Question: The collaural fistula is an abnormality of

The collaural fistula is a 1st branchial cleft anomaly which arises from the failure of fusion of the ventral pa of the 1st cleftIts upper pa opens into the floor of the external auditory canalIts lower pa opens in the neck between the angle of the mandible and sternocleidomastoid muscleRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 53


Question: Submandibular nodes are classified as

Level 1A =Submental Node Level1B = Submandibular nodes, lie between the anterior and posterior bellies of digastric muscle and the lower border of mandible. Level II=Upper Jugular Nodes Level III=Middle Jugular Nodes Ref: Textbook of ENT; Dhingra; 6th edition; Page no: 387; Table 76 ref img


Question: Most common organism cultured in CSOM is

Pus culture in both aerobic and anaerobic CSOM may show multiple organisms. Common aerobic organisms are Pseudomonas aeruginosa Proteus Escherichia coli Staphylococccus aureus While anaerobes include Bacteroides fragilis Anaerobic streptococcal (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 76)


Question: Nasopharyngeal Carcinoma is caused by

AETIOLOGY The exact aetiology is not known. The factors responsible are: 1. Genetic. Chinese have a higher genetic susceptibility 2. Viral. Epstein-Barr (EB) virus is closely associated with nasopharyngeal cancer. 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 a sensitivity of only 70-80% while IgA antibodies of VCA are more sensitive but less specific. 3. Environmental. Air pollution, smoking of tobacco and opium, nitrosamines from dry salted fish, smoke from the burning of incense and would have all been incriminated. (Ref: Diseases of Ear, Nose and Throat, P.L Dhingra, 7th edition, page 283)


Question: Maximum hearing loss is caused by

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: Frontal Sinus can be best visualized by

A. Caldwell's view -frontal sinuses are seen best B. Water's view-maxillary sinus seen best C. Towne's view-usually taken for acoustic neuroma and apical petrositis D. Schuller's view-to visualise the key area of the mastoid (attic, aditus, antrum) (Ref: Textbook of ENT, Dhingra; 7th edition, of no. 493, 494)


Question: Pleomorphic adenoma is


Question: Choanal atresia is due to the persistence of

Choanal atresia
Choana, also called posterior nares, is an opening in the posterior part of each nasal cavity, through which the nasal cavity communicates with nasopharynx.
Choanal atresia is a congenital anomaly characterized by closure of one or both posterior nasal cavies (i.e., choana). It is due to the persistence of bucconasal membrane.
Approximately 60- 70% of cases are unilateral and are more common on the right side.
Bilateral cases occur in 20-30% of patients and 50% of these patients are associated with other congenital anomaly, i.e.,
CHARGE syndrome
→ Coloboma, Heart defects, Choanal atresia, Retarded growth, Genitourinary abnormalies and Ear defects.
Diagnosis - Unilateral lesions go unnoticed until the child presents with persistent unilateral nasal discharge.
There is the absence of air bubbles in nasal discharge.
A simple test for unilateral choanal atresia is to have the child attempt nose blowing with opposite nostril occluded by external pressure.
Failure to detect any air movement is suspicious for complete obstruction.
Bilateral choanal atresia presents as respiratory distress in newborn and requires support immediately after birth.


Question: Parasympathetic secretomotor fibers to paranasal sinus


Question: Not an indication for Tracheostomy

Respiratory distress in carcinoma larynx


Question: The lymphatic drainage of pyriform fossa is to

Lymphatic drainage of Hypopharynx 1) Pyriform sinus drains into upper jugular chain and then to deep cervical group of lymph nodes. 2) Postcricoid region drains into parapharyngeal and paratracheal group of lymph nodes. 3) Posterior pharyngeal wall drains into parapharyngeal lymph nodes and finally to deep cervical lymph nodes. Ref:- Tuli; pg num:- 231, 232


Question: Epley's manoeuvre is used in treatment of

Ans. d (BPPV) (Ref. PL Dhingra ENT, 4th ed, 58)Epley Maneuver for Rx of BPPV: The patient is taken through 4 moves, starting in the sitting position with the head turned at a 45-degree angle toward the affected side. (1) The patient is placed into the Dix-Hallpike position (supine with the affected ear down) until the vertigo and nystagmus subside.(2) The patient's head is then turned to the opposite side, causing the affected ear to be up and the unaffected ear to be down.(3) The whole body and head is then turned away from the affected side to a lateral decubitus position, with the head in a face down position.(4) The last step is to bring the patient back to a sitting position with the head turned toward the unaffected shoulder.BPPV (BENIGN PAROXYSMAL POSITIONAL VERTIGO)It is characterized by vertigo when head is placed in a certain critical position.# Cause:- Disorder of posterior semicircular canal.- Otoconial debris, consisting of calcium carbonate, is released from the degenerating macula of utricle and floats freely in endolymph. When it settles on the cupula of posterior semicircular canal in critical head position, it causes displacement of cupula and vertigo.# H/o: Deafness, Vomiting, Tinnitus# Positional vertigo is precipitated by a recumbent head position, either to the right or to the left.# Benign paroxysmal positional (or positioning) vertigo (BPPV) of the posterior semicircular canal is particularly common. Although the condition may be due to head trauma, usually no precipitating factors are identified. It generally abates spontaneously after weeks or months. The vertigo and accompanying nystagmus have a distinct pattern of latency, fatigability, and habituation that differs from the less common central positional vertigo due to lesions in and around the fourth ventricle. Moreover, the pattern of nystagmus in posterior canal BPPV is distinctive.# When supine, with the head turned to the side of the offending ear (bad ear down), the lower eye displays a large- amplitude torsional nystagmus, and the upper eye has a lesser degree of torsion combined with upbeating nystagmus. If the eyes are directed to the upper ear, the vertical nystagmus in the upper eye increases in amplitude. Mild dysequilibrium when upright may also be present.FeaturesBPPVCentralLatency3-40 sNone: immediate vertigo and nystagmusFatigabilityYesNoHabituationYesNoIntensity of vertigoSevereMildReproducibilityVariableGood# Treatment:a) Epley's Maneuverb) Intra-labyrinthine Streptomycin / Gentamycin.# BPPV is caused by dislodged otoconia that move with changes in head position. Single applications of the Epley procedure or the Semont maneuver have been reported to relieve symptoms in the majority of patients. Repeated treatment sessions may be necessary before symptoms resolve. Sign or symptomPeripheral (Labyrinth)Central (Brainstem or Cerebellum)1. Direction of associated nystagmusUnidirectional; fast phase oppositeBidirectional or unidirectional2. Purely horizontal nystagmus without torsional componentUncommonCommon3. Vertical/purely torsional nystagmusNever presentMay be present4. Visual fixationInhibits nystagmus and vertigoNo inhibition5. Severity of vertigoMarkedOften mild6. Direction of spinToward fast phaseVariable7. Direction of fallToward slow phaseVariable8. Duration of symptomsFinite (minutes, days, weeks) but recurrentMay be chronic9. Tinnitus and/or deafnessOften presentUsually absent10. Associated CNS abnormalitiesNoneExtremely common (e.g., diplopia, hiccups, cranial neuropathies, dysarthria)11. Common causesBPPV, infection (labyrinthitis),Meniere's, neuronitis, ischemia, trauma, toxinVascularAdditional Educational Points:

BPPV (Benign primary positional vertigo)


Question: Commando operation is used as treatment for


Question: Graveyard of ENT surgeon

Tonsilolingual sulcus is seat of carcinoma usually missed by ENT doctor in OPD to check.


Question: In right external auditory canal, warm water (44 deg,c) pressure applied for 40 seconds then

(Right sided nystagmus): (92. P. Hazarika 3rd/ edition)* Cold water induces nystagmus to opposite side and warm water to the same side (mneumonic- COWS: cold- opposite, warm - same)CALORIC TEST (Filzgerald - Hallpike test)* Patient lies supine with head tited 30deg forward so that horizontal canal is vertical. Ear are irrigated for 40 second alternately with water at 30degc and at 44degc (ie 7deg below and above normal body temperature) and eyes observed for appearance of nystagmus till its end point* We can find -* Canal paresis or dead labyrinth* Directional preponderance (ie nytagmus is more in one particular direction than in the other)* Both canal paresis and directional preponderance


Question: Endolymphatic decompression is done in

Decompression of endolymphatic sac is done as a conservative procedure as a pa of the surgical treatment of Meniere's disease. Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra 7th Edition page no.115


Question: A 20 year old patient presents with difficulty in breathing and impaired hearing on examination enlargement of upper deep cervical lymph nodes, most likely diagnosis is


Question: Bell's palsy is paralysis of

Bells palsy is due to the lesion of LMN VII nerve which is idiopathic in nature. Ref: Dhingra 6th edition pg. 94


Question: Cricothyroid joint is a

Cricothyroid joint is a synol joint. Each is formed by inferior cornu of thyroid cailage with a facet on cricoid cailage. Cricoid cailage rotates at these joints on a transverse axis which passes transversely through these joints.


Question: Laryngocole arise as herniation of lorry regal mucosa through following membrane


Question: Gillette&;s space is

Retropharyngeal space is also called Space of Gillette.Also called danger space of neck as it extends from skull base to superior mediastinum and infections can lead to mediastinitis.Contains Glands of Henle and Rouviere`s nodes.Ref: Hazarika; 3rd ed; Pg 492


Question: Treatment of choice for acoustic neuroma is

Acoustic neuroma is surgically removed through translabyrinthine, middle cranial fossa, suboccipital or combined translabyrinthine- suboccipital approach. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 127


Question: Danger space of pharynx is bounded by

Buccopharyngeal fascia anteriorly and alar fascia posteriorly

Preveebral fascia anteriorly and veebral body posteriorly

Alar fascia anteriorly and preveebral fascia posteriorly

Tonsils anteriorly and superior constrictor muscle posteriorly


Question: In fracture maxilla, most common nerve involved is

Clinical Features of maxillary fractures: Ecchymosis of lid, conjunctiva and sclera Enophthalmos with inferior displacement of the eyeball. This becomes apparent when edema subsides. Diplopia, which may be due to displacement of the eyeball or entrapment of inferior rectus and inferior oblique muscles. Hypoaesthesia or anesthesia of cheek and upper lip, if infraorbital nerve is involved


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: Pain sensations from the ethmoidal sinus are carried by

nasociliary nerve branch of ophthalmic division of trigeminal nerve carries pain sensation from ethmoid sinus. Ref Dhingra 6/e,p 188


Question: In Stylalgia most common nerve affected is

The patient complains of pain in tonsillar fossa and upper neck which radiates to the ipsilateral ear. It gets aggravated on swallowing. Ref: Textbook of ENT, Dhingra; 6th edition; Pg no: 272


Question: Function of Larynx is A/E

(Immunity enhancement): (303-4- Dhingra 5th edition; 577-P Hazarika 3rd)Function of the Larynx1. Primary function is to protect lower respiratory tractProtection of tracheobronchial tree is fascilitated by'Three - tier' sphincter action- Laryngeal elevation - Mylohyoid- Laryngeal tilting - Stylopharyngeous- Cricopharyngeal sphincter relaxes- Cough reflex- Cessation of respirationLarynx is aptly, called the watch-dog of lungs as it immediately barks' at the entry of any foreign intruder2. Phonation - is also an important function of the lung which facilitates communication3. Respiration: Reflex adjustments of the glottis apparatus plays a role in the mechanism of respiration Larynx regulates flow of air into the lungs.Vocal cords abduct during inspiration and adduct during expiration4. Fixation of the chest - To increase intrathoracic pressure when larynx is closed, chest wall gets fixed and various thoracic and abdominal muscles can then act best. This function is important in digging, pulling and climbing. Coughing, vomiting, defaecation, micturition and childbirth (Straining) also require a fixed thoracic cage against a closed glottis.

Protect lower respiratory tract from infection


Question: Woodruff's plexus is seen at

Woodruff's Plexus - Site of posterior epistaxis in adults. Plexus of veins situated inferior to posterior end of inferior turbinate Ref: Dhingra 7e pg 197.


Question: Trotter's triad is seen in

Nasopharyngeal cancer can cause conductive deafness (eustachian tube blockage), ipsilateral temporoparietal neuralgia (involvement of CN V) and palatal paralysis (CN X)-- collectively called Trotter's triad. (Ref: Diseases of Ear, Nose and Throat, PL Dhingra, 7th edition, page 285)


Question: Crypts are seen in

Ans. (a) TonsilsRef: Dhingra's ENT 6th ed.l 257-58* Crypts are inward folding of the mucosa which are found in tonsils and they increase the surface area.* Crypts are also seen in small intestine.


Question: Treatment of choice for nasopharyngeal carcinoma is

Treatment of nasopharyngeal carcinomaIrradiation is the treatment of choice (external radiotherapy)Radical neck dissection is required for persistent nodes when the primary has been controlled and in post-radiation cervical metastasisSystemic chemotherapy is used as palliation for distant metastases or radiation failureFor advanced stages (stage III & IV), the cure rate can be doubled when chemotherapy is combined with radiotherapyRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 279 - 286


Question: Tear drop sign is seen in

FRACTURES OF ORBITAL FLOOR Zygomatic and Le Fo II maxillary fractures are always accompanied by fractures of orbital floor. Isolated fractures of orbital floor, when a large blunt object strikes the globes, are called "blow out fractures." Orbital contents may herniate into the antrum. CLINICAL FEATURES 1. Ecchymosis of lid, conjunctiva and sclera. 2. Enophthalmos with inferior displacement of the eyeball. This becomes apparent when oedema subsides. 3. Diplopia, which may be due to displacement of the eyeball or entrapment of inferior rectus and inferior oblique muscles. 4. Hypoaesthesia or anaesthesia of cheek and upper lip, if infraorbital nerve is involved. DIAGNOSIS Waters' view shows a convex opacity bulging into the antrum from above (tear-drop opacity). CT scans may confirm the Diagnosis. Entrapment of inferior rectus and inferior oblique muscles is diagnosed by asking the patient to look up and down, or by the traction test. The latter is performed by grasping the globe and passively rotating it to check for restriction of its movements. TREATMENT Indications for surgery include enophthalmos and persistent diplopia due to entrapment of muscle. Orbital floor fractures can be satisfactorily reduced by a finger passed into the antrum through a transantral approach. A pack can be kept in the antrum to suppo the fragments. Infraorbital approach, through a skin crease of the lower lid, can also be used either alone or in combination with transantral approach. Badly comminuted fractures of orbital floor can be repaired by a bone graft from the iliac crest, nasal septum or the anterior wall of the antrum. Silicon or teflon sheets have also been used to reconstruct the orbital floor but autogenous grafts are preferable. Ref : Diseases of ENT by Dhingra 6th edition Pgno : 184


Question: A minor symptom of sinusitis is

The clinical symptoms of acute sinusitis have been classified into major and minor. Major Facial pain or pressure Purulent nasal discharge Fever Nasal congestion Nasal obstruction Hyposmia or Anosmia Facial congestion or fullness Minor Headache Cough Fatigue Halitosis Dental pain Ear pain or pressure


Question: The earliest symptom of glomus tumor is

Ans. A Pulsatile tinnitus "The two most common presenting symptoms of paraganglioma of temporal bone (Glomus tumor) deg are conductive hearing loss and pulsatile tinnnus" Hearing loss is conductive and slowly progressive. Tinnitus is pulsatile and of swishing character", synchronous with pulse", and can be temporarily stopped by carotid pressure", Thus, both pulsatile tinnitus and deafness are seen in glomus tumor.


Question: Treatment of choice in bilateral ethmoidal polyp is


Question: The danger space in front of prevertebral fascia extends till


Question: Epley manoeuvre

This manoeuvre repositions the otoconial debris from the posterior semicircular canal back into utricle. (Ref: Diseases of EAR, NOSE AND THROAT by PL DHINGRA - 6th Edition)


Question: Most comon cause of obstruction in atrophic rhinitis is


Question: Ranula is a

Ranula The term "ranula" is used to describe a diffuse swelling in the floor of the mouth caused by either a mucous extravasation or, less commonly, a mucous retention cyst derived from the major sublingual or submandibular salivary glands. It is a cystic translucent lesion seen in the floor of the mouth on one side of the frenulum and pushing the tongue tip. Treatment It is complete surgical excision if small, or marsupialization, if large. Often it is not possible to excise the ranula completely because of its thin wall or ramifications in various tissue planes. (Ref:Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 252)


Question: Pseudosulcus in larynx

Ans. c. Laryngopharyngeal reflux Pseudosulcus vocalic or laryngeal pseudosulcus is a variable finding in patients with laryngopharyngeal reflux. This sulcus is believed to arise from reflux induced swelling in the subglottic area and is located between the true vocal cords and the suglottic swelling. Laryngeal sulcus Laryngeal Pseudosulcus (Pseudosulcus Vocalis) This sulcus is believed to arise from reflux induced swelling in the subglottic area secondary to laryngotracheal reflux Located between the true vocal cords and the subglottic swelling Laryngeal True sulcus (Sulcus Vergeture) True sulcus is related to scarring of the vocal folds in the phonatory striking zone Located within the true vocal folds at the site of the adherence of vocal fold epithelium to the vocal ligament


Question: Rinne&;s test is negative in

Rinne test: In this test air conduction of the ear is compared with its bone conduction. A vibrating tuning fork is placed on the patient's mastoid and when he stops hearing, it is brought beside the meatus. If he still hears, AC is more than BC. Alternatively, the patient is asked to compare the loudness of sound heard through air and bone conduction. Rinne test is called positive when AC is longer or louder than BC. It is seen in normal persons or those having sensorineural deafness. A negative Rinne (BC > AC) is seen in conductive deafness. A negative Rinne indicates a minimum air-bone gap of 15-20 dB. Ref:- Dhingra; pg num:-22


Question: Most common cause of stridor in children is

The most common cause of stridor in children is Laryngomalacia. Laryngomalacia is due to excessive flaccidity of supraglottic larynx which is sucked during inspiration. It manifests at bih or soon after and usually disappear by 2 years of age. Re: Textbook of Ear, Nose and Throat, Dhingra, 7th Edition; Pg no: 333


Question: Topical mitomycin C is used to aid the following treatment

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: Surfer's ear is


Question: CSF is similar to

Perilymph resembles extracellular fluid and rich in Na ions. It communicates with CSF through aqueduct of the cochlea which opens into scala tympani near the round window. Reference: Dhingra 6th edition.


Question: Halo sign and handkerchief test are positive in

Ans. is 'a' i.e., CSF Rhinorrhoea Tissue test (Handker chief test) and holo sign are for CSF Rhinorrhoea. Detection of CSF LeakBiochemical testsConcentrations of Glucose are higher in CSF than in nasal discharge. Glucose value > 30-40 mg% and protein value < 100 mg % (max 200 mg %) suppo a diagnosis of CSF leak.Presence of p, transferrin is the most definitive test for detection of CSF and P2 transferrin assay is the test of choice when a confirmatory test is needed, because of high sensitivity as well as specificity.(3-trace protein (prostaglandin D synthase) is also used, however it is nonspecific as it is also present in human testes, hea and seroma.Basic clinical testsTissue test (Handker chief test) : - Unlike nasal mucous, CSF does 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, i.e., double ring sign or halo sign.Queckensted test : - Compression of the jugular vein leas to increased CSF leak due to increase in ICP.Rhinoscopy : - Visualization of CSF leak from paranasal sinus.CSF tracersIntrathecal fluorescein dye adminstration, radionuclide cisternography, CT cisternography.


Question: End tracheostomy is performed in patients undergoing surgery for

Answer: a) Laryngectomy (DHINGRA 6th ED, P-316)TRACHEOSTOMY* Emergency tracheostomy* Elective or tranquil tracheostomy* Permanent tracheostomy* Percutaneous dilatational tracheostomy* Mini tracheostomy (cricothyroidotomy)Emergency tracheostomy* It is employed when airway obstruction is complete or almost complete and there is an urgent need to establish the airway.* Intubation or laryngotomy are either not possible or feasible in such cases.Elective tracheostomy (tranquil, orderly or routine tracheostomy)* Almost all operative surgical facilities are available, endotracheal tube can be put and local or general anaesthesia can be given.* Elective tracheostomy is often temporary and is closed when indication is over.* It is of two types:> Therapeutic, to relieve respiratory obstruction, remove tracheobronchial secretions or give assisted ventilation.> Prophylactic, to guard against anticipated respiratory obstruction or aspiration of blood or pharyngeal secretions such as in extensive surgery of tongue, floor of mouth, mandibular resection or laryngofissure.Permanent tracheostomy* This may be required for cases of bilateral abductor paralysis or laryngeal stenosis.* In laryngectomy or laryngopharyngectomy, lower tracheal stump is brought to surface and stitched to the skin.High tracheostomy* Above the level of thyroid isthmus (isthmus lies against II, III, IV tracheal rings)* It violates the I tracheal ring* Can cause perichondritis of the cricoid cartilage and subglottic stenosis* Always avoided* Only indication: carcinoma larynxMid tracheostomy* Preferred one* Through II or III rings (isthmus either divided or retracted)Low tracheostomy* Below the level of isthmus


Question: Citelli's abscess is

Ans. is 'b' i.e., Formed over occipital bone Abscesses related to mastoid infection* Acute mastoiditis can be complicated by following abscesses:-1) Postauricular abscess:- This is the commonest subperiosteal abscess associated with acute mastoiditis. It occurs lateral to the cortex of mastoid in MacEwen's triangle.2) Bezold abscess: - Pus passes through mastoid tip(UP06) and presents as upper neck swelling. The abscess may:-i) Lies deep to stemocleidomastoid(DNB 07, A1IMS 92)ii) Follow the posterior belly of diagastric and presents swelling between mastoid tip and angle of jaw.iii) Be present in posterior triangleiv) Reach the parapharyngeal pouchv) Track down along the carotid vessels.3) Zygomatic abscess: - Infection of zygomatic air cells.4) Meatal (Luc's) abscess: - Pus passes between the antrum and external osseous meatus.5) Citelli's abscess : - Abscess is formed behind the mastoid more towards occipital bone. Some consider it as abscess of diagastric triangle.6) Parapharyngeal and retropharyngeal abscess.


Question: Schuller's view and law's view is for

Law's view It is lateral oblique view of mastoid. Patient lies in such a way that sagittal plane of the skull is parallel to the film and X-ray beam is projected 15deg cephalocaudal Structures seen are: 1. External auditory canal superimposed on internal auditory canal 2. Mastoid air cells 3. Tegmen 4. Lateral sinus plate 5. Temporo mandibular joint. (Key area of the mastoid, i.e. attic, aditus and antrum are not well seen) Schuller's view Similar to Law's view but cephalocaudal beam makes an angle of 30deg to the sagittal. Structures seen are: 1. External canal superimposed on internal canal 2. Mastoid air cells 3. Tegmen 4. Lateral sinus plate 5. Condyle of mandible 6. Sino-dural angle 7. Antrum and upper pa of attic (i.e. key area). (This view is taken to see the extent of pneumatisation, destruction of intercellular septa as in mastoiditis, location of sinus plate and tegmen, cholesteatoma and longitudinal fracture of 6, petrous pyramid)


Question: Acute tonsillitis is caused by

B. i.e. (Beta hemolytic streptococcus) (240 - Dhingra)ACUTE TONSILLITIS* Haemolytic streptococcus is the most commonly infecting organism others causes may be - staphylococcus pneumococci or H. influenzae* Penicillin is the drug of choice*** Complications include - chronic tonsillitis, peritonsillar abscess, Parapharyngeal abscess cervical abscess,Acute otitis media, Rheumatic fever, acute glomerulonephritis, SABE* Tonsil is supplied by1. Tonsillar branch offacial artery*2. Ascending pharyngeal artery*3. Ascending palatine*4. Dorsal lingual*5. Descending palatine*TREATMENTS* Bedrest, giving plenty of fluids, analgesics* Penicilline is the drug of choice *** Erythromycin and ampicilline may be needed for resistant cases


Question: In infant most sensitive audiometric screening is

Used as a screening procedure for infants. Other uses of ABR: To determine the threshold of hearing in infants; also in children and adults who do not cooperate and in malingerers. To diagnose retrocochlear pathology paicularly acoustic neuroma. To diagnose brainstem pathology, e.g. multiple sclerosis or pontine tumours. To monitor CN VIII intraoperatively in surgery of acoustic neuromas to preserve the function of the cochlea. Ref: Dhingra; 6th Edition; pg no 27


Question: Androphonia is treated by


Question: Tonsillar fossa is bounded anteriorly by

Tonsilar fossa is bounded by Anterior - Palatoglossal fold containing palatoglossal muscle Posterior - Palatopharyngeal fold containing palato pharyngeal muscle Apex - Soft palate, where both arches meet Base - Dorsal surface of posterior one-third of tongue. (Ref: Anatomy of head, neck and brain. Vishram Singh. P 227 )


Question: A 10 years boy presented with sensory neural deafness not benefited with hearing aid, Next treatment is

A. i.e. (Cochlear implant) (125- Maqbool 11th) (121- Dhingra 4th)COCHLEAR IMPLANT - is indicated in patients with bilateral severe sensorineural deafness who do not respond to amplified sound stimuli* Cochlear implants are more useful in post lingually deaf patients i.e. who lost their hearing after acquisition of language* Stapedectomy with prosthesis replacement is the treatment of choice for otosclerosis*** Pathway for extension of the infection from meninges to labyrinth - Cochlear aqueduct*** **Cochlear implants electrodes are most commonly placed at cochlea to directly stimulate the fibre of VIII. nerve


Question: The most frequent site of branchial cyst is at

The branchial cyst is common in the second decade of life but can occur at any age with equal frequency in both sexes. Cyst presents as a swelling in the upper pa of the neck anterior to the sternocleidomastoid muscle. Mass is smooth, round, fluctuant, non-tender and not transilluminate. A painful increase in size at the time of upper respiratory infection can occur. Anomalies of the second branchial arch are the most common. A brachial cyst maybe associated with sinus or fistula. A second arch brachial sinus has an external opening at junction of lower and middle of the anterior border of sternomastoid and may exude mucoid discharge. It may have an internal opening in the tonsillar fossa. Treatment involves surgical excision along with its tract of the present. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 446,447)

Upper third of posterior border of sternocleidomastoid

Upper third of anteromedial border of sternocleidomastoid

Lower third of anterior border of sternocleidomastoid


Question: Surface area of tympanic membrance

The surface area of tympanic membrane is 90 mm2. Only 55 mm2 is functional. Ref: PL Dhingra 6th edition of Ear, Nose and Throat; pg no 14


Question: Tubercular laryngitis affects primarily

The disease affects posterior pa of larynx more than anterior. Pas affected are (i) interarytenoid fold (ii) ventricular bands (iii) vocal cords and (iv) epiglottis, in that order. Tubercle bacilli, carried by sputum from the bronchi, settle and penetrate the intact laryngeal mucosa paicularly in the interarytenoid region (bronchogenic spread). This leads to the formation of submucosal tubercles which may later caseate and ulcerate. Ref: PL Dhingra 6th edition of Ear, Nose and Throat; Pg no 293


Question: Rinne's test is negative in

A negative Rinne test is seen in conductive deafness - when bone conduction is greater than air conduction. Chronic suppurative otitis media is a disease of the middle ear and hence causes conductive deafness. (Ref: Diseases of EAR, NOSE AND THROAT by PL DHINGRA - 6th Edition. Page no. 22)


Question: "Steeple sign" seen in


Question: Mucoperichondrial flap in septoplasty is made on

In cases of deted septum, make a slightly curvilinear incision, 2-3 mm above the caudal end of septal cailage on the concave side (Killian's incision). In case of caudal dislocation, a transfixion or hemitransfixion (Freer's) incision is made. The latter is septocolumellar incision between caudal end of septal cailage and columella. Raise mucoperichondrial or mucoperiosteal flap on one side only. Separate septal cailage from the vomer and ethmoid plate and raise mucoperiosteal flap on the opposite side of septum. Ref: Dhingra 7e pg 473.


Question: Merciful anosmia is seen in

Merciful anosmia is seen in atrophic rhinitis(Ozaena). There is foul smell from the nose, but the patient himself is unaware of smell due to marked anosmia due to degenerative changes Ref: Dhingra 7e pg 173.


Question: Steeple sign is seen in

Acute laryngotracheobronchitis or croup is a viral infection caused by parainfluenza type 1, 2, and sometimes 3. The critical area involved is subglottic larynx producing oedema with stridor and respiratory distress. X-ray (PA view) larynx shows typical "steeple sign" but X-rays are avoided as any manipulation may precipitate acute obstruction. Ref: PL Dhingra 7th edition of Ear, Nose and Throat; Pg no 328


Question: The valve of Hasner is

Nasolacrimal duct (NLD) opens into the Inferior meatus through the Hasner`s valve.The direction of NLD--downward, backward, and laterally from the lacrimal sac to the nose, Length- 1.8 cmSphenoid sinus and posterior ethmoids open into the sphenoethmoidal recess (Superior meatus)Frontal, Maxillary and Anterior ethmoids open into the middle meatus.Ref: Hazarika; 3rd ed; Pg 240


Question: Columellar tympanoplasty is

Types of Tympanoplasty Wullstein classified tympanoplasty into five types . Type I Defect is perforation of tympanic membrane which is repaired with a graft. It is also called myringoplasty. Type II Defect is perforation of tympanic membrane with erosion of malleus. Graft is placed on the incus or remnant of malleus. Type III Malleus and incus are absent. Graft is placed directly on the stapes head. It is also called Myringostapediopexy or Columella tympanoplasty. Type IV Only the footplate of stapes is present. It is exposed to the external ear, and graft is placed between the oval and round windows. A narrow middle ear (cavum minor) is thus created to have an air pocket around the round window. A mucosa-lined space extends from the eustachian tube to the round window. Sound waves in this case act directly on the footplate while the round window has been shielded. Type V Stapes footplate is fixed but round window is functioning. In such cases, another window is created on horizontal semicircular canal and covered with a graft. Also called fenestration operation. Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition


Question: Rhinoscleroma is caused by

Ans. (b) BacteriaRef. Dhingra's ENT 6th ed./156-57B RHINOSCLEROMA* It is a chronic granulomatous disease caused by gram negative coccobacillus- Klebsiella Rhinoscleromatis.* It has 3 stages:# Catarrhal or atrophic stage: characterized by foul smelling purulent nasal discharge and crusting (causing obstruction). This stage resembles atrophic rhinitis.# Granulomatous stage: in this stage there are painless and non-ulcerative granulomatous nodules in nasal mucosa. There is also subdermal infiltration of lower part of external nose and upper lip giving a 'woody'feel.# Cicatricial stage: the last stage which causes adverse conditions like stenosis of nares, distortion of upper lip, adhesions in the nose, nasopharynx and oropharynx. There may be subglottic stenosis with respiratory distress.# Rhinoscleroma causes woody infiltration of nose, so it is also known as Woody Nose.# Characteristic cells upon biopsy are: Miculicz's cell and Russel Bodies.# Treatment: Streptomycin (lg/day) and tetracycline (2g/day) are given together for 4-6 weeks.


Question: Mucocele most commonly occurs

Mucoceles are dilated, mucous-containing sacs that are lined by mucous membranes and result from continuous secretions into an obstructed sinus. The frontal sinus is most commonly affected, whereas the sphenoid sinus is rarely involved. Sinus expansion with thinning and remodeling of the sinus walls occurs. When the frontal sinus is involved, as it expands downward and outward proptosis can occur. Ref : ENT textbook by Dhingra 6th edition Pgno : 198


Question: Gradenigo's triad is caused due to involvement of

Gradenigo Syndrome (GS) is classically described as a clinicaltriad of otitis media, facial pain, and abducens palsy that in the past most commonly developed from infection in the petrous temporal bone (i.e., petrous apicitis). Ref otolaryngology dhingra 3e p278


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

Ans. is 'a' i.e., Normal ear Test Normal Conductive deafness SN deafness Rinne AC > BC (Rinne positive) BC > AC (Rinne AC > BC (Rinne Weber Not lateralized negative) Lateralized to negative) Lateralized to ABC Same as examiner's poorer ear Same as better ear Reduced Schwabach Equal examiner's Lengthened Shoened


Question: Sinus of Morgagni is present in

It is a space between the base of the skull and upper free border of superior constrictor muscle. Through it enters the 1. Eustachian tube 2. Levator veli palatine 3. Tensor Veli palatine 4. Ascending palatine aery (facial aery). (Ref: Diseases of ENT, PL Dhingra, 7th edition, pg no. 271)


Question: Type of tympanic membrane perforation commonly seen in tubotympanic CSOM is

Ref: Diseases of ENT by Dhingra 6th edition Pgno : 69-74 Differences between tubotympanic and atticoantral type of CSOM Tubotympanic or safe type Atticoantral or unsafe type Discharge Profuse, mucoid, odourless Scanty, purulent, foul smelling Perforation Central Attic or marginal Granulations Uncommon Common Polyp Pale Red and fleshy Cholesteatoma Absent Present Complications Rare Common Audiogram Mild to moderate conductive deafness Conductive or mixed deafness


Question: Lyre sign is seen in

Carotid body tumour arises from the chemoreceptor cells in the carotid body, hence also called chemodectoma. Mostly presents after 40 years. It is a very slow-growing tumour and the history of mass in the neck may extend into several years. It presents as a painless swelling which is pulsatile.MRI angiography shows splaying of internal and external carotid aeries (Lyre's sign).Dhingra 6e pg: 392


Question: Galens anastomosis between SLN and RLN is

Galens anastomosis is purely sensory. Branch of internal branch of superior laryngeal nerve communicating with the recurrent laryngeal nerve in the wall of the laryngopharynx supplying sensory fibers to the latter. Ref:- TB of ENT, Hazarika; pg num:- 623


Question: Mastoid tip is involved in

Bezold abscess can occur following acute coalescent mastoiditis when pus breaks through the thin medial side of the tip of the mastoid and present as a swelling in the upper pa of the neck. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 87)


Question: Tonsils reach their maximum size by

Tonsils are most active from 4 to 10 years of age. Involution begins after pubey resulting in a decrease of B-cell production and a relative increase in the ratio of T to B cells. (Ref: Diseases of Ear, Nose and Throat, PL Dhingra; 7th edition ,pg no. 292)


Question: Stage IV a with thyroid cartilage invasion in larynegeal carcinoma is treated with


Question: Mikulicz and Russell bodies are characteristic of

Biopsy shows infiltration of submucosa with plasma cells, lymphocytes, eosinophils, mikulicz cells and Russell bodies.
The latter two are diagnostic features of the disease RHINOSCLEROMA. Mikulicz cells are large foam cells with a central nucleus and vacuolated cytoplasm containing causative bacilli. Russell bodies are homogenous eosinophilic inclusion bodies found in the plasma cells. They occur due to the accumulation of immunoglobulins secreted by the plasma cells.


Question: Epley's maneuver is used in the treatment of

Epley`s maneuver is used in the treatment of Positional Veigo (BPPV)Dix Hallpike`s test is the diagnostic testOther exercises are: Semont`s maneuver, Brandt Darrof exercisesSurgeries: Singular neurectomy, Posterior canal occlusion, Labyrinthectomy, Vestibular nerve sectionRef: Hazarika; 3rd edition; Page no: 108


Question: A pure tone audiogram with a dip at 2000Hz is characteristic of

In 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. Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra; 7th Edition; Page no.96


Question: Otoconia is related to

Otoconia are bio-crystals which couple mechanic forces to the sensory hair cells in the utricle and saccule, a process essential for us to sense linear acceleration and gravity for the purpose of maintaining bodily balance. In fish, structurally similar bio-crystals called otoliths mediate balance Ref : Internet sources.


Question: Bryce&;s sign is seen in

Bryce's sign: It is seen in laryngocele. When the swelling is pressed, a gurgling sound is produced. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 507


Question: Bezold abscess is located in

Bezold abscess: It can occur following acute coalescent mastoiditis when pus breaks through the thin medial side of the tip of the mastoid and presents as a swelling in the upper pa of the neck. The abscess may (i) Lie deep to sternocleidomastoid pushing the muscle outwards. (ii) Follows the posterior belly of digastric and present as swelling between the tip of the mastoid and angle o the jaw, (iii) Present in the upper pa of the posterior triangle, (iv) Reaches the parapharyngeal space or (v) Tracks down along the carotid vessels. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 87)


Question: Vincent's angina is also known as

(A) Trench mouth # Acute necrotizing ulcerative gingivitis:> It is also known as "Plaut-Vincent angina", "Vincent's stomatitis", "Vincent's angina", "Vincent's infection", "acute ulcerative gingivitis" or "trench mouth."> Causes: Causative organisms include anaerobes such as Bacteroides and Fusobacterium as well as spirochetes (Borrelia and Treponema spp.).


Question: Caldwell luc approach opens

Caldwell luc approach opens maxillary sinus. Ref- Dhingra, 6th edition, Page 412.


Question: Cadaveric position of vocal cords is seen in

Position of cord Location from midline Defect Median midline RLN palsy Paramedian 1.5 mm RLN palsy Intermediate 3.5 mm Both RLN and superior laryngeal nerve palsy Gentle abduction 7.5mm ADDUCTOR PALSY

Bilateral recurrent and superior laryngeal nerve palsy

Bilateral recurrent laryngeal nerve palsy

Unilateral superior laryngeal nerve palsy

Bilateral superior laryngeal nerve palsy


Question: The most common site of osteoma is

The commonest site of osteoma in the PNS is frontal sinus.Commonest benign tumor of PNS is an osteomaMost common benign tumor of the nose is capillary hemangioma (nasal septum)Gardner`s syndrome- Colonic polyposis, multiple soft tissue swellings, and facial osteomas(Autosomal Dominant hereditary defect of connective tissue)Ref: Hazarika; 3rd ed; Pg 370


Question: In Jarjaway fracture of nasal bone, the fracture line runs

Ans. c (Horizontal) (Ref. PL Dhingra ENT 4th/p. 141)Hint: Jar a horizontally jaway!!! & vertically CHEVAL !!!CauseMeans?JARJAWAY FRACTURE of nasal septumResults from blow from the frontIt starts just above the anterior nasal spine and runs horizontally backwards just above the junction of the septal cartilage with the vomer.CHEVALLETE FRACTURE of septal cartilageResults due to blow from belowIt runs vertically from the anterior nasal spine upwards to the junction of bony and cartilaginous dorsum of the nose.# Nasal bone is the most common fracture of the face.# Nasal bone fracture is best diagnosed b\ palpation. not by x-ray.# In Chevallet fracture of nasal bone. the mechanism of trauma is Blow from below.


Question: An elderly diabetic with excruciating pain in ear, appearance of granulation in meatus, skull base infection with facial paralysis should be treated with

All clinical features are suggestive of malignant otitis externa, an inflammatory condition of the external ear. Malignant otitis externa (also k/a Necrotizing external otitis) Malignant otitis externa is an inflammatory condition of the external ear usually spreading deep to cause osteomyelitis of temporal bone and base of skull. It occurs primarily in immunocompromised persons, especially older persons with diabetes mellitus, and is often initiated by self-inflicted or iatrogenic trauma to the external auditory canal [May also be seen in pts. who received radiotherapy to skull base I The most frequent pathogen is Pseudomonas aeruginosa. Others may be S. aureus, Staphylococcus epidermidis, Aspergillus, Actinomyces, and some gram-negative bacterial. One of the hallmarkof malignant otitis externs is granulation tissue in the external auditory canal, especially at the hone-cailage junction. As the infection spreads to the temporal bone, it may extend into the cranium and result in cranial nerve palsies (commonly the facial nerve) Cranial nerve involvement indicates poor prognosis. Death is usually due to intracranial complications such as sigmoid sinus thrombosis. It has high moality rate due to which the name 'malignant' is used for this disease. Treatment Includes correction of immunosuppression (when possible), local treatment of the auditory canal, long-term systemic antibiotic therapy, and in selected patients, surgery. - In all cases, the external ear canal is cleansed and a biopsy specimen of the granulation tissue sent for culture. - IV antibiotics is directed against the offending organism. - For Pseudomonas aeruginosa, the most common pathogen, the regimen involves an antipseudomonal penicillin or cephalosporin (3rd generation-piperacillin or ceftazidime) with an aminoglycoside. A fluoroquinolone antibiotic can be used in place of the aminoglycoside. Ear drops containing antipseudomonal antibiotic e.g. ciproflaxacin plus a glucocoticoid is also used. - Early cases can be managed with oral and otic fluoroquinolones only. - Extensive surgical debridement once an impoant pa of the treatment is now rarely needed.


Question: Triad of Meniere's disease is

A. i.e. (Fluctuating hearing loss, vertgo, tinnitus) (100 Dhingra 4th) (107-8 - Maqbool 11th)Cardinal symptoms of Meniere's disease1. Episodic vertigo2. Fluctuating hearing loss (Sensory neural)3. Tinnitus4. Sense of fullness or pressure in the involved ear** Recruitment phenomenon is seen in - Meniere's diseaseTREATMENTSMedical Surgical1. Reassurance, vitamins (Nicotinic acid and A and D)2. Bed rest. Diuretic (acetazolamide)3. Vestibular sedative (Dimanhydrinate, promethazine theoclate prochlorperazine, Diazepam)4. Vasodilators** (Betahistadine hydrochloride)(i) Inhalation of carbogen (5% CO2 with 95% O2)(ii) Histamine drip5. Intratympanic gentamicin therapy1. Labyrinthectomy2. Intermittent low pressure pulse therapy(Meniett device therapy)* LERMOYEZ'S SYNDROME - is a variant of Meniere syndrome in which hearing loss and tinnitus occurs first, followed by vertigo that appears suddenly and with it hearing and tinnitus improve

Fluctuating hearing loss, vertigo, tinnitus


Question: Recruitment phenomenon is seen in

Recruitment test which is a special audiometry test is positive in Meniere's disease. Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra; 7th Edition; page no.113


Question: CSF Rhinorrhea occurs d/t

Commonest area of # causing CSF Rhinorrhea → cribriform plate of ethmoid bone as it is extremely thin.
Other possible areas of # causing CSF Rhinorrhea Frontal sinus (Posterior wall) or of the anterior cranial fossa.
Difference between CSF Rhinorrhea & allergic or vasomotor rhinitis CSF contains glucose which can be demonstrated by chemical tests.
CSF when collected into a test tube and allowed to stand, it remains clear in contradistinction to nasal discharge that leaves a sediment because of mucus and other proteins.
Nasal discharge stiffens the handkerchief and CSF dries soft in it.
Treatment: Prophylactic antibiotics & X-ray * If more than 2 wks then correct it surgically.


Question: Laryngocele arises as a herniation of laryngeal mucosa through the following membrane

Laryngocele arises as a herniation of laryngeal mucosa through the Thyrohyoid membrane. It is dilatation of laryngeal saccule and extends between the thyroid cailage and the ventricle. It may be internal, external or combined. Treatment is endoscopic or external excision. Ref: PL Dhingra 7th edition of Ear, Nose and Throat, pg no. 345


Question: Patient presents with high fever, signs of raised ICT and a past history of chronic otitis media likely diagnosis is

Brain abscess develops through four stages. 1. Stage of invasion (initial encephalitis). It often passes unnoticed as symptoms are slight. Patient may have head-ache, low-grade fever, malaise and drowsiness. 2. Stage of localization (latent abscess). There are no symptoms during this stage. Nature tries to localize the pus by formation of a capsule. The stage may last for several weeks. 3. Stage of enlargement (manifest abscess). Abscess begins to enlarge. A zone of oedema appears round the abscess and is responsible for aggravation of symptoms. Clinical features at this stage are due to: (a) Raised intracranial tension. (b) Disturbance of function in the cerebrum or cerebellum, causing focal symptoms and signs. 4. Stage of termination (rupture of abscess). An expanding abscess in the white matter of brain ruptures into the ventricle or subarachnoid space resulting in fatal meningitis. Ref: Dhingra 7e pg 90.


Question: Most common presentation in nasopharyngeal carcinoma is with

This may be the only manifestation of nasopharyngeal cancer. A lump of nodes is found between the angle of the jaw and the mastoid and some nodes along with the spinal accessory in the posterior triangle of the neck. Nodal metastases are seen in 75% of the patients when first seen, about half of them with bilateral nodes (Ref: Diseases of Ear, Nose and Throat, P.L Dhingra, 7th edition, page 284)


Question: Antrum of Highmore is

Antrum of Highmore is maxillary sinus.
It is the largest of paranasal sinuses.


Question: Fracture mandible occurs most commonly in

Condylar fractures are most common fractures among the fractures of mandible. They are followed by in frequency of fractures of CABS Condylar process Angle Body Symphysis Caused by indirect trauma to the chin Ref: Dhingra 7e pg 207


Question: Tone decay test is done for

THRESHOLD TONE DECAY TEST It is a measure of nerve fatigue and is used to detect retrocochlear lesions. Normally, a person can hear a tone continuously for 60 s. In nerve fatigue, he stops hearing earlier. The threshold tone decay test is simple and is performed in the following manner: A tone of 4000 Hz is presented at 5 dB above the patient's threshold of hearing, continuously for a period of 60 s. If patient stops hearing earlier, intensity is increased by another 5 dB. The procedure is continued till patient can hear the tone continuously for 60 s, or no level exists above the threshold where tone is audible for full 60 s. The result is expressed as number of dB of decay. A decay more than 25 dB is diagnostic of a retrocochlear lesion. Ref:- Dhingra; pg num:-26


Question: Most common congenital dysplasia of Ear is


Question: Sinusitis is LEAST involved in

(Sphenoid) (181- Dhingra 4th)* Most common sinus involved is - Maxillary* Least common sinus involved in - Sphenoid* Order of sequence - Maxillary >ethmoid > frontal > sphenoid


Question: Brown's sign is seen In

Brown's sign, also called pulsation sign, is seen in glomus tumour. When pressure is raised in the ear canal with a Siegel's speculum, tumour first pulsates vigorously and then blanches; reverse occurs when pressure is released.


Question: Fordyce&;s (Spots) Granules in oral cavity arise from

Fordyce spots They are aberrant sebaceous glands present under the buccal or labial mucosa and shine through it as yellowish or yellow-brown spots. They are seen with equal frequency in both males and females and are considered normal. Ref:- Dhingra; pg num:-220


Question: Horizontal semicircular canal responds to

The three canals lie at right angles to each other but the one which lies at right angles to the axis of rotation is stimulated the most.Thus horizontal canal will respond maximum to the rotation on the veical axis. (Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra; 6th edition; page no.17)


Question: In Ramsay Hunt syndrome, most commonly involved nerve is

Ramsay Hunt syndrome affects V, VII and VIII cranial nerves and among them, VII is most commonly affected. Ref: Dhingra 6th edition pg. 96


Question: Boyce sign is seen in

Zenkers diveiculum - A Zenker&;s diveiculum, also pharyngeal pouch, is a diveiculum of the mucosa of the human pharynx, just above the cricopharyngeal muscle. It is a pseudo diveiculum. Boyce sign:- Boyce's sign, a gurgling sound due to noise of splashing fluid accumulated in a large Zenker's diveiculum, can be heard on palpation. Although small diveicula might not cause symptoms, larger diveicula are usually symptomatic and surgery could be warranted. Ref:- Dhingra; pg num:-275


Question: The length of Eustachian tube is

Eustachian tube, also called auditory or pharyngotympanic tube, connects nasopharynx with the tympanic cavity. In an adult, it is about 36 mm long and runs downwards, forwards and medially from its tympanic end, forming an angle of 45deg with the horizontal. It is divided into two pas: bony, which is posterolateral, forms one-third (12 mm) of the total length and f ibrocailaginous, which is anteromedial, forms two-thirds (24 mm). The two pas meet at isthmus which is the narrowest pa of the tube . Reference-Dhingra 6/e, p57.


Question: Dysphagia lusoria is due to

The MC anomaly is right subclan aery arising from the descending aoa and travels behind the esophagus to complete its course to the right upper extremity, may cause significant posterior compression of the esophagus Ref : ENT textbook by Dhingra 6th edition Pgno : 447


Question: Ostmann fat pad is related to

*There are small fat bodies located inferomedial to Eustachian tube. These are called Ostmann fat pads*They are impoant in normal closure of Eustachian tube and preventing transmission of nasopharyngeal pressure to the middle ear*These fat pads are absent in patulous tube syndromeRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 62


Question: Alkaline Nasal Douche does not contain


Question: Best management for inhaled Foreign body in an infant

Tracheal and bronchial foreign bodies can be removed by bronchoscopy with full preparation and under general anaesthesia. Emergency removal of these foreign bodies is not indicated unless there is airway obstruction or they are of the vegetable nature (e.g. seeds) and likely to swell up. Methods to remove the tracheobronchial foreign body Conventional rigid bronchoscopy. Rigid bronchoscopy with telescopic aid. Bronchoscopy with C-arm fluoroscopy. Use of Dormia basket or Fogay's balloon for rounded objects. Tracheostomy first and then bronchoscopy through the tracheostomy. Thoracotomy and bronchotomy for peripheral foreign bodies. Flexible fibreoptic bronchoscopy in selected adult patients. Ref: PL Dhingra; Textbook of EAR, NOSE and THROAT; edition 7; page no 367


Question: The prerequisite for endoscopic sinus surgery is

Endoscopic surgery of inflammatory diseases of paranasal sinuses (sinusitis or polyp) requires a very detailed preoperative knowledge of the individual anatomical conditions and pathological changesCT scan is used best to visualize sinus areasCT scan provides an excellent definition of paranasal sinuses and is a prerequisite for endoscopic surgeryRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 220 - 221


Question: The most common site of perforation in tympanic membrane is

Perforations. They may be central, attic or marginal and are associated with chronic otitis media The most common site of Tympanic membrane perforation is antero-inferior quadrant. Ref : Diseases of ENT by Dhingra 6th edition Pgno : 56,71


Question: Epiglottis is derived from


Question: Sago grain appearance is seen in

Myringitis bullosa It is a painful condition characterized by the formation of haemorrhagic blebs on the tympanic membrane and deep meatus. It is probably caused by a virus or Mycoplasma pneumonia. Ref: Dhingra, ENT, 6th edition, pg no.55


Question: Commonest cause of epistaxis in children is

Commonest cause of epistaxis in children is trauma in Little&;s area


Question: Moure's sign can be detected in

Moure`s sign- Absence of Laryngeal click or crepitusClassical sign in post-cricoid malignancy.Bocca`s sign - is also an absence of post-cricoid click or crackle in cricoid malignancy.Ref: Hazarika; 3rd ed; Pg 534


Question: Phelps sign is seen in

Phelps sign is the loss of crust of bone between the carotid canal and jugular bulb in glomus jugulare as seen in CT scan. Ref: Dhingra 7th edition pg.122


Question: In facial nerve injury, loss of lacrimation is due to involvement of

Secretomotor fibres to lacrimal gland leave at geniculate ganglion greater superficial petrosal nerve Ref: Dhingra 6th edition Pg. 97


Question: Familial tendency is not seen in


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

Jugular venography must be done to delineate multiple tumours, feeding vessels, embolization and involvement of jugular bulb, carotid aery or intradural extension. Ref: Dhingra 6th edition pg. 110


Question: Glue ear is

Otitis media with effusion/ Serous OM/Glue ear/Secretory OM is a painless condition following accumulation of non-inflammatory exudate in the middle ear. Commonly seen in children.OME is the commonest cause of conductive deafness in children, and due to adenoid hyperophyIn adults, Nasopharyngeal carcinoma is to be ruled out.Treatment of choice- Myringotomy with grommet inseion.Ref: Hazarika; 3rd ed; Pg 146


Question: Multiple Perforation and Pale granulation of Tympanic membrane is seen in


Question: Crocodile tears is due to

Crocodile tears or gustatory lacrimation is due to faulty regeneration of parasympathetic nerve fibres. Ref: Dhingra 6th edition pg. 98

Cross innervation of facial nerve fibers

Cross innervation of trigeminal nerve fibers

Improper regeneration of trigeminal nerve


Question: In right middle ear pathology, weber test will be

Weber`s test lateralizes to the affected ear in a conductive hearing loss and to the normal ear in a sensorineural hearing loss. In case of a middle ear pathology, there is conductive hearing loss and hence weber`s test lateralizes to the affected ear.Weber`s is the most sensitive test, lateralizes even at 5 dB of hearing difference between the two ears.Ref: Hazarika; 3rd ed; Pg 53


Question: C shaped curve on tympanometry is seen in

Type C tympanometry Maximum compliance occurs with negative pressure in excess of 100mm H2O Seen in retracted tympanic membrane and may show some fluid in middle ear. Ref: Dhingra 7e pg 27.


Question: Meyer cotton Grading system used for


Question: Bovine cough is charactstic of

(C) Laryngeal paralysis # Clinical Features: As all the muscles of larynx on one side are paralysed, vocal cord will lie in the cadaveric position i.e. 3.5 mm from the midline. The healthy cord is unable to approximate the paralysed cord, thus causing glottic incompetence. This results in hoarseness of voice and aspiration of liquids through the glottis. Cough is ineffective due to air waste.


Question: Tripod fracture is seen in

Tripod fracture is seen in zygoma fractures as it involves three sites:Zygomatico-maxillary, Zygomatico-frontal, Zygomatico-temporal(arch)Presentation: Flattening of malar prominence, Step deformity, infra orbital paraesthesia, epistaxis, trismus.Ref: Hazarika; 3rd ed; Pg 359


Question: Most common salivary gland to develop stones


Question: Tapir Nose is Complication of


Question: 10 year old boy developed hoarseness of voice following on attach of diphtheria, No other significant OLE or VR is paralysed, treatment of choice is

It is right recurent Laryageal nerve palsy, hense only hoarsness is seen,so wait for recovery.


Question: Pneumocephalus is seen in fracture of

Pneumocephalus is the presence of air or gas within the cranial cavity.Pneumocephalus is seen in fracture of frontal sinus (Posterior table); may also be seen in ethmoid fracturesRef: Hazarika; 3rd ed; Pg 355


Question: Static equilibrium is due to

Macula is the peripheral receptor of utricle and saccule; Static equilibrium is controlled by utricle and saccule Semicircular canals respond to angular acceleration and deceleration Cristae is located in the ampullary ends of the semicircular canals Ref: PL Dhingra 6th edition of Ear, Nose and Throat; pg no 18


Question: Maxillary sinus achieves maximum size at

Maxillary sinus is the first sinus to develop at bih. It is completely developed by 9 years of agei.e approximately at secondary dentition Ref Maqbool 11/e,p148.


Question: Glottic chink, in cadaveric positions of vocal cords is

Glottic chink It is the distance between the vocal cords. In cadaveric position--the vocal cords are 3.5 mm away from midline, so the distance between them i.e glottic chink is 7 mm. Similary in full abduction it is about 19 mm. Ref:- Mohan Bansal; pg num:- 374


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

The vocal cord vibrates during speech to produce speech. These vibrations occur due to subglottic airflow when the cord is in adduction (Median & paramedian).
During normal phonation the vocal cords are in median position and during strong whisper vocal cords are in paramedian position.
So, for proper voice, the vocal cords should be in median or paramedian position.
Same occurs in bilateral recurrent laryngeal nerve paralysis, where the vocal cords are in median or paramedian position → Voice is less likely to be impaired.

Now, the question comes to the mind immediately : - Why the voice is affected in unilateral paralysis, in which the cord is in median or paramedian position. The answer is : -

In unilateral vocal cord paralysis, one cord is paralysed and vibrates abnormally or does not vibrate at all, therefore cannot coordinate with the other side (normal) vocal cord. This results in voice problems.
In bilateral paralysis, both vocal cords vibrate abnormally but coordinate with each other, therefore voice is less affected.


Question: The most common site of osteoma is( REPEAT QUESTION)

Most osteomas are asymptomatic and are found incidentally when imaging the sinuses either for sinonasal symptoms or for unrelated complaints. Osteomas are frequently seen elsewhere in the head and neck paicularly the mandible and outer table of the skull vault. There is a paicular frequency distribution within the paranasal sinuses: frontal sinuses: 80%; ethmoid air cells: ~15%; maxillary sinuses: ~5 %; sphenoid sinus: rare. Osteomas are most commonly seen in the frontal sinus followed in turn by those of ethmoid and maxillary. They may remain asymptomatic, being discovered incidentally on X rays. Treatment is indicated when they become symptomatic, causing obstruction to the sinus sodium, formation of a mucocele, pressure symptoms due to their growth in the orbit, nose or cranium. (Ref: Textbook of Diseases of ENT, PL Dhingra, 7th edition, pg no. 231)


Question: Rhinoscleroma occurs due to

Rhinoscleroma

The causative organism is Klebsiella rhinoscleromatis Frisch bacillus, which can be cultured from the biopsy material.
The disease is endemic in several parts of the world.
In India, it is seen more open in northern than in the southern parts.
Biopsy shows infiltration of submucosa with plasma cells, lymphocytes, eosinophils, Mikulicz cells & Russell bodies.
There two are diagnostic features of the disease.
The disease starts in the nose & extends to nasopharynx, oropharynx, larynx, trachea & bronchi.
Mode of infection is unknown.
Both sexes of any age may be affected.


Question: Osteomeatal complex (OMC) connects

Ans. a (Nasal cavity with maxillary sinus). (Ref. ENT secrets 3rd ed., 100-107)Osteomeatal unit/complex (OMC) confluence# OMC is the normal aerated channel which provide airflow & mucociliary clearance for sinuses.# Anterior ethmoidal air cells, maxillary & frontal sinuses drain into it.# It is the cross road for drainage of most paranasal sinuses.# It is the key area for pathogenesis of chronic sinus diseases.# The concept that obstruction of OMC results in ethmoid, frontal & maxillary sinusitis is fundamental to FESS# Well identified on coronal CT with patient prone & head hyperextended (Coronal CT).# Thus, components of OMC include:# Middle meatus# Maxillary sinus ostium & infundibulum# Anterior & middle ethmoidal air cells ostia & ethmoidal infundibulum# Frontal recess/frontonasal duct# Bulla ethmoidalis# Hiatus semilunaris# Uncinate process# Sphenoethmoid recess & superior meatus (included by some authors)# Uncinate process is thin, curved lamina of bone from the lateral side of ethmoidal labyrinth that forms a portion of lateral nasal wall. It projects downwards & backwards & ranges from 1 to 4 mm in height and 14 to 22 mm in length. Superior edge of uncinate process is free and forms medial boundary of hiatus semilunaris.# Ethmoidal infundibulum is a trough shaped air space that is below bulla & above & lateral to uncinate process. It receives drain from anterior & middle ethmoid air cells & frontal & maxillary sinuses. The infund-ibulum may be narrowed if there is Concha bullosa &/or large Haller's cell (pneumatized middle turbinate).# Hiatus semilunaris is curvilinear opening of lateral wall that is above uncinate process & below the bulla ethmoidalis. This opening separates uncinate process from ethmoidal bulla & serves as connection between infundibulum & middle meatus.# The middle ethmoidal air cell produces a round swelling called bulla ethmoidalis on lateral wall of middle meatus.# Onodi cells are most posterior ethmoidal cells that surround optic canal.


Question: Carcinoma of maxillary sinus stage III {T3 No Mo}, Treatment of choice is

T3N0M0: Tumor invading the skin of the cheek, anterior ethmoid, pterygoid muscles and orbit with no nodal involvement and no distant metastasis. In most cases, a combination of surgery and radiotherapy is required. However, depending on histopathological nature, therapy may differ. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 234)


Question: Best view for superior orbital fissure


Question: Commando operation describes

Maxillectomy, Neck Dissection, Omohyoid muscle removal

Mandibulectomy, Neck Dissection, Omohyoid muscle removal

Mandibulectomy, Neck dissection, Oropharyngeal resection


Question: Middle Ear Function is

Middle ear functions: Conduct the sound from outer ear to inner ear Middle ear muscles provide protection from loud sound It serves as an acoustic transformer to match the impedance of air to the much higher impedance of cochlear fluids Couples sound preferably to only one window of cochlea, thus producing differential pressure between windows, necessary for cochlear fluid movement


Question: Commonest benign tumor of the esophagus

BENIGN NEOPLASMS OF OESOPHAGUS Benign neoplasms are rare compared to malignant ones. Leiomyoma is the most common and accounts for two- thirds of all the benign neoplasms. It arises from the smooth muscle and grows in the wall of oesophagus. Dysphagia is produced when tumour exceeds the diameter of 5 cm. Barium swallow shows an ovoid filling defect. Endoscopy reveals a submucosal swelling. Biopsy should not be taken. Treatment is enucleation of the tumour by thoracotomy. Mucosal polyps, lipomas, fibromas and haemangiomas are other benign tumours. They are often pedunculated and present in the oesophageal lumen. Endoscopic removal is avoided because of the danger of oesophageal perforation. Treatment is surgical excision by oesophagotomy Ref : ENT textbook by Dhingra 6th edition Pgno : 345


Question: Incisura terminalis is between

There is no cartilage between tragus and crus of the helix and an incision made in this area will not cut through the cartilage and is used for the endaural approach in surgery of external auditory canal and mastoid.


Question: According to European laryngeal Society, Subligamental cordectomy is classified as

Subligamental cordectomy is classified as Type II Excision of vocal cord after splitting the larynx (cordectomy laryngofissure) Ref: PL Dhingra; Textbook of EAR, NOSE and THROAT; edition 6; page no 310


Question: For myringoplasty, Graft material of choice is

Low metabolic rate, no need for a separate incision, same thickness as that of tympanic membrane ours the use of temporalis fascia. Other graft materials also include perichondrium, dura and cadaveric tympanic membrane. Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition


Question: Nasopharyngeal angiofibroma is most commonly seen in

Ans. (c) Young malesRef: Dhingra's ENT 5th ed.l 261"Nasopharyngeal angiofibroma is seen almost exclusively in ADOLESCENT males in the age group of 10-20 years."ABOUT NASOPHARYNGEAL ANGIOFIBROMA* It is a vascular tumor with lots of fibrous tissue without muscular coat. Hence it causes severe bleeding because of inability to contract.* Most common benign tumour of nasopharynx.* Arises from the posterior part of nasal cavity close to superior margin of sphenopalatine foramen.* Frog face deformity- if tumor Extends to orbit and causes proptosis* Antral/Holman-Millar sign -- Anterior bowing of posterior wall of maxillary sinus is pathognomonic.* Investigation of choice is C.E.C.T, scan* Treatment of choice is surgical excision.


Question: Palpatory thud, an audible snap is seen in

A foreign body in trachea may move up and down the trachea between the carnia and the undersurface of vocal cords causing "audible slap" and "palpatory thud&;.Symptoms and signs of foreign bodies at different levelsSite of foreign bodiesSymptoms and signsLarynxChoking, Cyanosis, Complete obstruction leading to death* Paial obstruction: stridor, hoarseness, cough, respiratory difficultyTrachea* Choking, stridor, wheeze, cough, palpatory thud, audible slap* Cough, wheeze and diminished air entry to lung forms a "triad"Bronchi Respiratory distress with swelling of the foreign body* Lung collapse, emphysema, pneumonitis, bronchiectasis or lung abscess are late featuresRef: Hazarika; 3rd ed; Pg 651


Question: Commonest cause of Eustachian tube disease is

Adenoids cause eustachian tube dysfunction by a) Mechanical obstruction to tubal opening b) Acting as a reservoir for pathogenic organisms c) In case of allergy, mast cells of the adenoid tissue release inflammatory mediators which cause tubal blockage (Ref: Textbook of diseases if ENT, PL Dhingra, 7th edition, pg no. 64)


Question: Diameter of head mirror in ENT is

Head mirror: It is a concave mirror used to reflect light from the Bull's eye lamp onto the pa being examined. It has a focal length of approximately 25 cm. The examiner sees through the hole in the centre of the mirror. Diameter of the mirror is 89 mm (3 1/2 ") and that of the central hole is 19 mm (3/4") Ref: Dhingra 7e pg 427.


Question: Tensors of vocal cord are

Intrinsic muscles acting on vocal cords: Abductors: Posterior cricoarytenoid Adductors: Lateral cricoarytenoid, lnterarytenoid (transverse arytenoid) Thyroarytenoid (external pa) Tensors: Cricothyroid, Vocalis (internal pa of thyroarytenoid) Intrinsic muscles acting on laryngeal inlet: Openers of laryngeal inlet: Thyroepiglottic (pa of thyroarytenoid) Closers of laryingeal inlet: Interarytenoid (oblique pa), Aryepiglottic (posterior oblique pa of interarytenoids)

Posterior cricothyroid, internal interarytenoid

Lateral cricothyroid, internal interarytenoid 1

Cricothyroid and internal thyroarytenoid


Question: Treatment of choice for vocal nodule is

Treatment of vocal nodules Early cases of vocal nodules can be treated conservatively by educating the patient about the proper use of voice. With this treatment, many nodules in children disappear completely. Surgery is required for large nodules or nodules of long standing in adults. They are excised with precision under an operating microscope either with cold instruments or laser avoiding any trauma to the underlying vocal ligament. Speech therapy and re-education in voice production are essential to prevent their recurrence. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 343


Question: Structure injured during excision of Ranula


Question: In normal adult wave V of ABR is generated from

Wave I - Distal pa of CN VIII Wave II - Proximal pa of CN VIII near the brainstem Wave III - Cochlear nucleus Wave IV - Superior olivary complex Wave V - Lateral lemniscus Waves VI and VII - Inferior colliculus Note: Auditory brainstem response (ABR): Also called BAER or BAEP (brainstem auditory evoked response or potential) or BERA (brainstem evoked response audiometry) is to elicit brainstem responses to auditory stimulation by clicks or tone bursts. Ref: Dhingra; 6th Edition; pg no 27


Question: Aery of epistaxis is the name given to

The "aery of epistaxis" is the sphenopalatine branch of the internal maxillary aery. This is called so because this vessel supplies the major poion of the nasal cavity. It enters the nasal cavity at the posterior end of the middle turbinate to supply the lateral nasal wall, it also gives off a septal branch which supplies the nasal septum. Ref: Diseases of ENT by Dhingra 6th edition Pgno : 179,180


Question: During maxillary wash sudden death is due to

Air embolism: It is rare but may prove fatal. This complication can be prevented by avoiding insufflation of air into the antrum after lavage. Ref : Dhingra 7e pg 466.


Question: Treatment of choice for the following disease is

The treatment of the established case is myringotomy and aspiration of the fluid. Performed under general anesthesia and with the help of the operating microscope. TREATMENT OF GLUE EAR: If the condition persists despite treatment of any underlying sinusitis or if no cause can be found, the patient should undergo an examination of the postnasal space with biopsies of any suspicious areas. Myringotomies should be carried out. If there is thick or serous fluid present. Grommets should be inseed even if there is a postnasal tumour present. Where the drum is collapsed or atrophic grommets may be inseed anteriorly, but if the atelectasis is longstanding they are unlikely to be beneficial, and the patient would be better served by having a hearing aid. If the condition persists after the grommets have come out. long-term ventilation tubes such as a T - tube or titanium should be used. Hence the best answer here would be choice A Ref: Diseases of ENT by Dhingra 6th edition Pgno : 64

Myringotomy with ventilation tube inseion


Question: Most common site of perforation in tympanic membrane is

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: Commonest site of Ivory osteoma is

Osteoma: They are most commonly seen in the frontal sinus followed in turn by those of ethmoid and maxillary. They may remain asymptomatic, being discovered incidentally on X-rays. Ref: Textbook of ENT, Dhingra; 6th edition; Pg no: 205 ref img


Question: In Adenoids hyperophy, treatment is

When symptoms are not marked, breathing exercises, decongestant nasal drops, and antihistaminics. When symptoms are marked adenoidectomy is done. (Ref: Diseases of Ear, Nose and Throat, PL Dhingra; 7th edition, pg no. 276)


Question: Most common sinus involved in acute sinusitis

The alveolar process of the maxillae holds the upper teeth and is referred to as the maxillary arch.
Each maxilla attaches laterally to the zygomatic bones (cheekbones).
Each maxilla assists in forming the boundaries of three cavities: the roof of the mouth. the floor and lateral wall of the nasal cavity.


Question: Not seen in Ludwig&;s angina

Ludwig angina is a type of bacterial infection that occurs in the floor of the mouth, under the tongue. It often develops after an infection of the roots of the teeth (such as tooth abscess) or a mouth injury. This condition is uncommon in children. CLinical features: There is marked difficulty in swallowing (odynophagia) with varying degrees of trismus. When infection is localized to the sublingual space, structures in the floor of mouth are swollen and tongue seems to be pushed up and back. When infection spreads to submaxillary space, submental and submandibular regions become swollen and tender, and impa woody-hard feel. Usually, there is cellulitis of the tissues rather than frank abscess. Tongue is progressively pushed upwards and backwards threatening the airway. Laryngeal oedema may appear. Complications: 1.Spread of infection to parapharyngeal and retropharyngeal spaces and thence to the mediastinum. 2. Airway obstruction due to laryngeal oedema, or swelling and pushing back of the tongue. 3.Septicaemia. 4.Aspiration pneumonia. Ref - otolaryngology Dhingra 6E p263


Question: Queckenstedt test is done for

Drainage of CSF in some cases may often be elicited on endoscopy by having the patient perform a Valsalva maneuver or by compressing both jugular veins (Queckenstedt-Stookeytest) Ref : internet sources


Question: Sensory Nerve supply of Anterior 2/3rd tongue


Question: A patient presents with enophthalmos after a trauma to face by blunt object. There is no fever or extraocular muscle palsy. Diagnosis is

Due to a trauma to face by a blunt object, an increased pressure may rupture the floor of the orbit and extrude the fat content of orbit, resulting in enophthalmos. Thus it is due to a &;blow-out fracture&; or fracture of orbital floor Ref: Diseases of nose throat and ear; Logan Turner; 10th edition; pg no 27


Question: Furstenberg's test is seen positive in


Question: Drug of choice in 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: Cause of unilateral secretory otitis media in an adult is

Benign and malignant tumours of nasopharynx should always be excluded in unilateral serous otitis media in an adult. Nasopharyngeal carcinoma Clinical features Nasal: Nasal obstruction, nasal discharge, denasal speech and epistaxis. Otalgic: Due to obstruction of the eustachian tube, there is a conductive type of hearing loss, serous or suppoive otitis media. Tinnitus and dizziness may occur. Presence of unilateral serous otitis media in an adult should raise suspicion of nasopharyngeal growth. Ophthalmoneurologic: Squint and Diplopia(CN 6), Ophthalmoplegia( CN 3,4 and 6) facial pain and reduction of corneal reflex(CN 5), exophthalmos and blindness(CN 2).Involvement of CN 9,10,11 may occur constituting jugular foramen syndrome. Involvement of the cervical sympathetic chain causes horner's syndrome. Cervical nodal metastasis. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 284,285)


Question: The earliest symptom of acoustic nerve tumour is

Cochleovestibular symptoms are the earliest symptoms when a tumour is still intracanalicular and are caused by pressure on cochlear or vestibular nerve fibres or on the internal auditory aery.Progressive unilateral sensorineural hearing loss, often accompanied by tinnitus, is the presenting symptom in the majority of cases. There is marked difficulty in understanding speech, out of propoion to the pure tone hearing loss. This feature is characteristic of acoustic neuroma. Vestibular symptoms are imbalance or unsteadiness. True veigo is seldom seen. Ref : Diseases of ENT by Dhingra Pgno : 112


Question: Fistula test stimulates

Fistula test: It induces nystagmus by producing pressure changes in the external canal which are then transmitted to labyrinth Normally the test is negative as the pressure changes in the external canal cannot be transmitted to labyrinth It is positive in the presence of the fistula which is attached to the lateral semicircular canal Ref: Dhingra 7e pg 43, internet sources.


Question: Atrophic dry nasal mucosa, extensive encrustations with 'woody' hard external nose; is suggestive of

Ans. b (Rhinoscleroma). (Ref. ENT PL Dhingra, 3rd ed., 194)In the granulomatous stage, painless and non-ulcerative nodules are formed in nasal mucosa, resulting in formation of so-called Woody Nose/ Hebry's Nose.RHINOSCLEROMA# Chronic granulomatous disease.# Caused by: a gram-negative bacterium Klebsiella rhinoscleromatis/Frisch bacillus- Atrophic stage--atrophic rhinitis--foul-smelling purulent nasal discharge & crusting.- Granulomatous stage--nodules in nasal mucosa, 'Woody' hard external nose & upper lip.- Cicatricial stage--stenosis of nares, distortion of upper parts in nose, nasopharynx & oropharynx.# It is common between 20 and 40y age and is found almost exclusively in lower socioeconomic class.# Mikulicz cells & Russel bodies are seen.- Mikulicz cells are large foam cells containing causative bacilli.# Rx: Streptomycin, tetracyclines, steroids, surgery.


Question: Positional veigo is

The disease is caused by the disorder of posterior semicircular canal. Otoconial debris when settles in the cupula of the posterior semicircular canal in a critical head position causes displacement of cupula and veigo. (Ref: Diseases of EAR, NOSE AND THROAT by PL DHINGRA - 6th Edition)


Question: The most common site of the leak in CSF rhinorrhea is( REPEAT QUESTION)

Leakage of CSF is most commonly seen in the anterior cranial fossa at the level of the cribriform plate as it is extremely thin. (Ref: Diseases of nose ear and throat; Logan Turner; pg 28)


Question: Rhinosporidiosis is caused by

Rhinosporidiosis is a chronic granulomatous infection of the mucous membrane.
The ecological agent is Rhinosporidium seeberi.
Rhinosporidium seeberi is an aquatic bacterium (not a fungus). Infection usually results from a local trauma inoculation with the organism.
It is seen in India, Pakistan and Sri Lanka. In India, most of the cases are seen in Southern states.
Infection of the nose and nasopharynx is observed in 70% of persons with rhinosporidiosis; infection of the palpebral conjunctiva or associated structures (including lacrimal apparatus) is observed in 15% of cases.
Other structures of the mouth and upper airway may be sites of disease. Disease of the skin, ear, genitals and rectum has also been described.
Rhinosporidiosis is an infection that typically limited to the mucosal epithelium.
The disease progress with local replication of R. seeberi and associated hyperplastic growth of host tissue and a localized immune response.
Clinical features of Rhinosporidiosis
Rhinosporidiosis presents as soft leafy polypoidal mass (soft polyp), which is pink to purple in colour studded with white dots, i.e., strawberry appearance. This appearance results from sporangia, which is visible as grey or yellow spots in the vascular polypoid masses.
Because the polyps are vascular and friable, they bleed easily upon manipulation.
Treatment - The treatment of choice is surgical excision.
Complete excision of mass is done with diathermy knife and cauterization of the base. Dapsone is being tried for treating rhinosporidiosis but with limited success.


Question: Schwaz sign is seen in

In otosclerosis sometimes, a reddish hue may be seen on the promontory through the tympanic membrane. This is called Schwaze sign. This is indicative of active focus with increased vascularity. Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra; 7th Edition page no.96


Question: Destruction of right labyrinth causes nystagmus to

In sudden vestibular failure, the patient is found to have first degree, second degree and third-degree nystagmus to unaffected side., a so-called paralytic nystagmus (Ref: Diseases of EAR - Harold Rudman, Tony Wright - 6th Edition)


Question: Teardrop sign is seen in

In 'blowout fractures' or fractures of orbital floor, x-ray shows a convex opacity bulging into the antrum from above. This occurs because of the herniation of orbital contents into the antrum. This sign is known as teardrop sign or teardrop opacity. Ref: Textbook of diseases of ENT; PL Dhingra, 7th edition, pg no. 206


Question: Impedance audiometry is for pathology of

It is done for the pathology of the middle ear. It is a test for conductive deafness. It is an objective test, widely used in clinical practice and is paicularly useful in children. It consists of: Tympanometry Acoustic reflex measurements. Ref: Dhingra; 6th Edition; pg no 24


Question: The function of stria vascularis is

Cochlear duct: Also called membranous cochlea or the scala media. It is a blind coiled tube. It appears triangular on cross-section and its three walls areformed by:(a) the basilar membrane, which suppos the organ of Coi(b) the Reissner's membrane, which separates it from the scala vestibule; and(c) the stria vascularis, which contains vascular epithelium and is concerned with the secretion of endolymphRef: Dhingra; 6th edition; Page no: 10

To maintain the electronic milieu of endolymph


Question: Gerlach tonsil in Waldeyer’s ring is

The tubal tonsil is one of the four main tonsil groups comprising Waldeyer's tonsillar ring, which also includes the palatine tonsils, the lingual tonsils, and the pharyngeal tonsils.


Question: Rollover phenomenon in audiometry is seen in

Roll over phenomenon:- it is seen in retro cochlear hearing loss . With increase in intensity above paicular level phonetically balanced score (PB score) falls rather than maintain a plateau as in cochlear type of sensineural hearing loss .


Question: Gelle's phenomenon is absent in

Gelle's test compares the intensity of bone conducted tuning fork sound without and with raising pressure on the tympanic membrane with Siegel's speculum. Normally, Gelle's test is positive because the intensity of hearing decreases when air pressure is raised in the external auditory canal. In ossicular fixation or ossicular discontinuity, increased air pressure makes no change in the sound intensity(Gelle's negative) Ref: Diseases of EAR, NOSE and Throat by PL Dhingra; 7th Edition; Page no.508


Question: Not included in Gredenigo syndrome


Question: CT view in paranasal polyp is

Both coronal and axial view are used, but coronal views are best to study paranasal sinus polypsRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 217 - 218


Question: Treatment of Puberphonia is

Normally, childhood voice has a higher pitch. When the larynx matures at pubey, vocal cords lengthen and the voice changes to one of lower pitch. This is a feature exclusive to males. Failure of this change leads to persistence of childhood high-pitched voice and is called puberophonia. Type III Thyroplasty- 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: Moure&;s sign can be detected in

Moure's sign: in normal persons, there is a click felt when the larynx is moved from side to side over the veebral column. The sign is absent in patients with post-cricoid carcinoma (Moure's sign positive). Ref: Internet sources


Question: Fungus causing otomycosis most commonly is

Otomycosis Otomycosis is a fungal infection of the ear canal that often occurs due to Aspergillus niger, A. fumigatus( niger > fumigatus) or Candida albicans. It is seen in hot and humid climate of tropical and subtropical countries. Secondary fungal growth is also seen in patients using topical antibiotics for treatment of otitis externa or middle ear suppuration. clinical features: include intense itching, discomfo or pain in the ear, watery discharge with a musty odour and ear blockage. The fungal mass may appear white, brown or black and has been likened to a wet piece of filter paper. Examined with an otoscope: A. niger appears as black- headed filamentous growth, A. fumigatus as pale blue or green and Candida as white or creamy deposit. Meatal skin appears sodden, red and oedematous. Ref:- Dhingra; pg num:-52


Question: Most common site of mandibular fracture is

Mandibular fractures are typically the result of trauma. This can include a fall onto the chin or a hit from the side. Rarely they may be due to osteonecrosis or tumors in the bone. The most common area of fracture is at the condyle (36%), body (21%), angle (20%) and symphysis (14%).


Question: Darwin tubercle is seen in

Darwin's tubercle (or auricular tubercle) is a congenital ear condition which often presents as a thickening on the helix at the junction of the upper and middle thirds The features present in approximately 10.4% of the population. This acuminate nodule represents the point of the mammalian ear. Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 3


Question: Woodruff plexus is seen at

It is a plexus of veins situated inferior to posterior end of inferior turbinate . It is a site of posterior epistaxis in adults . ( Ref : Diseases of ENT , PL Dhingra , 6th edition , Pg no . 176 )


Question: Thyroplasty Type I is done for vocal cord.........

Ans: a (Medialisation) Ref: Dhingra, 3rded, p. 364 & 4thed, p. 278Laryngeal frame work surgery - Isshiki's classificationType I thyroplastyType II thyroplastyType III ThyroplastyType IV thyroplasty- Medial displacement- Lateral displacement- Shortening (relaxation)- Elongation (tensioning) Indications: Type III thyroplastyIndications: Type IV thyroplasty1) Adductor spasmodic dysphonia2) Mutational falsetto3) Gender transformation (female to male)1) Androphonia2) Post surgical defects3) Gender transformation (male to female)


Question: Most common bacterial cause of Rhinitis is

Secondary Invaders Streptococcus haemolyticus Pneumococcus Staphylococcus Haemophilus influenza Klebsiella Ref : Dhingra 7e pg 171.


Question: Unilateral middle ear serous effusion in an adult, most common cause is

"In adults presenting with a unilateral middle ear effusion, the possibility of a nasopharyngeal carcinoma should be considered""A high incidence of NPC (Nasopharyngeal carcinoma) in South East Asia and southern China correlates with the high incidence of OME (Otitis Media with Effusion) in adults in these regions"Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 279 - 286


Question: Most common site for laryngeal cailagenous tumors is

Laryngeal cailaginous tumors- Cricoid cailage is the most common site of laryngeal cailaginous tumor. Ref:- Essentials of ENT Mohan Bansal; pg num:- 372


Question: Pitch discrimination is best between

Pitch is a subjective sensation produced by frequency of the sound Normal person can hear frequencies of 20-20,000 Hz Audiometry testing is done for only 125 - 8000 Hz Ref: Dhingra 7e pg 21,22.


Question: Paranasal sinuses presents at bih are

Paranasal sinuses develop as outpouchings from the mucous membrane of a lateral wall of the nose. The growth of sinuses continues during childhood and into early adult life. Radiologically maxillary sinuses can be identified at 4-5 months, ethmoids at 1 year, sphenoid at 4 years and frontals at 6 years. Reference: Diseases of ear, nose and throat; PL Dhingra; 6th edition; Pg no.189


Question: Woodruff's plexus is located at

O Woodruff's plexus (also called nasopharyngeal plexus) is a confluence of vessels on the lateral wall of nose and is often implicated in 'posterior' bleeds. O It is a venous plexus situated posterior to posterior end of Middle and inferior turbinate. In recent histological studies it is found to consist of thin walled vessels with very little muscle or fibrous tissue. O It is the most common site of posterior epistaxis in adults. A more recent study with endoscopic photography and anatomical micro-dissectionconfirmed that the plexus does indeed exist but showedit to be a venous plexus.


Question: Lymphatic drainage of oropharynx is mainly through

Lymphatics from oropharynx drain into the upper jugular chain, paicularly the jugulodigastric ( tonsilar) node. Some pas drain to the posterior cervical group also. The base of the tongue may drain bilaterally. Lymphatic drainage of the nasopharynx - upper deep cervical nodes. (Ref: Diseases of Ear, Nose and Throat, PL Dhingra; 7th edition, pg no. 271)


Question: Surgery to widen the cailaginous pa of EAC

Meatoplasty- Operation in which crescent of conchal cailage is excised to widen the meatus. Myringoplasty is repair of a perforation of the tympanic membrane (the pars tensa). (TYMPANUM=Middle ear) Tympanoplasty is ossicular reconstruction with myringoplasty. Otoplasty is Reconstruction of Pinna


Question: Le Fort's fracture does NOT involve

(D) Mandible # FRACTURES OF MAXILLA: They are classified into 3 types.> Le Fort I (transverse) fracture runs ab and parallel to the palate. It cross lower part of nasal septum, maxillary antra and the pterygoid plates.> Le Fort II (pyramidal) fracture through the root of nose, lacrimal bone, floor of orbit, upper part of maxillary sinus and pterygoid plates.> This fracture has some features common with the zygomatic fractures.> Le Fort III (craniofacial dysfunction): There is complete separation of facial bones from the cranial bones. The fracture line passes through root of nose, ethmofrontal junction, superior orbital fissure, lateral wall of orbit, frontozygomatic and temporozygomatic sutures and the upper part of pterygoid plates.> Mandibular fractures are not a part of Le Fort classification.


Question: Laryngitis sicca is associated with

It is characterized by atrophy of laryngeal mucosa and crust formation. This condition is often seen in women and is associated with atrophic rhinitis and pharyngitis. Common symptoms include hoarseness of voice which temporarily improves on coughing and removal of crusts. Dry irritating cough and sometimes dyspnoea is due to obstructing crusts. Examination shows atrophic mucosa covered with foulsmelling crusts. When crusts have been expelled, the mucosa may show excoriation and bleeding. Crusting may also be seen in the trachea. Treatment is the elimination of the causative factor and humidification. Laryngeal sprays with glucose in glycerine or oil of pine are comfoing and help to loosen the crusts. Associated nasal and pharyngeal conditions will require attention. Expectorants containing ammonium chloride or iodides also help to loosen the crusts. Ref: PL Dhingra 7th edition of Ear, Nose and Throat; Pg no 331


Question: A patients hears better in noisy surrounding known as

A. i.e. (Paracusis) (87- Dhingra 4th) (120 - Maqbool 11th)* Paracusis willisii - an otosclerotic (otospongiosis patients hears better in noisy than quite surroundings* In cochlear lesions patients do not hear at conversational intensity but get irritated by loud sound - RECRUITMENT* Sociacusis - is the hearing impairment because of recreative places like pop music, snow mobiles and carraces etcHyperacusis (Phonophobia) - sounds appears as uncomfortably loud to the patients cause -(i) Stapedius muscle paralysis as after suprastaedial facial nerve paralysis(ii) Congenital syphilis (Hennebert's sign**)PRESBYACUSIS (Senile deafness) - Sensorineural hearing loss associated with physiological aging process in the ear is called presbycusis.* Young man whose voice has not broken is called Puberphonia* White noise - consist of a random mixture of all frequencies


Question: Most common nerve damaged in CSOM is

The facial nerve is most commonly damaged in CSOM because it traverses through the middle ear.Ref: Hazarika; 3rd ed; Pg 164


Question: Orbital apex syndrome involves

Orbital apex syndrome is a complication of a paranasal sinus infection. Superior orbital fissure syndrome along with the involvement of maxillary division of trigeminal nerve and optic nerve is known as orbital apex syndrome. In superior orbital fissure syndrome, there is progressive paralysis of abducent, oculomotor and trochlear nerves. Ref: Diseases of ENT by Dhingra 6th edition Pgno : 200


Question: WEBER'S test in otitis media will be

Otitis media causes conductive hearing lossWeber's testLateralized to poorer ear-conductive hearing lossLateralized to better ear-SNHLNo lateralization - NormalRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 24


Question: Causative organism for malignant otitis externa is

Malignant/necrotizing otitis externa is a disorder involving inflammation and damage of the bones and cailage at the base of the skull. Malignant otitis externa is caused by the spread of an outer ear infection (otitis externa, also called swimmer's ear). It is an uncommon complication of both acute swimmer's ear and chronic swimmer's ear. Risks for this condition include: Chemotherapy Diabetes Weakened immune system External otitis is often caused by difficult-to-treat bacteria such as pseudomonas. The infection spreads from the floor of the ear canal to the nearby tissues and into the bones at the base of the skull. The infection and inflammation may damage or destroy the bones. The infection may spread more and affect the cranial nerves, brain, or other pas of the body.


Question: Not a contra indication for Tonsillectomy


Question: Type 'C' tympanogram is seen in


Question: Most common nerve to be damaged in CSOM is

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: Pneumatocele is seen in fracture of

Pneumatocele is a rare complication following head trauma. The pathophysiology is access of air into the cranium through a fracture involving air sinuses or middle ear roof or depressed fracture of the skull resulting in a craniodental fistula. Frontal bone fracture gives direct access to the cranium.


Question: A patient has carcinoma of right tongue on its lateral border of anterior 2/3rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is

Carcinoma Oral Tongue: Ref:- Dhingra; pg num:-228


Question: Most common type of hearing loss in TB otitis media

Ans. (a) Conductive hearing lossRef: Dhingra's ENT 5th ed. / 83Clinical features of Tubercular otitis media:# Painless foul smelling ear discharge: very characteristic finding.# Perforation: multiple perforations usually 2-3 on pars tensa is classical sign of disease.# Hearing loss: There is a severe hearing loss , out of proportion to symptoms . Mostly conductive, it may be SNHL if labyrinth is involved.# Facial paralysis* In the presence of secondary pyogenic infection, tubercular otitis media may be indistinguishable from chronic suppurative otitis media. Culture of ear discharge for tubercle bacilli, histopathological examination of granulations and other evidence of tuberculosis in the body help to confirm the diagnosis.Treatment# Systemic antitubercular therapy as being carried for primary focus.# Local treatment in the form of aural toilet and control of secondary pyogenic infection. Mastoid surgery is indicated for complications. Healing is delayed in tuberculous cases. Wound break-down and fistula formation are common.


Question: Lines of Sebileau pass through

Lederman's classification of carcinoma of the maxillary sinus is using two lines of Sebileau, one passing through the floor of maxillary antrum the other through the roof of antrum or floor of orbit dividing area into Supra structure, Mesostructure and Intra structure. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 233)

Floor of nasal cavity and maxillary antrum