Question: Type 1 thyroplasty is for

Thyroplasty types Type I: It is medial displacement of vocal cord as in achieved in Teflon paste injection. Type II: It is lateral displacement of the vocal cord and is used to improve the airway. Type III: It is used to shoen the vocal cord. Relaxation of vocal cord lowers the pitch. This procedure is done in mutational falsetto or in those who have undergone gender transformation from female to male. Type IV: This procedure is used to lengthen the vocal cord and elevate the pitch. It coves the male character to a female and has been used in gender transformation. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 341


Question: Not an example of velopharyngeal  Insufficiency


Question: Lymphatic drainage of the oropharynx is mainly through

Lymphatics from oropharynx drain into the upper jugular chain, particularly the jugulodigastric (tonsillar) node. Some parts drain to the posterior cervical group also. The base of the tongue may drain bilaterally.
Lymphatic drainage of nasopharynx - upper deep cervical nodes.


Question: Parapharygeal space is also known as

Parapharyngeal space is situated on the side of the pharynx. It is pyramidal in shape with the base at the base of the skull and apex at the hyoid bone. It contains carotid vessels, jugular vein, last 4 cranial nerves and cervical sympathetic chain. Ref: Diseases of ENT, PL Dhingra, 7th edition, pg no. 301


Question: Malignant otitis externa is caused by

Malignant otitis externa is often caused by difficult to treat bacteria such as Pseudomonas aeruginosa. Only are cases of malignant otitis externa due to S.aureus, Proteus mirabilis and Aspergillus fumigates have been repoed.Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 55


Question: Graft for myringoplasty

Ans. is 'a' i.e., Temporalis fascia Graft material used for myringoplasty are : Temporalis fascia (most common) Tragal cailage Perichondrium from the tragus Vein


Question: Supranuclear lesion of facial nerve affects

It is caused by cerebrovascular accidents (haemorrhage, thrombosis or embolism), tumour or an abscess. It causes paralysis of only the lower half of face on the contralateral side. Forehead movements are retained due to bilateral innervation of frontalis muscle. Involuntary emotional movements and the tone of facial muscles are also retained. Ref: Dhingra 7e pg 107.


Question: FESS means

Ans. d (Functional endoscopic sinus surgery), (Ref. Scott Brown, Otolaryngology, 6th ed., 12, 29)Functional Endoscopic Sinus Surgery (FESS) is based on the philosophical concept that function can be restored to the paranasal sinuses and normal structures can be preserved through removal of minimal amounts of tissue. This concept embodies a new understanding of the pathophysiology and development of sinus disease and requires a more delicate, minirealist approach to sinus surgery than the extirpative procedures of the past. These techniques were developed by Walter Messerklinger of Graz, Austria. Uncinectomy is 1st step of FESS.


Question: The nerve supply of middle ear

Tympanic branch supplies innervation to the medial surface of the tympanic membrane,tympanic cavity,mastoid air cells and the bony eustachian tube. Reference- Dhingra 6/e,p 8.


Question: Fistula tests stimulates


Question: The size of the Fenestra vestibule on an average is

The size of the Fenestra vestibule on an average is 3.25 mm long and 1.75 mm wide. Ref- Dhingra ENT Textbook 6th edition.


Question: Treatment of middle ear papilloma is

In carcinomas of middle ear radical mastoidectomy followed by radiotherapy is an alternative ton an en bloc removal of temporal bone Ref: PL DHINGRA diseases of ear nose and throat, 6th edition, page no 131


Question: Prussak space is in


Question: Synkinesis is a sequel of

Synkinesis or mass movement is a complication of peripheral facial nerve paralysis which occurs due to cross-innervation of fibres. Ref: Dhingra 6th edition pg. 98


Question: Length of external auditory canal is

Ans. c (24 mm). (Ref. PL Dhingra Diseases of ENT 2nd/pg.3)EXTERNAL AUDITORY CANAL# It starts at the external auditory meatus and ends at the tympanic membrane, where a bony structure (bony outer attic wall at tympanic membrane, where ECA ends) projects, called scutum.# It is almost S shaped curved canal of about 24 mm length.# It has:- outer cartilaginous part (2/3rd) and- inner bony part (l/3rd).# It is directed upwards, backwards and medially in outer part and downwards, forwards and medially in inner part.# The periosteum is very firmly adherent in EAC and hence even a minor infection like a furuncle is extremely painful.


Question: Singular nerve is a

A small subdivision of the vestibular nerve that carries information from the posterior semicircular canal to the brain. Singular neurectomy is a surgical procedure to divide the singular nerve, occasionally used in the treatment of benign paroxysmal positional veigo. Ref-Dhingraa textbook for ENT 6th edition.

Superior vestibular nerve supplying posterior semicircular canal

Inferior vestibular nerve supplying posterior semicircular canal

Superior vestibular nerve supplying anterior semicircular canal

Interior vestibular nerve supplying anterior semicircular canal


Question: Paracusis is seen in

(Otosclerosis) (87-Dhingra 4th edition) (89- Maqbool 11th)Paracusis- Willisii - An otosclerotic patients hears better in noisy than quite surrounding. This is because a normal person will raise his voice in noisy surroundings, like in public transport, machine shops, engine rooms"Schwartze sign " - tympanic membrane shows flemingo-pink tinge in otosclerosis"Carhart's notch " -This is a pure tone audiometric findings is characteristic of otosclerosis (maximum at 2000 Hz)Clinical symptoms of Otosclerosis* Hearing loss conductive deafness* Paracusis - willisii* Tinnitus - More common in cochlear otosclerosis* Speech- monotonous* Vertigo- is uncommon* Presbycusis - sensorineural hearing loss associated with physiological aging process in the ear


Question: The ideal time for operation of quinsy after an attack of acute tonsillitis is

Treatment The above conservative measures may cure peritonsillitis. If a frank abscess has formed, incision and drainage will be required. INCISION AND DRAINAGE: A peritonsillar abscess is opened at the point of a maximum bulge above the upper pole of the tonsil or just lateral to the point of junction of the anterior pillar with a line drawn through the base of uvula. INTERVAL TONSILLECTOMY: Tonsils are removed 6 weeks following an acute attack of quinsy. ABSCESS OR HOT TONSILLECTOMY: Some people prefer to do hot tonsillectomy instead of incision and drainage. (Ref: Diseases of Ear, Nose and Throat and head and neck surgery, 7th edition Pg no. 298)


Question: Most common cause of oroantral fistula

A most impoant cause of oroantral fistula is dental extraction. It is a communication between the antrum and the oral cavity. Roots of the second premolar and upper molars are closely related to the antral cavity and their extraction may lead to fistula formation. It presents with regurgitation of food foul smelling discharge filling nose and inability to build positive or negative pressure in the mouth. Ref: Textbook of diseases of ENT; PL Dhingra; 7th edition, pg 208


Question: Bing test is

Bing test: It is a test of bone conduction Examines the effect of occlusion of ear canal on the hearing. A vibrating tuning fork is placed on the mastoid while the examiner alternately closes and opens the ear canal by pressing on the tragus inwards. A normal person or one with sensorineural hearing loss hear louder when the ear canal is occluded and softer when the canal is open (Bing positive). A patient with conductive hearing loss will appreciate no change (Bing negative). Ref: Dhingra; 6th Edition; pg no 22


Question: Paracusis Willisii is a feature of

An otosclerotic patient hears better in noise than in quiet surroundings. This is called Paracusis Willisii. This is because a normal person will raise his voice in noisy surroundings Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra; 7th Edition; page no 96


Question: In Bilateral palsy of recurrent larygeal nerve there is

In BLL RLN palsy - VC is in median position, so speech preserved has stridor and dysphoea.

Complete loss of speech with steidor and dysphonia

Comlete loss of speech but no difficulty in breathing

Preserved speech with severe stridor and dyspnocr

Pressure speech with no difficulty of breating.


Question: Most definitive diagnosis of sinusitis is by

Sinuscopy is a method of Endoscopic sinus observation or surgery using Nose telescope. It involves the evaluation of nasal and sinus passages using the endoscope called Sinuscope. The Sinuscope has a narrow tube with a built-in camera so that the physician can see the internal details of the sinuses. By observing the sinus, it is possible to diagnose the problems and treat properly.


Question: Elastic cailage is present in

Elastic cailage is present in - Epiglottis. It is a yellow, leaf-like elastic cailage forming the anterior wall of the laryngeal inlet. It is attached to the body of the hyoid bone by the hyoepiglottic ligament, which divides into suprahyoid and infrahyoid epiglottis. Other elastic cailage structures are corniculate, cuneiform and tip of arytenoid near corniculate cailage. Thyroid, cricoid and most of the arytenoid cailage are by hyaline cailage. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 319


Question: Most common site for the initiation of otosclerosis is

In stapedial otosclerosis which is the most common variety, the lesion stas just in front of the oval window in an area called "fissula ante fenestram". Ref: Diseases of EAR, NOSE, THROAT by PL Dhingra; 7th Edition; page no.95


Question: Investigation of choice for nasopharyngeal angiofibroma

Computed tomography (CT) scan of the head with contrast enhancement is now the investigation of choice. It has replaced conventional radiographs. It shows the extent of a tumour, bony destruction or displacements. Anterior bowing of the posterior wall of maxillary sinus often called antral sign or Holman-Miller sign is pathognomic of angiofibroma (Ref: Diseases of Ear, Nose and Throat, P.L Dhingra, 7th edition, page 280)


Question: Lombard test is used in diagnosis of

Lombard's test depends on the fact that to the normal man the sound of his own voice is necessary to the proper regulation of its tone and intensity. The Barany noise apparatus is adjusted in the patient's sound ear,and its machinery staed in order to accustom him to its grating noise. He is given a book, and told to read aloud in his natural voice,and not to stop reading when the instrument is set in action.As soon as the noise begins,a man whose opposite ear is profoundly deaf will at once raise his voice . The malingerers on the other hand,claiming a one-sided deafness which is not real,will continue to read in an even tone or in a tone only slightly elevated. In this way,Lombard's test is used in the diagnosis of Non -Organic hearing loss. ref:LOGAN TURNER'S textbook,8th edition,page no.400


Question: The glomus tumor invasion of jugular bulb is diagnosed by

MRI - gives soft tissue extent of tumor; Magnetic Resonance Angiography (MRA) shows compression of the carotid aery whereas magnetic resonance venography shows invasion of jugular bulb by the tumor.


Question: Kemicetine solution does not include

Kemicetine solution has chloramphenicol,Estradiol,Propylene Glycol,Vitamine D2.


Question: Spontaneous vertical nystagmus is seen in the lesion of

“Vertical nystagmus means vertical displacement of the eye, not side to side nystagmus when attempting upward or down ward gaze. As defined vertical nystagmus always indicates brainstem dysfunction”


Question: Type I thyroplasty is for

Type I Thyroplasty It is the most commonly used surgical procedure to correct unilateral vocal cord paralysis (a condition where the vocal cord of one side is paralysed). Procedure In this type of thyroplasty, a rectangular poion of the thyroid cailage is mobilized and pushed towards the medial side using a piece of silastic block of proper shape under local anesthesia. Earlier, the piece of the thyroid cailage was kept along with implant and the stitches were taken, but nowadays, the piece of the thyroid cailage is cut and removed to avoid complications. Ref : https://en.m.wikipedia.org/wiki/Thyroplasty


Question: Pendred's syndrome is due to a defect in

Pendred disease is an autosomal recessive disorder leading to congenital bilateral sensorineural hearing loss and goitre with euthyroid or mild hypothyroidism. It has been linked to mutations in the PDS gene, which codes for the pendrin protein. The gene is located on the long arm of chromosome 7 (7q) Ref : Dhingra 7e pg 130.


Question: IOC for angiofibroma is

NASOPHARYNGEAL FIBROMA (JUVENILE NASOPHARYNGEAL ANGIOFIBROMA) INVESTIGATIONS :- 1. Computed tomography (CT) scan of the head with contrast enhancement is now the investigation of choice. It has replaced conventional radiographs. It shows the extent of tumour, bony destruction or displacements. Anterior bowing of the posterior wall of maxillary sinus, often called antral sign or Holman-Miller sign, is pathognomic of angiofibroma. 2. Magnetic resonance imaging (MRI) is complementary to CT scans and shows any soft tissue extensions present intracranially in the infratemporal fossa or in the orbit. 3. Carotid angiography shows the extent of tumours, its vascularity and feeding vessels which mostly come from the external carotid system. In very large tumours or those with intracranial extension vessels may also come from internal carotid system. Embolization of vessels can be done at this time to decrease bleeding at operation. Feeders from only the external carotid system can be embolized. Resection of tumour should not be delayed beyond 24-48 h of embolization to avoid vascularization from the contralateral side. Ref:- Dhingra; pg num:-247,248


Question: Ceruminous glands are modified

Cailaginous pa of an external auditory meatusThe skin covering it is thick and has ceruminous glands (modified apocrine sweat glands), pilosebaceous glands and hair. Since hair is confined to cailaginous pa, furuncle is seen only is the outer third of the canal.Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 3


Question: Auditory fatigue is seen at

Auditory fatigue occurs at 90dB, 4000Hz. 90dB for 8hour a day for 5weeks is the maximum safe limit. (Ref: Diseases of EAR, NOSE AND THROAT by PL DHINGRA - 6th Edition)


Question: charecters of tb otitis media is

Tuberculous Otitis Media * Painless , odourless otorrhoea refractory to antibiotics * Multiple TM perforations and a large perforation * Middle ear mucosa pale (congest., around E.T.0.) * Pale granulations in mastoid & middle ear * Severe deafness with bony necrosis (caries) * Facial palsy & labyrinthitis * Tb: Anti-TB therapy and mastoidectomy red : hazarika 4th ed


Question: The sleep apnea syndrome is defined as

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and stas. If you snore loudly and feel tired even after a full night's sleep, you might have sleep apnea. The main types of sleep apnea are: Obstructive sleep apnea, the more common form that occurs when throat muscles relax Central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, which occurs when someone has both obstructive sleep apnea and central sleep apnea

30 or more episodes of apnea during 12hours

28 or more episodes of apnea during 7hours

30 or more episodes of apnea during 7hours

30 or more episodes of apnea during 10hours


Question: High frequency audiometry is used in

In ototoxicity, there is high-frequency hearing loss. Note: Pure tone audiometry has only frequency of 125 to 8000 Hz. OTOTOXIC DRUGS: A. Aminoglycoside antibiotics * Streptomycin * Dihydrostreptomycin * Gentamicin * Tobramycin * Neomycin * Kanamycin * Amikacin * Netilmycin * Sisomycin B. Diuretics * Furosemide * Ethacrynic acid * Bumetanide C. Antimalarials * Quinine * Chloroquine * Hydroxychloroquine D. Cytotoxic drugs * Nitrogen mustard (Mechlorethamine) * Cisplatin * Carboplatin E. Analgesics * Salicylates * Indomethacin * Phenylbutazone * Ibuprofen F. Chemicals * Alcohol * Tobacco * Marijuana * Carbon monoxide poisoning G. Miscellaneous * Erythromycin * Ampicillin * Propranolol * Propylthiouracil * Deferoxamine Ref: Dhingra; 6th Edition; pg no 34


Question: The most frequent complication after resection of Carotid Body tumour is

The vagal nerve or hypoglossal nerve damage associated with removal of larger tumours. Ref : ENT textbook by Dhingra 6th edition Pgno : 392,393

Baroreceptor failure with fluctuations in blood pressure


Question: Impedance audiometry is done using frequency probe of

It consists of a probe which fits into the external acoustic canal and has 3 channels: To deliver a tone of 220Hz To pick up the reflected sound a microphone To bring about changes in air pressure in the canal from positive to normal and then negative Ref: Dhingra; 6th Edition; pg no 24


Question: Preferred imaging modality for choanal atresia is

CT SCAN in choanal atresia CT SCAN in coronal and saggital projections provides a thorough evaluation of choanal atresia and adjescent structures. The axial views supply fundamental information including site of obstruction, composition of atretic plate and unilateral or bilateral involvement. Thus CT SCAN is the preferred imaging modality.


Question: Common age for otosclerosis is

Hearing loss usually stas between 20 to 30 years of age and is rare before 10 and after 40 years. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 95)


Question: Nasopharyngeal Ca is caused by

NASOPHARYNGEAL CANCER AETIOLOGY :- The exact aetiology is not known. The factors responsible are: 1. Genetic:- Chinese have a higher genetic susceptibility to nasopharyngeal cancer. Even after migration to other countries they continue to have higher incidence. 2. Viral:- Epstein-Barr (EB) virus is closely associated with nasopharyngeal cancer. Specific viral markers are being developed to screen people in high-incidence areas. EB virus has two impoant antigens: viral capsid antigen (VCA) and early antigen (EA). IgA antibodies of EA are highly specific for nasopharyngeal cancer but have sensitivity of only 70-80% while IgA antibodies of VCA are more sensitive but less specific. AgA antibodies against Both EA and VCA should be done for screening of patients for nasopharyngeal cancer. 3. Environmental:- Airpollution, smoking of tobacco and opium, nitrosamines from dry salted fish, smoke from burning of incense and wood have all been incriminated. Ref:- Dhingra; pg num:-250


Question: CSF rhinorrhea "immediate" management is

CSF rhinorrhea may be classified as: Traumatic (>90%) - Approximately 80% of all traumatic leaks occur in the setting of accidental trauma, and the remaining traumatic leaks occur after neurosurgical and rhinological procedures Nontraumatic (Nontraumatic etiologies include neoplasms and hydrocephalus High pressure flow- intracranial tumours & hydrocephalous Low pressure flow- congenital defects Most common site for leak is through cribform plate and ethmoidal air sinuses. Less common sites are through frontal and sphenoidal sinuses. Rarely, the leak can originate in the middle or posterior cranial fossa and can reach the nasal cavity by way of the middle ear and eustachian tube Diagnosis: Basic clinical tests - Rhinoscopy-visualisation of CSF leakage from paranasal sinuses - Tissue test-unlike nasal mucous ,CSFdoes not cause a tissue to stiffen - Filter paper test-sample of nasal discharge on a filter paper exhibits a light CSF border and a dark central area of blood 'double ring sign' or ' halo sign' (in cases of traumatic CSF leak where blood and CSF are mixed.) - Queckenstedt test-compression of jugular veins leads to increased CSF leakage d/t increase in 1CP Biochemical tests: - Concentrations of glucose & protein are higher in CSF than in nasal discharge. - 12-transferrin is the preferred biochemical marker of CSF. It helps in distinguishing CSF from other nasal secretions. - Beta-trace protein (11TP) is another chemical marker that could be used for the detection of CSF CSF tracers: Intrathecal fluorescein dye administration, radionuclide cisternography, CTcisternography Radiological studies: High-resolution CT provides detailed information about the bony skull base anatomy, and MR1 assesses soft tissues , including unrecognized tumors and coincidental meningoencephaloceles Treatment: Traumatic rhinorrhea often stops spontaneously Conservative treatment consists of 1-2 weeks trial of? - Strict bed rest - Head elevation - Stool softeners - Advising patient to avoid coughing, sneezing, nose blowing, and straining - Prophylactic antibiotics - Subarachnoid drainage through a lumbar catheter Surgical repair is generally advocated in patients with large fistulas especially in the presence of pneurnocephalous.


Question: Gradenigo&;s triad is caused due to the involvement of

Gradenigo syndrome is the classical presentation and consists of a triad of (i) external rectus palsy (VIth nerve palsy),(ii) deep-seated ear or retro-orbital pain (Vth nerve involvement) and (iii) persistent ear dischargeDue to petrositis in CSOM.(Spread of infection from middle ear and mastoid to the petrous pa of the temporal bone is called petrositis.)Dhingra 6e pg: 79


Question: During normal conversation, sound heard at 1meter distance is

At a distance of 1 m, intensity of Whisper = 30 dB Normal conversation = 60 dB Shout = 90 dB Discomfo of the ear = 120 dB Pain in the ear = 130 dB Ref: Dhingra 7e pg 21.


Question: Muscular voice in females is treated by

THYROPLASTY Isshiki divided thyroplasty procedures into four categories to produce functional alteration of vocal cords. (a) Type I:- It is medial displacement of vocal cord as is achieved in teflon paste injection. (b) Type II:- It is lateral displacement of vocal cord and is used to improve the airway (c) Type III:- It is used to shoen (relax) the vocal cord. Relaxation of vocal cord lowers the pitch. This procedure is done in mutational falsetto or in those who have undergone gender transformation from female to male. (d) Type IV:- This procedure is used to lengthen (tighten) the vocal cord and elevate the pitch. It conves male character of voice to female and has been used in gender transformation. It is also used when vocal cord is lax and bowing due to aging process or trauma. Ref:- Dhingra; pg num:-301,302


Question: Wood workers are associated sinus Ca


Question: Infection of CNS spreads to inner ear through

The scala tympani is closed by a secondary tympanic membrane. It is also connected with subarachnoid space through aqueduct of cochlea Reference: Dhingra 6th edition.


Question: Pseudosulcus in larynx is

Laryngeal pseudosulcus refers to edema of the ventral surface of the true vocal fold that extends from the anterior commissure to the posterior larynx. Patients with pseudosulcus are nearly 2.5 times more likely to have pH-documented Larynopharyngela reflux.


Question: Commonest cause for grommet inseion is

The main pathology in Serous otitis media is effusion, which can be managed by drainage. Inseion of grommet in infection can lead to foreign body granuloma. www.mydr.com.au Tympanostomy tube, also known as a grommet or myringotomy tube, is a small tube inseed into the eardrum in order to keep the middle ear aerated for a prolonged period of time, and to prevent the accumulation of fluid in the middleear. Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition; Pg no: 396


Question: Most common site of stapedial otosclerosis is

(D) Fissula ante fenestram # STAPEDIAL OTOSCLEROSIS. Stapedial otosclerosis causing stapes fixation & conductive deafness is the most common variety.> Lesion starts just in front of the oval window in an area called 'fissula ante fenestram'. This is the site predilection (anterior focus).> Lesion may start behind the oval window (posterior focus), around the margin of the stapes footplate (circumferential), in the footplate but annular ligament being free (biscuit type). Sometimes, it may completely obliterate the oval window niche (obliteralivetype)


Question: The following test is useful for diagnosis of

Ans. (b) Meniere's disease.* The image shows performance of the caloric stimulation test.* Irrigation of the external meatus with water 7deg above and later 7deg below body temperature sets up convection currents of the endolymph in the semi-circular canals.* This causes nystagmus, and the duration of the nystagmus gives an index of the activity of the labyrinth. The nystagmus can be directly observed or recorded electrically (electronystagmography).* This test is particularly valuable in the diagnosis of Meniere's disease and acoustic neuroma. A reduced or absent nystagmus is found (canal paresis).


Question: Mouse Nibbled appearance of vocal cord seen in

Earliest sign : Hyperaemia of UC &bposterior commissure area.
Mamillated arytenoids : Swollen arytenoids.
Mouse nibbud appearance : Multiple ulcer on vocal cord.
Tubon epiglottis : Swollen epiglottis of cellular infiitrations (pseudoedima).


Question: Stria vascularis are seen in

Ans. (c) CochleaRef: Dhingra's ENT 5th ed. /12* Upon taking the section of cochlea, we see 3 compartments and 3 membranes:# Scala vestibuli: contains perilymph# Scala media: contains endolymph# Scala tympani: contains perilymph* 3 membranes are:# Reissner's membrane: separates scala vestibule from scala media.# Basilar membrane: separates scala tympani from scala media. Also supports organ of corti.# Stria vascularis: on the wall of scala media. Converts perilymph into endolymph.


Question: Ossicular ratio is =


Question: Turban epiglottis is seen in

Turban epiglottis is due to oedema and infiltration of the epiglottis and is caused by laryngeal tuberculosis. Lupus: a form of tuberculosis, on the other hand, eats away and destroys the epiglottis. Pseudoedema of the epiglottis is known as "turban epiglottis". Ref: PL Dhingra 7th edition of Ear, Nose and Throat; Pg no 331


Question: Female with stapedectomy done, has a conductive hearing loss at 60 dB. Diagnosis is

1. Complete obstruction of ear canal: 30 dB 2. Perforation of tympanic membrane (It varies and is directly propoional to the size of perforation): 10-40 dB 3. Ossicular interruption with intact drum: 54 dB 4. Ossicular interruption with perforation: 38 dB 5. Malleus fixation: 10-25 dB 6. Closure of oval window: 60 dB Ref: Dhingra 7e pg 31.


Question: Dohlmann&;s procedure is done in

PHARYNGEAL POUCH Also called hypopharyngeal diveiculum or Zenker's diveiculum, it is a pulsion diveiculum where pharyngeal mucosa herniates through the Killian's dehiscence--a weak area between two pas of the inferior constrictor. TREATMENT :- 1. Excision of pouch and cricopharyngeal myotomy. This is done through cervical approach. 2. Dohlman's procedure. The paition wall between the oesophagus and the pouch is divided by diathermy through an endoscope. This is done in poor risk debilitated patients. 3. Endoscopic laser treatment. It is similar to Dohlman's procedure. Paition between the pouch and oesophagus is divided by CO2 laser using operating microscope. Ref:- Dhingra; pg num:-274,275


Question: A 3 year old child with Bilateral hearing loss, On examination Bluish tympanic membrane


Question: Most common benign lesion of larynx in the pediatric age group is

Juvenile papillomatosis is the most common benign neoplasm of the larynx in children. It is viral in origin and is caused by human papilloma DNA virus type 6 and 11. It is presumed that affected children got the disease at bih from their mothers who had vaginal human papilloma virus disease.Patient, often a child, between the age of 3 and 5 years presents with hoarseness or aphonia with respiratory difficulty or even stridor.Dhingra 6e pg: 306


Question: The incision used in endomeatal approach to the ear is

The tympanomeatal flap is raised to expose the middle ear in endomeatal approach. Rosen's incision is used in the endomeatal approach for stapedectomy. It is also used for exploratory tympanotomy. It requires the meatus and canal to be wide enough to work. It consists of two pas: (i) a small veical incision at 12 o'clock position near the annulus (ii) a curvilinear incision staing at 6 o'clock position to meet the first incision in the posterosuperior region of the canals, 5-7 mm away from the annulus Ref : Diseases of ENT by Dhingra 6th edition Pgno : 401


Question: Identity the Instrument used in ENT surgery


Question: Hot potato voice seen in


Question: If a patient gets an attack of veigo by loud noise, he is having

Tullio phenomenon - A condition in which loud sound produces veigo. It can occur in syphilis. (Ref: Diseases of EAR, NOSE AND THROAT by PL DHINGRA - 6th Edition)


Question: During the ear examination, cough occurs due to stimulation of

Arnold nerve. It is an auricular branch of jugular ganglion of the vagus.
It supplies the skin of posterior part of pinna on the medial surface of the concha, and posterior wall of the external auditory canal and tympanic membrane.
The auricular nerve is the afferent limb of the Ear-Cough or Arnold Reflex.


Question: The common site for CSF rhinorrhoea is

The cribriform plate and air cells of the ethmoid sinus account for a maximum number of CSF leaks, i.e., through anterior cranial fossa. Other sites are frontal sinus, an area of sella turcica and sphenoid sinus. Rare sites of the leak are middle or posterior cranial fossa and CSF and reach the nasal cavity by way of the middle ear and Eustachian tubeTraumatic leak-Cribriform plate and ethmoidal air cellsSpontaneous (non-traumatic) leak -Cribriform plateRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 183 - 185


Question: Treatment of erythroplakia


Question: Ideal treatment of rhinosporidiosis is

Rhinosporodiosis * Rhinosporodiosis is a Fungal Granuloma. * Agent : Rhinosporidium seeberi. * Source : Contaminated water of ponds. Clinical features:- * Leafy polypoidal mass, pink to purple in color studded with while dots (Strawberry appearance). * It is highly vascular and bleeds on touch. * Patients complain of blood tinged nasal discharge/epistaxis Diagnosis:- * Biopsy shows several sporangia filled with spores. * Treatment - Complete excision of mass with diathermy knife and cauterization of base. * Recurrence is common after surgery. Ref:- Dhingra 5th edition pg num:- 174


Question: Ostamann fat pad is related to

It is related laterally to the membranous pa of the eustachian tube.It helps to keep the tube closed and thus protect it from the reflux of nasopharyngeal secretions. Veical section of Eustachian tube- Ref: Dhingra 6th edition pg. no - 57


Question: Lymphatics of tip of the tongue drain into


Question: Bryce sign seen in

On compression of sxternal swelling of laryngoule cause escape of air through larynk causing hissing of sound is know as Bryce sign.


Question: Ratio of tympanic members to oval window is

According to some workers (Wever and Lawrence) out of a total of 90 mm2 area of human tympanic membrane, only 55 mm2 is functional and given the area of stapes footplate (3.2 mm2), the areal ratio is 17:1 and total transformer ratio (17x 1.3) is 22.1. Ref: Dhingra 7e pg 17.


Question: The voice in a patient with bilateral abductor paralysis of larynx is

As both the cords lie in median or paramedian position, the airway is inadequate causing dyspnoea and stridor but the voice is good. Dyspnoea and stridor become worse on exeion or during an attack of acute laryngitis. Ref: PL Dhingra Textbook of Ear, Nose and Throat, Edition 7, page - 339


Question: Hot potato voice is characteristic of

Peritonsillar abscess shows muffled and thick speech often called as " hot potato voice ". Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 298


Question: A patient after having a fracture of middle cranial fossa complains of loss of tear secretion. This is due to the injury to

Greater petrosal nerve arises from the geniculate ganglion of the facial nerve, enters the middle cranial fossa by emerging at the hiatus for the greater petrosal nerve on the anterior surface of the petrous temporal bone. It joins the deep petrosal nerve and forms the nerve of the pterygoid canal which reaches the pterygopalatine ganglion. The postganglionic parasympathetic fibres ultimately supply the lacrimal gland and the mucosal glands of pharynx, palate and nose. Ref:


Question: Last taste sensation discovered is

Umami a savory taste is one of the five basic tastes (together with sweetness, sourness, bitterness, and saltiness)People taste umami through receptors specific to glutamate. Glutamate is widely present in savory foods, such as meat broths and fermented products, and commonly added to some foods in the form of monosodium glutamate (MSG) since umami has its own receptors rather than arising out of a combination of the traditionally recognized taste receptors, scientists now consider umami to be a distinct taste. Ref: https://en.m.wikipedia.org/wiki/Umami


Question: Passavant ridge is formed by

Passavant ridge Near the superior margin of the pharynx, a few fibers of superior constrictor blend with a band of muscle fibers belonging to the palatopharyngeus muscle These fused fibers form a band or ring around the posterior wall and sidewalls of the nasopharyngeal isthmus When the soft palate is elevated this muscle band appears as a ridge is known as passavant ridge. Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 271

Superior constrictor and palatopharyngeus

Inferior constrictor and palatopharyngeus


Question: Elastic cartilage is present in

Elastic cartilage is present in – Epiglottis. It is a yellow, leaf-like elastic cartilage forming anterior wall of laryngeal inlet. It is attached to the body of hyoid bone by the hyoepiglottic ligament, which divides into suprahyoid and infrahyoid epiglottis.
Other elastic cartilage structures are corniculate, cuneiform and tip of arytenoid near corniculate cartilage.
Thyroid, cricoid and most of the arytenoid cartilage are hyaline cartilages.


Question: Gradcnigo's syndrome is characterized by a/e

Ans. a (Conductive deafness). (Ref. PL Dhingra, ENT, 2nd ed., 78)GRADENIGO'S SYNDROME# Petrositis, a complication of otitis media classically presents with a triad of symptoms, known as Gradenigo's syndrome characterized by:- Abducent nerve (lateral rectus) palsy.- Deep seated ear or retro-orbital pain (Vth nerve involvement)- Persistent ear discharge# However, fever, headache, vomiting & sometimes neck stiffness occurs.# Towne's & Stenver's (StockholmC) view for petrous apex and internal auditory meatus point towards diagnosis whileHRCT of temporal bone is confirmatory & gives greater anatomical details. CTT1 MRIT2MRICEMRIAcute petrous apecitis with osteomyelitis (Gradenigo syndrome)Opacified air cells with bony breakdown; nonexpansileLowHighrim enhancement or enhancement of adjacent meninges# Rx these days is antibiotic therapy alone, but sometimes mastoidectomy may be required.


Question: Most common site for mucoepidermoid carcinoma is

Mucoepidermoid carcinoma is the most frequently diagnosed malignancy of the salivary gland. Among the major salivary glands, the parotid gland is most commonly involved.


Question: In Galen's anastomosis, superior laryngeal nerve pierces inferior constrictor of pharynx and unites with

GALEN'S ANASTOMOSIS: Superior laryngeal nerve ends by piercing inferior constrictor of pharynx and unites with ascending branch of recurrent laryngeal nerve. This is called as Galen's anastomosis & is purely sensory.

Superior laryngeal nerve of opposite side


Question: A lumpy feeling in throat relieved on taking food is attributed to

Globus PharyngeusSymptom: a patient describes something stuck in the throat or a sensation of lump or tightness in the throat which is relieved by taking food or talkingRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 389


Question: Facial nerve exits the skull through

Facial nerve enters the temporal bone through - Internal acoustic meatus Facial nerve exits the skull through - Stylomastoid foramen. Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 99


Question: For a case of pubero phonia,Thyroplasty used is


Question: 4 year old male, recurrent URTI, has difficulty breathing, High arched palate, Failure to grow and impaired hearing, management is


Question: Most common cause of vocal cord palsy is

Neuritis or surgical trauma (thyroidectomy) is the most impoant cause. Thyroid surgery is the most common cause when both recurrent and external laryngeal nerves of one side may be involved. Ref: PL Dhingra Textbook of Ear, Nose and Throat, Edition 6, page - 300


Question: Crocodile tears is due to abnormal regeneration of


Question: The cause for contact ulcer of vocal cord


Question: The most common site of the leak in CSF rhinorrhea is

CSF rhinorrhea- Commonest site- Lateral lamella of cribriform plate of the ethmoidOther sites- Roof of ethmoids, posterior wall of the frontal sinus, Sphenoid sinusThe commonest cause of CSF rhinorrhoea- Iatrogenic TraumaRef: Hazarika; 3rd ed; Pg 361


Question: Most common cause of chronic laryngeal stenosis is

The most common cause of chronic laryngeal stenosis is Trauma. Complications of laryngeal trauma Laryngeal stenosis which is supraglottic, glottic or subglottic. Perichondritis and laryngeal abscess. Vocal cord paralysis. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 326


Question: Rosen's incision is used for

Rosen's incision is the most commonly used for stapedectomy. It requires the meatus and canal to be wide enough to work. It consists of two pas: A small veical incision at 12 o'clock position near the annulus and A curvilinear incision staing at 6 o'clock position to meet the first incision in the posterosuperior region of the canals, 5-7 mm away from the annulus. Tympanomeatal flap is raised to expose the middle ear in endomeatal approach. Rosen's incision is used in the endomeatal approach for stapedectomy. It is also used for exploratory tympanotomy Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition


Question: Injury to superior laryngeal nerve causes

Paralysis of the superior laryngeal nerve causes paralysis of cricothyroid muscle and ipsilateral anaesthesia of the larynx above the vocal cord. Paralysis of cricothyroid can also occur when the external laryngeal nerve is involved in thyroid surgery, tumours, neuritis or diphtheria. Voice is weak and pitch cannot be raised with decreased ability to sing. Flapping of the paralyzed cord. As the tension of the cord is lost, it sags down during inspiration and bulges up during expiration. Ref: PL Dhingra Textbook of Ear, Nose and Throat, Edition 7, page - 339


Question: Sensory nerve supply of larynx below the level of vocal cord is

NERVE SUPPLY OF LARYNX Motor:- All the muscles which move the vocal cord (abductors, adductors or tensors) are supplied by the recurrent laryngeal nerve except the cricothyroid muscle. The latter receives its innervation from the external laryngeal nerve-- a branch of superior laryngeal nerve. Sensory:- Above the vocal cords, larynx is supplied by internal laryngeal nerve--a branch of superior laryngeal, and below the vocal cords by recurrent laryngeal nerve. Ref:- Dhingra; pg num:-298

External branch of superior laryngeal nerve

Internal branch of superior laryngeal nerve


Question: During normal conversation sound heard at a 1meter distance is

Intensity: It is the strength of sound which determines its loudness. It is usually measured in decibels. At a distance of 1 m, intensity of Whisper = 30 dB Normal conversation = 60 dB Shout = 90 dB Discomfo of the ear = 120 dB Pain in the ear = 130 dB Ref : Diseases of ENT by Dhingra 6th edition Pgno : 19


Question: Schwaz operation is done in

Coical mastoidectomy, known as simple or complete mastoidectomy or Schwaz operation It is complete exenteration of all accessible mastoid air cells and conveing them into a single cavity. The posterior meatal wall is left intact and Middle ear structures are not disturbed. INDICATIONS 1. Acute coalescent mastoiditis. 2. Incompletely resolved acute otitis media with reservoir sign. 3. Masked mastoiditis. Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition; Pg no: 401


Question: Rhinitis medicamentosa is due to

Rhinitis medicamentosa is due to the prolonged use of topical nasal decongestants like oxymetazoline and xylometazolineTreatment- Stoppage of the decongestants, topical and systemic steroids.Ref: Hazarika; 3rd ed; Pg 298


Question: Acoustic neuroma causes

The tumour almost arises from the Schwann cells of the vestibular, but rarely from the cochlear division of VIIIth cranial nerve. Acoustic neuroma causes progressive unilateral sensorineural hearing loss by pressure on cochlear nerve fibres. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 125


Question: A patient with Pancoast's tumour develops loss of voice after radiation. It is due to

The recurrent laryngeal nerve is involved in Pancoast's tumour. Pancoast's tumour is a tumour of the pulmonary apex. Right recurrent laryngeal nerve arises from the vagus at the level of the subclan aery, hooks around it and then ascends between the trachea and oesophagus. The left recurrent laryngeal nerve arises from the vagus in the mediastinum at the level of the arch of the aoa, loops around it and then ascends into the neck in the tracheo-oesophageal groove. Ref: PL Dhingra; Textbook of EAR, NOSE and THROAT; edition 6

Involvement of recurrent laryngeal nerve


Question: Endolymph in the inner ear

Endolymph fills the membranous labyrinth and rich in K ions and is secreted by stria vascularis and the dark cells present in the utricle and near the ampullated end of semicircular ducts. Reference Dhingra 6th edition pg-24.


Question: Not a cardinal sign of chronic tonsillitis

Upper deep cervical lymph nodes enlarged


Question: Tober Ayer test is positive in

Tobey Ayer test is positive in Lateral sinus thrombophlebitis.Compression of Inferior Jugular Vein in the neck on the normal side causes a rise in CSF pressure but not on the affected side.Ref: Hazarika; 3rd ed; Pg 171


Question: Mode of inheritance of otosclerosis is

There is a marked hereditary tendency to otosclerosis in ceain families, and in nearly 50 percent of cases, a positive family history can be obtained. The pattern of inheritance is autosomal dominant with incomplete penetrance.Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 95 - 98


Question: Carhart's notch is seen in

i.e. (Otosclerosis): (99-Dhingra 5th)* Carhart's notch - maximum at 2000 Hz or 2KHZ carharts notch disappears after successful stapedectomy in OTOSCLEROSIS* Schwartze sign - flamingo-pink bluish tympanic membrane due to hyperaemia of the promontory and affords good evidence that the otosclerotic process is an active phase in OTOSCLEROSISOTOSCLEROSIS (otospongiosis)- Commonest site -fissula ante fenestram**- Painless and progressive bilateral conductive deafness**- Paracusis willisii (hears better in noisy than quite surroundings)**- Tinnitus, vertigo, monotonous speech**


Question: Pathognomic features of Maxillary sinusitis is

Clinical features of maxillary sinusitis: Constitutional symptoms: fever, general malaise and body ache. Headache Pain: It is typically situated over the jaw but may be referred to gums or teeth. Occasionally, it is referred to the ipsilateral supraorbital margin. Tenderness: pressure or tapping over the anterior wall of the antrum produces pain. Redness and oedema of the cheek: lower eyelid may become puffy. Nasal discharge: Anterior rhinoscopy shows pus/mucopus in the middle meatus. Mucosa of the middle meatus and terminate may appear red and swollen. Postnatal discharge: Pus may be seen on the upper soft palate on posterior rhinoscopy or nasal endoscopy. (Ref: Textbook of Diseases of ENT, 7th edition, PL Dhingra, pg no. 214)


Question: The voice is not affected in

Unilateral injury to recurrent laryngeal nerve results in ipsilateral paralysis of all the intrinsic muscles except the cricothyroid. The vocal cord thus assumes a median or paramedian position and does not move laterally on deep inspiration. Unilateral recurrent laryngeal paralysis may pass undetected as about one-third of the patients are asymptomatic. Others have some change in voice but no problems of aspiration or airway obstruction. The voice in unilateral paralysis gradually improves due to compensation by the healthy cord which crosses the midline to meet the paralyzed one. Ref: PL Dhingra Textbook of Ear, Nose and Throat, Edition 7, page - 339


Question: Not used in treatment of Rhinoscleroma


Question: Tonsil reach their maximum size by

Tonsils reach maximum size by 6-7 years and then involuteClosest among the options is 5 yearsRef: Hazarika; 3rd ed


Question: Unsafe eardrum perforation is

Ans. b (Marginal) (Ref. Diseases of ENT PL Dhingra 3rd/pg, 91-99).Attic and posterosuperior marginal perforations are seen in dangerous type of CSOM and are often associated with cholesteatoma while central perforation is considered safe, as cholesteatoma is usually not asso with it.OTITIS MEDIA# Tubotympanic disease (central perforation) remains localized to mucosa and that too mostly to anteroinferior part of middle ear cavity.# While atticoantral type or marginal or unsafe otitis media involves posterosuperior part of middle ear cleft (attic, antrum, posterior tympanum and mastoid) and is associated with cholesteatoma, which due to its bone-eroding property causes risk of serious complications and hence called unsafe or dangerous type.Chronic suppurative otitis mediaChronic suppurative otitis media (CSOM) is classified into two types: tubotympanic disease, in which there is a perforation of the pars tensa; and atticoantral disease, in which a retraction pocket develops from the pars flaccida.CSOM of the tubotympanic type. CSOM of the tubotympanic type can result from trauma or infection. When perforated the tympanic membrane usually repairs itself, but occasionally the outer layer of the tympanic membrane fuses with inner mucosa and a chronic perforation results. With this type of disease the patient's main symptoms are of an intermittent or chronic mucoid discharge associated with a mild conductive hearing loss. It is rare for this type of disease to be associated with intracranial complications. A diagnosis is made on otoscopy and the tuning forks usually suggest a conductive hearing impairment. The first-line treatment is topical antibiotic and steroid drops, and on occasion microsuction. If medical treatment fails, the patient may request an operation to graft the tympanic membrane in order to give a dry ear. This operation is termed a myringoplasty (type I tympanoplasty). The edges of the perforation are freshened and a small piece of temporalis fascia is inserted under the tympanic membrane to graft the drum.CSOM of the atticotympanic type. CSOM of the atticoantral type is important because of the complications associated with it. Cholesteatoma is the alternative name and means a cyst or sac of squamous epithelium that is present in the attic part of the middle ear. The exact aetiology of cholesteatoma is not known, although poor eustachian tube function is implicated. A retraction pocket develops in the pars flaccida and, if the squamous epithelium cannot migrate out of this pocket, a cholesteatoma results. The expanding ball of skin causes a low-grade osteomyelitis which results in the release of fatty acids from the bone. This gives the discharge its characteristic faecal smell. Invariably the discharge is accompanied by hearing loss and mild discomfort. The infection spreads to the dura via emissary veins which connect the middle ear mucosa to the dura or by direct extension of the disease through the bone. Meningitis, extradural, subdural or intracerebral abscess, or a combination of these may occur. Diagnosis should be suspected on otoscopy. Pus, crusts, granulations or a whitish debris in the attic are hallmarks of the disease. Examination under the microscope, audiometry and, sometimes, HRCT are indicated. The treatment is surgical and follows the principle of exposing the disease, excising the disease and then exteriorising the affected area. Two commonly applied operations for this disease are an atticotomy and a modified radical mastoidectomy.


Question: The investigation of choice for vestibular schwannoma is

MRI with gadolinium contrast. It is superior to CT scan and is the gold standard for diagnosis of acoustic neuroma.Intracanalicular tumour, of even a few millimetres, can be easily diagnosed by this method.Dhingra 6e pg: 113


Question: Posterior epistaxis occurs from

Ans) a or CRef: Dhingra 5th ed p l90, 191There is a confusion regarding the formation of this question. In this question whether the commonest siteOR the commonest cause of the epistaxis is to be answered is not clear.If the commonest site is asked answer will be Woodruffs plexus and if the commonest cause is asked it will be atherosclerosis Littles area is situated in the anterior inferior part of nasal septum, just above the vestibule.Four arteries - anterior ethmoidal, septal branch of superior labial, septal branch of sphenopalatine and the grater palatine, anastomose here to form a vascular plexus called Kiesselbach's plexus. Anterior epistaxis mostly occurs from this site.Woodruffs area is situated under the posterior end of inferior tur-binate where the sphenopalatine artery anastomoses with the posterior pharyngeal artery. Posterior epistaxis may occur in this area


Question: Earliest sign seen in Acoustic neuroma is

The earliest cranial nerve to be involved is the fifth cranial nerve causing reduced corneal sensitivity, numbness, anaesthesia of face. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 125


Question: Best time for hearing assessment in an infant is

It is recommended that all infants be screened for hearing loss by 1 month of age All infants who do not pass the hearing screening need to complete a diagnostic hearing evaluation by 3 months of age and All children identified with permanent hearing loss need to receive appropriate intervention by 6 months of age This plan is also called the 1-3-6 plan Ref: Logan Turner&;s pg no 382


Question: Most common complication of Sinusitis is

Orbital cellulitis is an infection of the soft tissues of the orbit posterior to the orbital septum. Orbital cellulitis is caused most commonly in all age groups by ethmoid sinusitis. The organisms gain access to the orbit through thin bones of the orbital walls, venous channels, foramina, and dehiscence. Orbital cellulitis resulting from infection of the maxillary sinus secondary to dental infections can be caused by microorganisms indigenous to the mouth.


Question: Most common presentation of nasopharyngeal carcinoma.

Painless cervical lymphadenopathyis the most common presenting feature of nasopharyngeal carcinoma. Presence ofunilateral serous otitis media in an adult should raise suspicion of nasopharyngeal growth. (Eustachian tube obstruction leads to serous otitis media which causes deafness). Commonest site of origin for nasopharyngeal carcinoma is thefossa of Rosenmuller. EXTRA EDGE: Nasopharyngeal cancer can causeTrotter's triadof Conductive deafness(eustachian tube blockage), Ipsilateral temporoparietal neuralgia (involvement ofCN V) and Palatal paralysis (CN X)


Question: Passavant's ridge is formed by

It is a mucosal ridge raised by fibres of palatopharyngeus. It encircles the posterior and lateral walls of the nasopharyngeal isthmus.
Soft palate, during its contraction, makes firm contact with this ridge to cut off nasopharynx from the oropharynx during the deglutition or speech.

Superior constrictor and palatopharyngeus

Inferior constrictor and palatopharyngeus


Question: Anti gravity Aspiration done in


Question: Cotton&;s grading is used for

Subglottic stenosis is graded according to the Cotton-Myer classification system from one to four based on the severity of the blockage. Grade 1 - <50% obstruction Grade 2 - 51-70% obstruction Grade 3 - 71-99% obstruction Grade 4 - no detectable lumen Ref: Internet sources- Wikipedia


Question: Cold water is not used for ear cleaning because

temperature for ear syringing - 370c because if you decrease or increase the temperature we can stimulate lateral semicircular canal in the middle ear and patient will have veigo and nystagmus (caloric stimulation )

Caloric stimulation caused by cold water


Question: Most common cause of chronic retropharyngeal abscess

CHRONIC RETROPHARYNGEAL ABSCESS (PREVEEBRAL ABSCESS) AETIOLOGY :- It is tubercular in nature and is the result of (i) caries of cervical spine or (ii) tuberculous infection of retropharyngeal lymph nodes secondary to tuberculosis of deep cervical nodes. Ref:- Dhingra; pg num:-266,267

Suppuration of retropharyngeal lymph node


Question: Multiple perforations of pars tensa is charecteristic of

TUBERCULAR OTITIS MEDIA In most of the cases, infection is secondary to pulmonary tuberculosis; infection reaches the middle ear through eustachian tube. Disease is mostly seen in children and young adults. PATHOLOGY The process is slow and insidious. Tubercles appear in the submucosal layers of middle ear cleft and caseate. There is painless necrosis of tympanic membrane. Multiple perforations may form which coalesce to form a single large perforation. Middle ear and mastoid get filled with pale granulations. Caries of bone and ossicles may occur leading to complications. Mastoiditis, facial paralysis, postauricular fistula, osteomyelitis with the formation of bony sequestra and profound hearing loss are often seen in these cases. Ref : Diseases of ENT by Dhingra 6th edition Pgno : 74


Question: Gerlach tonsil in waldeyer's ring is

Tubal tonsil is otherwise called Gerlach`s tonsil, seen towards the tubal openingWaldeyer&;s ring consists of - Adenoids, Palatine, Lingual, Tubal tonsils, and Lateral pharyngeal bandsRef: Hazarika; 3rd ed; Pg 436


Question: The most common cause of conductive deafness in children is

SEROUS OTITIS MEDIA, SECRETORY OTITIS MEDIA, MUCOID OTITIS MEDIA, "GLUE EAR" This is an insidious condition characterized by accumulation of nonpurulent effusion in the middle ear cleft. The fluid is nearly sterile. The disease affects children of 5-8 years of age. Hearing loss. This is the presenting and sometimes the only symptom. It is insidious in onset and rarely exceeds 40 dB. Deafness may pass unnoticed by the parents and may be accidentally discovered during audiometric screening tests. Ref : Diseases of ENT by Dhingra 6th edition Pgno : 64


Question: Laser used in laryngeal work is

CO2 laser:- CO2 laser is used in laryngeal surgery to excise vocal nodules, polyps, cysts, granulomas or juvenile laryngeal papilloma. Also used in case of leukoplakia, T1 lesion of vocal cord or localized leisions of supraepiglottis and infraglottis. 1) CO2 laser has wavelength 10,400nm 2) It can cut pericisely (0.3 mm percision), coagulate bleeders and vaporise tissues 3) Besides laryngeal surgery it is used in oropharyngeal surgery to excise benign or malignant lesions and in plastic surgery. Ref:- Dhingra; pg num:-357


Question: Most common malignant tumour of minor salivary glands


Question: First branch of the facial nerve is

Greater petrosal nerve arises from geniculate ganglion Ref: Dhingra 6th edition pg. 90


Question: Persistent bucconasal membrane result in

Ans. b (Choanal atresia). (Ref. Diseases of ENT, PL Dhingra, 3rd ed., 78, 210, 510)# Persistant bucconasal membrane leads to choanal atresia.Choanal atresia# Is a autosomal recessive trait in which the posterior choanae unilaterally or bilaterally fail to develop properly.# Persistent bucconasal membrane is the basic etiology.# Occurs in 1 in 5,000 births; more common among girls (2:1)# Unilateral > bilateral atresia.# Because newborns are obligate nose breathers, bilateral atresia is immediately apparent as respiratory distress.# Characteristics is the history or failure to pass a rubber catheter or nasogastric tube into the pharynx.# Symptoms of choanal atresia include failure to thrive due to poor feeding and mucoid nasal discharge.# The presence of choanal atresia can be confirmed with visualization of retention material in the posterior part of the nose on a lateral radiograph with the patient in the supine position.# Anatomic characterization of the deformity with CT can be important for planning surgical procedures.# Surgical treatment methods for membranous atresia include puncture of the choanal membrane and placement of a stent for 6 weeks.# If bony atresia is present, the bony wall can be taken down transnasally with microsurgical techniques followed by placement of a stent.# When suboptimal resection for atresia or choanal stenosis occurs, transpalatal repair at 3-4 years age is advised.# The septum usually deviates to the affected side; however, more posterior examination shows atresia.# Transpalatal repair is being replaced by endoscopic techniques of repair of atresia in children and adults.


Question: Unilateral sensorineural hearing loss may occur in

Mumps(epidemic parotitis) may result in a profound sensorineural hearing loss (90 dB or more), unilaterally (one ear) or bilaterally (both ears). Coronavirus and Rotavirus are associated with diarrhoea. (Ref: Diseases of EAR, NOSE AND THROAT by PL DHINGRA - 6th Edition, Microbiology - Anantanarayanan)


Question: Primary receptor cells of hearing are

Hair cells are impoant receptor cells of hearing. Inner hair cells are more impoant in the transmission of auditory impulses. Outer hair cells mainly receive efferent innervation from the olivary complex and are concerned with modulating the function of inner hair cells. (Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra; 6th edition; page no.13)


Question: Killian&;s incision is used for

Killian&;s incision is used for septoplasty Killians incision in case of deted nasal septum, make a slightly curvilinear incision, 2-3mm above the caudal end of septal cailage on the concave side . Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition; Pg no: 416


Question: Type of speech seen in nasopharyngeal carcinoma is

Denasal speech (rhinolalia clausa) is seen in nasopharyngeal carcinoma. It is lack of nasal resonance for words which are resonated in the nasal cavity Rhinolalia apea (hypernasality- Seen when ceain words which have little nasal resonance are resonated through the nose) Muffled and thick speech, often called "hot potato voice. (Ref: Diseases of Ear, Nose and Throat, P.L Dhingra, 7th edition, Pg no. 284)


Question: Steeple sign is seen in case of

X-ray finding in Acute LaryngotracheobronchitisIt is an inflammatory condition of the larynx, trachea and bronchi.Mostly, it is a viral infection (parainfluenza type I and II) affecting children between 6 months and 3 years of age. - Thumb sign is seen in Acute epiglottitisDhingra 6e pg: 290


Question: Modified radical neck dissection type II

Removal of level I - V lymph nodes with only spinal accessory nerve

Removal of level I - V lymph nodes with spinal accessory nerve and internal jugular vein

Removal of level I - V lymph nodes with sternocleidomastoid muscle and internal jugular vein


Question: In sensorineural hearing loss, weber's test is lateralized to

In Sendeafness deafness: Lateralised to better ear. In conductive deafness: Lateralised to worse ear. Ref: Dhingra; 6th Edition; pg no 22


Question: Vocal cord is lined by

MUCOUS MEMBRANE OF THE LARYNX It lines the larynx and is loosely attached except over the posterior surface of epiglottis, true vocal cords and corniculate and cuneiform cailages. Epithelium of the mucous membrane is ciliated columnar type except over the vocal cords and upper pa of the vestibule where it is stratified squamous type. Mucous glands are distributed all over the mucous lining and are paicularly numerous on the posterior surface of epiglottis, posterior pa of the aryepiglottic folds and in the saccules. There are no mucous glands in the vocal folds. Ref:- Dhingra; pg num:-285


Question: Primary receptor cells of hearing is

Hair cells: are impoant receptor cells of hearing and transduce sound energy into electrical energy.


Question: Most common extracranial complication of ASOM is

Pus may break through mastoid coex leading to subperiosteal abscess which may even burst on surface leading to a discharging fistula It occurs as a sequence of mastoiditis Ref: Dhingra 7e pg 84.


Question: After tonsillectomy, secondary haemorrhage occurs

After tonsillectomy primary haemorrhage occurs during surgery reactionary bleeding with in 24 hrs, secondary haemorrhage between 5-10 days Secondary haemorrhage is the result of sepsis and premature separation of the membrane Simple measures like removal of clots, application of adrenaline or hydrogen peroxide usually suffice. For profuse bleeding, electrocoagulation is done Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition; Pg no: 430


Question: Most common nerve injured in ligation of inferior thyroid aery

Recurrent laryngeal nerve may pass anterior, posterior or through the branches of the aery and care is taken to preserve it. RLN is injured near the ligament of Berry when cautery or aery forceps is used indiscriminately while cutting the ligament of Berry to free the thyroid lobe. Ref: Dhingra 7e pg 382.


Question: Ca Wheel sign is seen in

In a stage of pre-suppuration of ASOM, there is congestion of pars tensa. A leash of blood vessels appears along with the handle of malleus and at the periphery of tympanic membrane impaing it a ca-wheel appearance. Later, whole tympanic membrane including pars flaccid becomes uniformly red. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 67


Question: Congenital larygeal stridor also know as


Question: Mucormycosis of paranasal sinus is most common in

MUCORMYCOSIS: Caused by - rhizopus , rhizomucor , cunninghamella Moulds with non septate hyphae The higher prevalence of mucormycosis in India turned out to be statistically significant (p < 0.0001) in comparison with all other countries Predisposing factors - Organ transplant recipients - Long term desferroxamine therapy - Immunosuppression due to steroids or cytotoxic drugs Hematological malignancy - Diabetics - Chronic renal failure Five forms Rhinocerebral (most common site) Pulmonary mucormycosis (2' most common) Cutaneous Gastrointestinal Disseminated Diagnosis: Microscopy and biopsy show organisms that appears as broad ribbon like usually non septate hyphae which branch at right angles


Question: Stage II laryngeal carcinoma treated by

Neo adjuvant chemotherapy and then surgery


Question: Retraction of tympanic membrane touching the promontory. It is

Retraction of tympanic membrane touching the promontory is called atelectasis. When the tympanic membrane is thin and atrophic a segment of it or the entire membrane may collapse due to eustachian tube insufficiency. It may get plastered onto a promontory and also wrap around the ossicles. Stage Ill is also called as middle ear atelectasis. Tympanic membrane comes to lie on the promontory and ossicles. Middle ear space is totally or paially obliterated but middle ear mucosa is intact. The tympanic membrane can be lifted from the promontory with suction tip. It also balloons up when N2O is used during anaesthesia. The tympanic membrane is thin because it's collagenous middle layer had been absorbed due to prolonged retraction. In these cases, long process of the incus and stapes superstructure are absorbed. Placement of the ventilation tube helps to restore the position of the tympanic membrane. Ref: PL Dhingra; 7th edition of Ear, Nose and Throat; Pg no 79


Question: Following total thyrordectory the patient duclops respiratory stridor cause is


Question: Cochlear microphonic potentials exhibits

i.e. (Produced by outer hair cells):COCHLEAR MICROPHONIC (CM) - when basilar membrane moves in response to sound stimulus, electrical resistance at the tip of hair cells changes allowing flow of K+ through hair cells and produces voltage fluctuations called cochlear microphonic. It is an alternating current (AC) potentialsElectrical Potentials of Cochlea and CN VIIIFROM COCHLEA1. Endocochear potentials - It is direct current (DC) potential recorded from scala media. It is +80 mV and is generated from the stria vascularis by Na+ / K+ ATPase pump and provides source of energy for cochlear transduction. It is present at rest and does not require sound stimulus. This potential provides a sort of "battery" to drive the current through hair cells when they move in response to a sound stimulus.2. (Cochlear microphonic (CM)3. Summating potentials (SP) - It is a DC potential and follows "envelop" of stimulating sound It is produced by hair cells. It may be negative or positive. SP has been used in diagnosis of Meniere's disease. It is superimposed on VIII nerve lesionsFROM NERVE FIBRERS (CN VIII)4. Compound action potential - It is an all or none response of auditory nerve fibresBoth CM and SP are receptor potentials as seen in other sensory end organs - The differ from action potentials in that(a) They are graded rather than all or none phenomenon(b) Have no latency(c) Are not propagated(d) Have no post response refractory period

Electrodes have to be inserted over round window


Question: In infants most sensitive audiometric screening is

BERA is the investigation of choice for congenital deafness in children.OAE (otoacoustic emissions) is the commonest screening test in neonates.Electrocochleography- Used to measure the electrical activity of the cochlea, commonly used to diagnose Meniere&;s disease. Ref: Hazarika; 3rd ed; Pg 64


Question: Presenting symptom of nasal myiasis is

Clinical features of nasal myiasisInitial symptoms (3-4 days maggots):- Intense irritation, sneezing, headache, blood stained discharge, lacrimationLater:- Maggots may crawl out of the nose and there is a foul smellRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 181 - 182


Question: Treatement of choice of vocal nodule is

Ans. is 'b' i.e. Micro laryngoscopic removal Vocal Nodules (Also k/a singers nodule)Bilateral*Appear symmetrically on the free edge of vocal card at the junction of anterior one - third with the posterior 2/3* as this is the area of maximum vibration of the cord and thus subject to maximum trauma. They are seen in people or children who misuse their voice (Speak too much or speak in unnatural low tones)Symptoms:* Hoarseness of voice, vocal fatigue, pain in neck. t/t:-Small nodules and early cases can be tit conservatively by education of patient in proper use of voice.Large nodules or long standing nodules - Micro laryngoscopic surgery*.


Question: Endolymph resembles

PerilymphEndolymphBony labyrinthMembranous labyrinthFormed from CSFSecreted by stria vascularisResembles ECFResembles ICFNa+ richK+ richReabsorbed into subarachnoid spaceReabsorbed into endolymphatic sacRef: Hazarika; 3rd ed; Pg 24


Question: Acoustic neuroma commonly arises from

Acoustic neuroma commonly arises from vestibular nerve and rarely from the cochlear division of the 8th nerve. Ref: Textbook of diseases of Ent, PL Dhingra, 7th edition, pg. 125


Question: In jarjaway fracture of nasal bone, the fracture line is

Jarjaway' fracture of nasal septum occurs due to blows from the front. Fracture line stas just above the anterior nasal spine and runs horizontally backwards just above the junction of septal cailage with the vomer. Ref: Textbook of ENT; PL Dhingra;7th edition, pg no.165


Question: The most common site of perforation in the Tympanic membrane is(REPEAT QUESTION)

In the stage of resolution, usually, a small perforation is seen in the anteroinferior quadrant which is commonest of all quadrants of pars tensa. (Ref: Textbook of diseases of ENT, PL Dhingra, pg no. 68)


Question: Carcinoma known for perineural invasion is

ADENOID CYSTIC CARCINOMA (CYLINDROMA) It is a slow-growing tumour but infiltrates widely into the tissue planes and muscles. It also invades perineural spaces and lymphatics and thus causes pain and VIIth nerve paralysis. It can metastasize to lymph nodes. Local recurrences after surgical excision are common and can occur as late as 10-20 years after surgery. Distant metastases go to the lung, brain and bone. Treatment is radical parotidectomy with largest cuff of grossly normal tissue around the boundaries of the tumour. Radical neck is not done unless nodal metastases are present. Postoperative radiation is given if margins of the resected specimen are not free of tumour. 2nd most common Malignancy of salivary glands after mucoepidermoid carcinoma Advanced tumours may present with pain or nerve paralysis, as it has a propensity to invade peripheral nerves Histology of Adenoid cystic carcinoma Ref : Diseases of ENT by Dhingra 6th edition Pgno : 235


Question: TESPAL is used in management of

Tespal: (Trans nasal endoscopic sphenopalatine aery ligation) Indication: Epistaxis not responding to conventional conservative management. Posterior epistaxis Complications of TESPAL: 1. Palatal numbness 2. Sinusitis 3. Decreased lacrimation 4. Septal perforation 5. Inferior turbinate necrosis Ref otolaryngology dhingra 3e


Question: The most common cause of recurrent epistaxis in a 15 year old female is

Causes for recurrent epistaxis in the female child are haematological disorders like Haemophilia, Christmas disease, Vit. K deficiency, Scurvy Leukaemia, Aplastic anaemia, Thrombocytopenic and vascular purpura


Question: Crypta Magna is the remnant of

Medial surface of each tonsil has 15-20 crypts, the largest of which is called Intratonsillar cleft or crypta Magna (which represents the persistence of the ventral poion of the second pharyngeal pouch)'.Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 291


Question: The only abductor of vocal cord is

Ans. a (Posterior cricoarytenoid) (Ref. Diseases of ENT by PL Dhingra 2nd ed., 337)The posterior cricoarytenoid is the only true abductor of the vocal folds and is principally responsible for control of the glottic airway.ActionMusclesAbductor of Vocal cord-Posterior cricoarytenoidAdductor of Vocal cord-Lateral cricoarytenoid, Inter-arytenoid, Cricothyroid, ThyroarytenoidTensor of Vocal cord -Cricothyroid, VocalisOpening of laryngeal inlet -ThyroepiglotticusClosing of laryngeal inlet-Interarytenoid, AryepiglotticusAlso Know:Type of thyroplastyMeaningUseIMedialization of vocal cordCombined (RLN and superior laryngeal N) palsyIILateralization of vocal cordBilateral RLN paralysis to improve airwayIIIShortening of Vocal cordFemale -male voice (For androphonia)IVLengthening of Vocal cordMale -female voice. Also used when vocal cord is lax.


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

The patient is presenting with features of the postauricular subperiosteal abscess. Treatment for this is antibiotics along with drainage of the abscess and coical mastoidectomyThe patients have developed this abscess as a complication of CSOM (History of chronic ear discharge) for which he requires mastoidectomyRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 86 - 87

Mastoidectomy with incision and drainage and antibiotics


Question: Suprastructure of stapes develops from


Question: The water cane in the larynx (saccules) are present in

Ventricle (sinus of larynx):- It is a deep elliptical space between vestibular and vocal folds, also extending a sho distance above and lateral to vestibular fold. The saccule is a diveiculum of mucous membrane which stas from the anterior pa of ventricular cavity and extends upwards between vestibular folds and lamina of thyroid cailage. When abnormally enlarged and distended, it may form a laryngocele--an air containing sac which may present in the neck. There are many mucous glands in the saccule, which help to lubricate the vocal cords. Ref:- Dhingra; pg num:-284


Question: Treatment of choice of Carcinoma maxillary sinus with T3NOMO


Question: A patient is suspected to have Vestibular Shwanomma. The investigation of choice for its diagnosis is

(B) Gadolinium enhanced MRI # Neurological tests. Complete examination of cranial nerves, cerebellar functions, brainstem signs of pyramidal and sensory tracts should be done. Fundus is examined for blurring of disc margins or papilloedema.> Radiological tests, (a) Plain x-rays (transorbital, Stenver's, Towne's and submentovertical views) give positive findings in 80% of patients. However, small intracanalicular tumours are not detected.> CT scan. A tumour that projects even 0.5 cm into the posterior fossa can be detected by a CT scan. If combined with intrathecal air, even the intrameatal tumour can be detected.> CT scan has replaced earlier methods of pneumoencephalography and myodil meatography.> MRI with gadolinium contrast. It is superior to CT scan and is the gold standard for diagnosis of acoustic neuroma. Intracanalicular tumour, of even a few millimeters, can be easily diagnosed by this method.> Vertebral angiography. This is helpful to differentiate acoustic neuroma from other tumours of cerebellopontine angle when doubt exists.> Electric response audiometry. It is very useful in the diagnosis of retrocochlear lesions.> In the presence of VINth nerve tumour, a delay of >0.2 msec in wave V between two ears is significant.> CSF examination. Protein level is raised. Lumbar puncture is usually avoided.


Question: Commonest cause of acute otitis media in children is

Ans. is 'b' i.e Streptococcus pneumoniae Aetiology of ASOM in children:S. pneumoniae (35%)H. influenzae (25%)M. Catarrhalis (15%)Aetiology in adultsH. influenza (25%)*S. pneumonia (21%)


Question: Masculine voice in females is treated by

The masculine voice in females is treated by Thyroplasty type 3. It is used to shoen (relax) the vocal cord. Relaxation of vocal cord lowers the pitch. This procedure is done in mutational falsetto or in those who have undergone gender transformation from female to male. Ref: PL Dhingra Textbook of Ear, Nose and Throat, Edition 6, page - 302


Question: CHARGE syndrome does not include


Question: "Rising sun" appearance is seen in

Rising sun appearance is seen when a glomus tumour arises from the floor of the middle ear in otoscopy. Sometimes, the tympanic membrane appears bluish and maybe bulging. Ref: Dhingra 7th edition pg. 121


Question: Frog face deformity of nose caused by

EXTENSIONS OF NASOPHARYNGEAL FIBROMA Nasopharyngeal fibroma is a benign tumour but locally invasive and destroys the adjoining structures. It may extend into: 1. Nasal cavity causing nasal obstruction, epistaxis and nasal discharge. 2. Paranasal sinuses. Maxillary, sphenoid and ethmoid sinuses can all be invaded. 3. Pterygomaxillary fossa, infratemporal fossa and cheek. 4. Orbits giving rise to proptosis and "frog-face deformity." It enters through the inferior orbital fissure and also destroys apex of the orbit. It can also enter the orbit through superior orbital fissure. 5. Cranial cavity. It can extend into: (a) Anterior cranial fossa through roof of ethmoids or cribriform plate. (b) Middle cranial fossa through erosion of floor of middle cranial fossa or indirectly by invading the sphenoid sinus and sella turcica. In the former case, tumour lies lateral to internal carotid aery and in the latter case medial to the aery. Ref:- Dhingra; pg num:-246


Question: Superior sagittal sinus thrombosis causes

(D) Otitis hydrocephalus> Adequacy of collateral circulation in the hand Extracranial Complications of Otitis Media: Petrositis# Intracranial Complications of Otitis Media> Extradural abscess> Lateral sinus thrombosis> Otitis hydrocephalus> Meningitis> Brain abscess: temporal lobe; cerebellum> Subdural abscess> Cortical thrombophlebitis# Lateral Sinus Thrombophlebitis (Sigmoid Sinus Thrombosis)> It is an inflammation of inner wall of lateral venous sinus with formation of a thrombus.> Thrombosis of the sigmoid sinus is always secondary to infection in the middle ear or otitis media, or in the mastoid process called the mastoiditis.> During operations on the mastoid process one should be careful about the sigmoid sinus, so that it is not exposed.> Spread of infection or thrombosis from the sigmoid and transverse sinuses to the superior sagittal sinus may cause impaired CSF drainage into the latter and may, therefore, lead to the development of hydrocephalus,> Such a hydrocephalus associated with sinus thrombosis following ear infection is known as otitis hydrocephalus.


Question: Positive head impulse test is suggestive of

The HIT test is a bedside technique used to diagnose reduction in vestibular function in one ear versus the other. It describes the result of having an examiner abruptly accelerate and then decelerate the head, moving the head rapidly at high speed and then stopping it. Positive HIT is suggestive of injury to the peripheral vestibular nerve.


Question: In acoustic neuroma, cranial nerve to be involved earliest is

The earliest cranial nerve to be involved is V nerve causing reduced corneal sensitivity. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 125


Question: Glomus tumor invading the veical pa of carotid canal. It is

Ans. is 'c' i.e., Type C2 Fisch classification The Fisch classification of glomus tumors is based on extension of the tumor to surrounding anatomic structures and is closely related to moality and morbidity. Type A :- Limited to middle ear cleft (glomus tympanicum). Type B :- Limited to tympanomastoid area with no involvement of infralabyrinthine compament. Type C :- Involving infralabrinthine compament extending upto petrous apex Type C1 :- Limited involvement of veical poion of carotid canal Type C2 :-Invading veical poion of carotid canal Type C3 :-Invasion of horizontal poion of carotid canal Type D Intracranial extension Type D1 Intracranial extension < 2 cm in diameter Type D2 :-Intracranial extension > 2 cm in diameter


Question: Test of detecting damage to cochlea is

Bone conduction is a measure of cochlear function. In ABC test: Patient's bone conduction is compared with that of the examiner (presuming that the examiner has normal hearing). In conductive deafness, the patient and the examiner hear the fork for the same duration of time. In sensorineural deafness, the patient hears the fork for a shoer duration. Ref: Dhingra; 6th Edition; pg no 22


Question: Most common pa of larynx involved in Tuberculosis is

Tubercular laryngitisThe disease affects the posterior third of larynx more commonly than anterior paThe pas affected in descending order of frequency are:- i) Interarytenoid fold, ii) Ventricular band, iii) Vocal cords, iv) EpiglottisRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 329 - 330


Question: Most definitive diagnosis of sinusitis is

Sinuscopy or Diagnostic nasal endoscopy is the most appropriate investigation.The classical feature is the presence of mucopus in the middle meatus or above the middle meatusA more appropriate investigation would be CT scan of the nose and PNS.Ref: Hazarika; 3rd ed; Pg 331


Question: The commonest cause of acute otitis media in children is

The commonest cause of Acute otitis media is Streptococcus pneumoniae in all age groups.Other agents- H. Influenzae, Moraxella catarrhalis, and Pseudomonas.Ref: Hazarika; 3rd ed; Pg: 149


Question: First lymph node involved in maxillary carcinoma

In paranasal sinus tumors

Lymphatic spread: Nodal metastases are uncommon and occur only in the late stages of disease. Submandibular and upper jugular nodes are enlarged. Maxillary and ethmoid sinuses drain primarily into retropharyngeal nodes, but these nodes are inaccessible to palpation.
Systemic metastases are rare. May be seen in the lungs (most commonly) and occasionally in bone.
Intracranial spread can occur through ethmoids, cribriform plate or foramen lacerum.


Question: Most common congenital anomaly of larynx is

Laryngomalacia (congenital laryngeal stridor): It is the most common congenital abnormality of the larynx. It is characterized by laryngeal excessive flaccidity of supraglottic region which is sucked in during inspiration producing stridor and sometimes cyanosis. Stridor is increased on crying but subsides on placing the child in the prone position. The cry is normal. This condition manifests at bih or soon after, and usually disappears by 2 years of age. Direct laryngoscopy shows elongated epiglottis, curled upon itself (omega-shaped O), floppy aryepiglottic folds and prominent arytenoids. A flexible laryngoscope is very useful to make the diagnosis. Laryngomalacia cannot be diagnosed in a paralyzed patient. Mostly, treatment is conservative. Tracheostomy may be required for some cases of severe respiratory obstruction. Supraglottoplasty is required in cases of severe laryngomalacia. Ref: PL Dhingra 7th edition of Ear, Nose and Throat, pg no. 333


Question: Pseudomembrane over tonsil and pharynx is caused by

Pseudomembrane is formed in diphtheria, which is caused by Corynebacterium diphtheria, which is a gram-positive bacillus Ref: Harshmohan textbook of pathology; 7th edition


Question: Infection of submandibular space is seen in

Ludwig's angina is an infection of submandibular space. AETIOLOGY 1. Dental infections. They account for 80% of the cases. Roots of premolars often lie above the attachment of mylohyoid and cause sublingual space infection while roots of the molar teeth extend up to or below the mylohyoid line and primarily cause submaxillary space infection 2. Submandibular sialadenitis, injuries of oral mucosa and fractures of the mandible account for other cases (Ref: Diseases of ear, nose and throat, P.L Dhingra, 7th edition, page 297)


Question: Stapedius muscle is


Question: Frog face deformity of nose is caused by

It is due to the extension of nasopharyngeal fibroma into orbit through the inferior and superior orbital fissure and destroys apex of the orbit, giving rise to proptosis and frog face deformity. (Ref: Diseases of ear, nose and throat, PL Dhingra, 7th edition, Pg no. 279)


Question: Adam's apple in Male is due to.

Thyroid Cailage Largest cailage, hyaline in nature. It is V shaped and consists of right and left lamina which meet anteriorly in midline and form an angle (Adams angle) Adams angle: -- Male: 90 degree -- Female: 120 degree The outer surface of each lamina is marked by an oblique line which extends from superior thyroid tubercle to inferior thyroid tubercle. Oblique line gives attachment to: -- Thyrohyoid -- Sternothyroid -- Inferior constrictor muscle. Vocal cords are attached to middle of thyroid cailage.


Question: Presbycusis is

Presbycusis is a sensorineural hearing loss associated with ageing. Manifests at the age of 65years (Ref: Diseases of EAR, NOSE AND THROAT by PL DHINGRA - 6th Edition)


Question: The glomus tumour, invasion to the Jugular bub, is diagnosed by

(Jugular venography) (214-15-LT) (140-41-LT) (108-D 4,h) (97-Maqbool 11th)Diagnosis of Glomus tumours* Carotid angiography and vertebral angiography will demonstrate the blood supply of the tumour* Jugular venography may demonstrate the extent of tumour invasion into the jugular bulb.MRI- will demonstrate the extent of tumour invasion* CT-scan head - helps to distinguish glomus tympanicum from the glomus jugular tumour by identification of carotico-jugular spine which is eroded in later CT-scan also helps to differentiate it from the aberrant carotid artery, high or dehiscent jugular bulbMRI- MR angiography and venography further help to delineate invasion of jugular bulb and vein or compression of the carotid artery.* Four vessel angiography - useful to found out extent of tumor, compression of internal carotid artery.* Diagnostic biopsy is CONTRAINDICATEDTreatment - smaller tumour are excised. Larger lesions may be treated by radiotherapy followed by surgery


Question: Cauliflower ear is

It is due to collection of blood between the auricular cailage and its perichondrium. If haematoma gets infected, severe perichondritis may set in. Often it is the result of blunt trauma seen in boxers, wrestlers and rugby players. Extravasated blood may clot and then organize, resulting in 'Cauliflower ear'. (Reference: Diseased of Ear, Nose and Throat, PL Dhingra,7th edition, pg no.52)


Question: Carha's notch in audiometry is seen in

In some cases of otosclerosis, there is a dip in bone conduction curve. It is different at different frequencies but maximum at 2000Hz and is called Carha's notch. (5db at 500Hz, 10db at 1000Hz, 15db at 2000Hz and 5db at 4000Hz) Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra; 7th Edition; Page no.96


Question: Drug treatment for laryngeal stenosis is

Mitomycin-C is an antineoplastic antibiotic that acts as an alkylating agent by inhibiting DNA and protein synthesis. ... Topical application of mitomycin-C (0.4 mg/mL) was used as an adjuvant treatment in the endoscopic laser management of laryngeal and tracheal stenosis Ref: Internet sources


Question: TURBHAN epiglottis is pathognomic of

Appears as turban like thickening of epiglottis .


Question: Metastasis of carcinoma buccal mucosa goes to

The spread of carcinoma of buccal mucosa

Buccal carcinoma spread locally and to regional lymph nodes.

1) Local spread: - From its site of origin, the lesion may spread deeply involving submucosa → muscle → Subcutaneous fat → skin. Involvement of buccinator muscle or anterior masseter causes trismus.
2) Lymphatic spread: - Nodal involvement occurs in about 50% of cases. Submandibular and later the upper jugular nodes may get involved. Upper jugular nodes may also be involved, directly skipping the submandibular group.


Question: Key nob appearance is seen in

PHONASTHENIA It is weakness of voice due to fatigue of phonatory muscles. Thyroarytenoid and interarytenoids or both may be affected. It is seen in abuse or misuse of voice or following laryngitis. Patient complains of easy fatiguability of voice. Clinical examination:- Indirect laryngoscopy shows three characteristic findings: 1. Elliptical space between the cords in weakness of thyroarytenoid. 2. Triangular gap near the posterior commissure in weakness of interarytenoid. 3. Key-hole appearance of glottis when both thyroarytenoid and interarytenoids are involved. Treatment:- Treatment is voice rest and vocal hygiene, emphasizing on periods of voice rest after excessive use of voice. Ref:- Dhingra; pg num:-314


Question: Shape of septal cartilage of nose is

Ans. is 'c' i.e., Quadrilateral * The septal cartilage of the nasal septum is a quadrilateral cartilage."Cartilage of the septum, also known as the quandragular cartilage because it is roughly quadrilateral in shape - separates the nostrils".Medial nasal wall or Nasal septum* Nasal septum is the osseo - cartilaginous partition between the two halves of the nasal cavity.* Nasal septum consists of1) Columellar septum It is formed by columella containing the medial crura of alar cartilages united together by fibrous tissue.2) Membranous septum It consists of double layer of skin with no bony or cartilaginous support.3) Septum properThis forms the major portion of nasal spetum and consists of osteocartilagenous framework which is coverd by mucous membrane. Its constituents arei) Osseous part# The vomer# Perpendicular plate of ethmoid# Nasal spine of frontal bone# Rostrum and crest of sphenoid# Nasal crest of nasal bone# Nasal crest of palatine bone# Nasal crest of maxillary bone ii) Cartilaginous part# Septal (Quadrilateral or Quadrangular) cartilage.


Question: Diameter of head mirror


Question: Paranasal sinuses are ventilated during


Question: Sensory nerve supply of middle ear cavity is provided by

The nerve supply of middle ear is derived from tympanic plexus which lies over the promontory.
The inferior ganglion of the glossopharyngeal nerve gives off the tympanic nerve which enters the middle ear through the tympanic canaliculus and takes part in formation of the tympanic plexus on the medial wall of middle ear.
This distributes it fibres to the middle ear, and also to the auditory tube, aditus ad atrum mastoideum (aditus to mastoid antrum).


Question: Cochlear aqueduct

THE INTERNAL EAR The internal ear or the labyrinth is an impoant organ of hearing and balance. It consists of a bony and a membranous labyrinth. The membranous labyrinth is filled with a clear fluid called endolymph while the space between membranous and bony labyrinths is filled with perilymph. BONY LABYRINTH It consists of three pas: the vestibule, the semicircular canals and the cochlea. Cochlea: The bony cochlea is a coiled tube making 2.5 to 2.75 turns round a central pyramid of bone called modiolus. The base of modiolus is directed towards internal acoustic meatus and transmits vessels and nerves to the cochlea. Around the modiolus and winding spirally like the thread of a screw, is a thin plate of bone called osseous spiral lamina. It divides the bony cochlea incompletely and gives attachment to the basilar membrane. The bony bulge in the medial wall of middle ear, the promontory, is due to the basal coil of the cochlea. The bony cochlea contains three compaments: (a) Scala vestibuli, (b) Scala tympani, (c) Scala media or the membranous cochlea. The scala vestibuli and scala tympani are filled with peri- lymph and communicate with each other at the apex of cochlea through an opening called helicotrema. Scala vestibuli is closed by the footplate of stapes which separates it from the air-filled middle ear. The scala tympani is closed by secondary tympanic membrane; it is also connected with the subarachnoid space through the aqueduct of cochlea. Ref:- Dhingra; pg num:-09,10

Connects internal ear with subarachnoid space


Question: Paracusis Willisii is a symptom frequently present in

(B) Otosclerosis # SYMPTOMS OF OTOSCLEROSIS:> Hearing loss This is the presenting symptom and usually starts in twenties. It is painless and progressive with insidious onset.> Often it is bilateral conductive type. Paracusiss willisii Tinnitus Vertigo Speech Chronic conductive hearing loss (CHL) is the finding in almost all cases of otosclerosis> This usually will begin in one ear but will eventually affect both ears with a variable course.> On audiometry, the hearing loss is characteristically low frequency, with higher frequencies being affected later> Sensorineural hearing loss has also been noted in patients with otosclerosisthis is usually a high frequency loss, and usually manifests late in the disease.


Question: Positional veigo is most commonly seen due to pathology in

Positional veigo is commonly due to pathology in the Posterior Semicircular Canal.BPPV is the commonest cause of peripheral veigoRef: Hazarika; 3rd ed; Pg 105


Question: The most common site of sinusitis in children(( REPEAT QUESTION)

Acute ethmoid sinusitis Aetiology Acute ethmoiditis is often associated with infection of other sinuses. Ethmoid sinuses are more often involved in infants and young children.It opens into middle meatus. (Ref: Diseases of ENT, PL Dhingra, 7th edition, of no. 216)


Question: Holman Millar sign is seen in

Anterior bowing of the posterior wall of maxillary sinus often called antral sign or Holman-Miller sign, which is pathognomic of angiofibroma Ref:(Diseases of Ear, Nose and Throat, P.L Dhingra, 7th edition, page 281)


Question: Lighthouse sign is seen in

Lighthouse sign is seen in Stage of suppuration of AOMStages of AOM-1. Stage of hyperemia/Congestion- Cawheel appearance of TM2. Stage of exudation/Pre suppuration3. Stage of suppuration- Lighthouse sign (Pinpoint perforation)4. Stage of resolution/complicationsRef: Hazarika; 3rd ed; Pg 149


Question: Sphenopalatine foramen is 1 cm behind


Question: Apple jelly nodule in Nasal septum


Question: Most Common site of perilymph fistula is

In this condition perilymph leaks into the middle ear. Footplate of stapes is fixed on oval window. It can occur as a complication of stapedectomy, or ear surgery when stapes is dislocated, and also from sudden pressure change in the middle ear. (Ref: Diseases of EAR, NOSE AND THROAT by PL DHINGRA - 6th Edition)


Question: Commonest causative organism for ASOM in 2 years child is

ACUTE SUPPURATIVE OTITIS MEDIA It is an acute inflammation of middle ear by pyogenic organ isms. Here, middle ear implies middle ear cleft, i.e. eustachian tube, middle ear, attic, aditus, antrum and mastoid air cells. ROUTES OF INFECTION 1. Via eustachian tube: It is the most common route. Infection travels the lumen of the tube or along subepithelial peritubal lymphatics. Eustachian tube in infants and young children is shoer, wider and more horizontal and thus may account for higher incidence of infections in this age group. Breast or bottle feeding in a young infant in horizontal position may force fluids through the tube into the middle ear and hence the need to keep the infant propped up with head a little higher. Swimming and diving can also force water through the tube into the middle ear. 2. Via external ear: Traumatic perforations of tympanic membrane due to any cause open a route to middle ear infection. 3. Blood-borne: This is an uncommon route. AETIOLOGY : It is more common especially in infants and children of lower socioeconomic group. Bacteriology: Most common organisms in infants and young children are Streptococcus pneumoniae (30%), Haemophilus influenzae (20%) and Moraxella catarrhalis (12%). Other organisms include Streptococcus pyogenes, Staphylococcus aureus and sometimes Pseudomonas aeruginosa. Ref:- Dhingra; pg num:-62


Question: Most common nerve damaged in CSOM is(REPEAT QUESTION)

Facial paralysis occurs as a complication of both acute and chronic otitis media. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 88)


Question: The Lombard test is used in the diagnosis of

Tests for Functional (Non-organic) Hearing loss:1. Stenger`s test2. Chimani Moos test3. Teal test4. Erhards test5. Lombard`s test6. Acoustic reflex threshold7. BERA8. Bekesy audiometryRef: Hazarika; 3rd ed; Pg 72


Question: Pain sensation from ethmoid sinus is carried by


Question: Nerve supply of the tympanic membrane is by

The auriculotemporal nerve supplies the anterior half of the lateral surface. Auricular branch of vagus nerve supplies posterior half of lateral surface. Tympanic branch of CN 9 supply medial surface. Reference: Dhingra 6th edition


Question: Hectic picket type of fever with rigor is important feature in

(B) (Lateral sinus thrombosis) (84- Dhingra 6th)LATERAL SINUS THROMBOSIS* Inflammation of inner wall of lateral venous sinus with formation of an intrasinus thrombosis* Complicatin of - Acute coalescent mastoiditis- Masked mastoiditis- CSOM- Cholesteatoma* Clinical features1. Hectic picket. Fence type of fever with rigor. This is due to septicaemia2. Headache in early stage due to perisinus abscess3. Progressive anaemia and emaciation4. Griesinger's sign- due to thrombosis of mastoid emissary vein.5. Papilloedema6. Tobey-Ayer test - record CSF pressure7. Crowe Beck test = pressure on jugular vein of healthy side produces engorgement of retinal vein(seen in ophthalmoscopy) and supraorbital vein, Engorgement of vein subsides on release of pressure8. Tendemess along jugular veinCT & MRI shows- "Delta sign"TREATMENT(1) Intravenous antibacterial therapy(2) Mastoidectomy and exposure of sinus(3) Ligation of internal jugular vein(4) Anticoagulant therapy.


Question: Most common frequency of Tuning fork used in ENT

Tuning fork test can be performed using tuning fork of different frequencies such as:
. • MC used/ ideal for routine clinical practice is of 512 Hz.
• Tuning fork of lower frequencies produce sense of bone vibration while those of higher frequencies have a shorter decay time and are thus not routinely preferred.
• Tests done with tuning fork:
■ Rinne’s test
■ Weber's test
■ Absolute bone conduction (ABC) test
■ Bing test
■ Gelle’s test
■ Lewis test


Question: Pierre Robbin syndrome does not include


Question: Graft for myringoplasty is taken from

Graft material used for myringoplasty are:Temporalis fascia (most common)Tragal cailagePerichondrium from the tragusVeinRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 463


Question: Surfers ear is

Exostoses are multiple and bilateral, often presenting as smooth, sessile, bony swellings in the deeper pa of the meatus near the tympanic membrane. They arise from the compact bone. Exostosis is often seen in persons exposed to the entry of cold water in the meatus as in divers and swimmers. Hence called a surfers ear. Reference: Diseased of Ear, Nose and Throat, PL Dhingra, 7th edition, pg no.119


Question: Patient with anotia, ideal hearing aid

Bone-anchored hearing aids can be used in People who have chronic inflammation or infection of the ear canal and cannot wear the standard "in the ear" air conduction hearing aids Children with malformed or absent outer ear and ear canals as in microtia or canal atresia Single-sideddeafness. Ref: Dhingra 7e pg 137.


Question: Tone decay test is used for

Answer- D. Sensory neural deafnessThreshold tone decay test is used for retrocochlear type of SNHL.


Question: Most common site for contact ulcer in larynx is


Question: Ramu, 15 yrs of age presents with haemorrhage 5 hrs after tonsillectomy. Treatment of choice is

Ans. is 'd' i.e Reopen immediately Post tonsillectomy haemorrhages can be of two types :Primary or reactionary- occurs with in a few hrs of the operation (by definition within 24 hrs)Secondary haemorrhage- usually seen between 5th to 10th post - op dayIt is due to infection.*MxPrimary - return to the operation theatre where the bleeding vessel is ligated under anesthesia.Secondary - Patient should be readmitted to hospital;An appropriate dose of morphine for adults or heroin for children is injectedA course of systemic antibiotics.Bleeding vessel is searched and ligated if the conservative methods fail which is not common.Remember:MC vessel responsible for post tonsillectomy haemorrhage*- Palatine vein {also called as external palatine vein)


Question: Most common cause of SNHL

Presbycusis - Most common cause of SNHL. A/W physiological aging process in the ear Bilateral slopping curve Usually manifests at the age of 65 years, (old age) but may do so early if there is a hereditary predisposition, chronic noise exposure or generalized vascular disease.


Question: Definition of sleep apnoea