezolds abscess 4. Trautmam abscess

Answer 44

Trautmam abcsess

Question 45

Non tender edema of mastoid suggestive of

Answer 45

Sigmoid vien thrombosis Thrombus passed in mastoid emissiory vein

Question 46

Tender edema of mastoid suggestive of

Answer 46

Mastoiditis

Question 47

Which is most common intracranial complication of unsafe csom

Answer 47

Meningitis

Question 48

Gradenigos triad ......

Answer 48

Persistence of discharge after MRM 5 nerve involvement ( retro orbital pain) 6 nerve palsy ( lateral rectus palsy - diplopia(

Question 49

Explain Crowe Beck sign | Explain Toby ayer test

Answer 49

Crowe Beck sign --- If there if IJV Thrombosis of one side , on oressing the IJV of the normal side ... ICP increases... Which can be seen by Pailledema Toby ayer. Inccraese ICP can be seen by lumber puncture

Question 50

CECT mri result of lateral vein thrombosis

Answer 50

Empty traingle sign | Delta sign