Question: Treatment of nasopharyngeal carcinoma stage T1 is

Radiotherapy is the treatment of choice for nasopharyngeal cancer. Stage I and II are treated by radiotherapy alone while stage III and IV require concomitant radiation and chemotherapy or radiation followed by chemotherapy. External beam radiation of 6000-7000 cGy can be delivered by the linear accelerator to the primary and both sides of the neck. More advanced techniques of radiotherapy such as three-dimensional conformal radiotherapy and intensity modulated radiotherapy (IM) are now being used more and more. They allow higher dose delivery to the tumour with reduced damage to the adjacent normal structures such as spinal cord, brainstem and parotid glands. IM has also been used for a recurrent disease where conventional radiotherapy produces more serious side effects such as transverse myelitis (Ref: Diseases of Ear, Nose and Throat, P.L Dhingra, 7th edition, page 285)


Question: An electrode of a cochlear implant is placed in

Pas of the implant: External pa- Microphone, Speech processor, and Transmitter coilInternal pa- Receiver stimulator, Electrode arrayThe electrode array is inseed into the scala tympani by widening the round window (Cochleostomy)Ref: Hazarika; 3rd ed; Pg: 87


Question: 60 years old man with foul breath, Regurgitates food eaten 3 days ago, the likely diagnosis

Loss of tone of upper esophageal sphincter


Question: "Facial palsy' in Herpes Zoster infection is seen in

(A) Ramsay Hunt syndrome # Herpes zoster oticus (HZ oticus) is a viral infection of the inner, middle, and external ear. HZ oticus manifests as severe otalgia and associated cutaneous vesicular eruption, usually of the external canal and pinna.> When associated with facial paralysis, the infection is called Ramsay Hunt syndrome.> Pathophysiology: Reactivation of the varicella-zoster virus (VZV) along the distribution of the sensory nerves innervating the ear, which usually includes the geniculate ganglion, is responsible for HZ oticus. Associated symptoms such as hearing loss and vertigo are thought to occur as a result of transmission of the virus via direct proximity of cranial nerve (CN) VIII to CN VII at the cerebellopontine angle or via vasa vasorum that travel from CN VII to other nearby cranial nerves.> If diagnosis of Ramsay Hunt syndrome is not established by physical examination alone, consider a head CT scan to investigate other etiologies of facial paralysis.> Early administration (<72 h) of acyclovir showed an increased rate of facial nerve function recovery and prevented further nerve degeneration. Evidence is accumulating that VZV may be responsible for many cases of Bell palsy that go unrecognized because of a lack of cutaneous findings (zoster sine herpete).> Accordingly, the clinician should entertain more liberal use of antivirals such as acyclovir, valacyclovir, and famciclovir. Systemic corticosteroids are used to relieve acute pain, decrease vertigo, and limit the occurrence of postherpetic neuralgia, although evidence proving benefit attributed specifically to steroids is still limited.


Question: Not used in the treatment of Juvenile Larynegeal papillomatosis


Question: Caldwell view is done for

Caldwell view is the occipito frontal view. The frontal sinuses are seen clearly in this view.


Question: Nasopharyngeal angiofibroma of stage II is treated with


Question: Superior margin of infants larynx as at the level of


Question: Preferred treatment in a 60years old patient with Maxillary carcinoma involving anterolateral pa of maxilla is

Treatment of maxillary carcinomas: Early cases with Stage I and II squamous cell carcinomas are treated with surgery or radiation with equal results. T3 and T4 lesions are treated by combined modalities of radiation and surgery. Radiation in such cases may be given preoperatively or postoperatively Ref: Dhingra 7e pg 233.

Total/extended Maxillectomy followed by radiotherapy

Radiotherapy followed by total/extened maxillectomy


Question: Tobey Ayer test is positive in

Tobey Ayer test is positive in lateral sinus thrombosis. Tobey-Ayer test: This is to record CSF pressure by the manometer and to see the effect of manual compression of one or both jugular veins. Compression of a vein on the thrombosed side produces no effect while compression of a vein on the healthy side produces a rapid rise in CSF pressure which will be equal to bilateral compression of jugular veins. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 93)


Question: Cartilaginous part of the external auditory canal is

Lateral one-third (8mm) of the total external auditory canal (24mm) is cartilaginous.


Question: External auditory canal exostosis occurs due to

Exostoses are multiple and bilateral, often presenting as smooth, sessile, bony swellings in the deeper pa of the meatus near the tympanic membrane.They often arise from the compact bone. Exostoses is often seen in persons exposed to the entry of cold water in the meatus as in swimmers and divers. Reference: Diseases of Ear, Nose and Throat, PL Dhingra, 7th edition, pg no. 118


Question: VEMP detects lesion of

The vestibular evoked myogenic potential (VEMP) are sho latency electromyograms that are evoked by acoustic stimuli of high intensity and recorded from surface electrodes over the tonically contracted sternocleidomastoid muscle. The origin of VEMP is in the saccule. The response pathway consists of Saccule; Inferior Vestibular Nerve, Lateral Vestibular Nucleus, Lateral Vestibulospinal Tract and Sternocleidomastoid muscle.The test provides diagnostic information about saccular and/or inferior vestibular nerve function. An intact middle ear is required for the response quality.Ref: Hazarika; 3rd edition


Question: CSOM with Picket fence fever is seen in

Sigmoid sinus thrombosis/lateral sinus thrombosis is an inflammation of inner wall of lateral venous sinus with formation of an intra sinus thrombus It occurs as a complication of chronic suppuration of middle ear or acute coalescent mastoiditis, and cholesteatoma Picket fence fever temperature never comes back to normal baseline. Remittent fever. Complications of CSOM - Intra temporal Intracranial Mastoiditis Meningitis - m/c Petrositis Brain abscess Facial paralysis Extradural abscess Labyrinthitis Subdural abscess Lateral sinus thrombophlebitis Otitic hydrocephalus


Question: Bed of tonsil is formed by

The tonsillar bed is formed by the following: Pharyngobasilar fascia Superior constrictor muscle Buccopharyngeal fascia Styloglossus muscle Glossopharyngeal nerve Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 291


Question: The most common benign tumor of the salivary gland is

PLEOMORPHIC ADENOMA It is the most common benign tumour of salivary glands. It can arise from the parotid, submandibular or other minor salivary glands. In the parotid it usually arises from its tail. Pleomorphic adenomas are slow-growing tumours. They are usually seen in the third or fouh decade, with propensity for females. They are called "mixed tumours" because both epithelial and mesenchymal elements are seen in histology. The stroma of the tumour may be mucoid, fibroid, vascular, myxochondroid or chondroid and its propoion to the epithelial element may vary. Though tumour is encapsulated, it sends pseudopods into the surrounding gland which are left behind if the tumour is simply shelled out. It is therefore essential that surgical excision of the tumour should include normal gland tissue around it. In the parotid, it amounts to superficial parotidectomy. Ref:- Dhingra; pg num:-234


Question: Type of tympanogram seen in thick tympanic membrane condition is

TypeConditionType ANormal tympanogramType AsCompliance is lower at or near ambient air pressure. Seen in fixation of ossicles, e.g. otosclerosis or malleus fixationType ADHigh compliance at or near ambient pressure.Seen in the ossicular discontinuity or thin and lax tympanic membraneType BA flat or dome-shaped graph. No change in compliance with pressure changes. Seen in middle ear fluid or thick tympanic membraneType CMaximum compliance occurs with negative pressure in excess of 100 mm H2O. Seen in a retracted tympanic membrane and may show some fluid in the middle earRef: Dhingra; 6th edition; Chapter 4; Page no: 24


Question: Commonest postoperative complication of tonsillectomy is

Commonest postoperative complication of tonsillectomy is haemorrhage Haemorrhage may be primary, secondary and reactionary haemorrhage Primary haemorrhage occurs at the time of operation Reactionary haemorrhage occurs within a period of 24 hrs Secondary haemorrhage occurs 5-10th postoperative day Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition; Pg no: 430


Question: Not a surgical landmark for parotid surgery is

surgical landmark of parotid surgery are : Tragal pointer Digastric posterior belly Styloid process tympansmastoid suture ref : hazarika 4th ed


Question: Peritonsillar abscess is most commonly caused by

Peritonsillar abscess ( Quinsy) is the collection of pus in the peritonsillar space which lies between the capsule of tonsil and superior constrictor muscle. A peritonsillar abscess usually follows acute tonsillitis. First crystal Magna is infected and sealed off. Culture of pus from the abscess May reveal beta-hemolytic streptococci, S.aureus, or anaerobic organisms. (Ref: Diseases of ENT, PL Dhingra, 7th edition, pg no.298)


Question: Following operations are done in case of otosclerosisa) Stapedectomyb) Fenestration c) Stapedotomyd) Sacculotomye) Mastoidectomy


Question: A young patient with a headache, epiphora, bilateral nasal obstruction but no fever. Diagnosis is

CLINICAL FEATURES 1. Age and sex. Tumour is seen almost exclusively in males in the age group of 10-20 years. Rarely, it may be seen in older people and females. 2. Profuse, recurrent and spontaneous epistaxis. This is the most common presentation. The patient may be markedly anaemic due to repeated blood loss. 3. Progressive nasal obstruction and denasal speech. It is due to the mass in the postnasal space. 4. Conductive hearing loss and otitis media with effusion. It occurs due to obstruction of the eustachian tube. 5. Mass in the nasopharynx. Tumour is sessile, lobulated or smooth and obstructs one or both choanae. It is pink or purplish in colour. Consistency is firm but digital palpation should never be done until at the time of operation. 6. Other clinical features like broadening of the nasal bridge, proptosis, swelling of the cheek, infratemporal fossa or involvement of IInd, IIIrd, IVth and VIth cranial nerves will depend on the extent of the tumour (Ref: Diseases of Ear, Nose and Throat, P.L Dhingra, 7th edition, page 279 )


Question: Odiosoft rhino is a method used for

Odiosoft rhino is an equipment used to measure the sound produced by nasal airflow. Measurement of nasal air flow sounds helps us to indirectly assess the presence/absence of nasal block as well as accurately identifying the site of the block. Ref:

Detecting nasal mucosal secretory function


Question: Cawheel sign is seen in

Cawheel appearance is seen in ASOM. Leash of blood vessels appears along the handle of malleus and at the periphery of tympanic membrane impaing it a ca-wheel appearance. Later, whole of tympanic membrane including pars flaccida becomes uniformly red. Seen in stage of Presuppuration Reference: Dhingra; Chapter 10; Page no: 62


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

In Sensorineural deafness: Lateralized to better ear.
In conductive deafness: Lateralized to worse ear.


Question: Esthesio Neuroblastoma is tumour arising from


Question: Most common presentation in nasopharyngeal carcinoma

NASOPHARYNGEAL CANCER CLINICAL FEATURES:- Cervical nodal metastases:- This may be the only manifestation of nasopharyngeal cancer. A lump of nodes is found between the angle of jaw and the mastoid and some nodes along the spinal accessory in the posterior triangle of neck. Nodal metastases are seen in 75% of the patients, when first seen, about half of them with bilateral nodes. Ref:- Dhingra; pg num:-252


Question: Most common cause of acute epiglottitis is

It is an acute inflammatory condition confined to supraglottic structures i.e, epiglottis, aryepiglottic folds and arytenoids. There is marked oedema of these structures which may obstruct the airway. Aetiology It is a serious condition and affects children of 2-7 years of age but can also affect adults. Haemophilus influenzae B is the most common organism responsible for this condition in children. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 327)


Question: Internal Acoustic Meatus connects Inner Ear to


Question: Absorption of one of the following can occur without being broken down

Absorption of undigested protein can occur, especially in infants. This decreases with age. However, adults can still absorb undigested protein. The M cells (microfold cells) overlying the Payer's patches absorb antigens.

Triglycerides, although this seen only in infants


Question: Keratosis obturans is

Keratosis obturans is a collection of the pearly white mass of desquamated epithelial cells in the deep meatus. This, by its pressure effect, causes absorption of bone leading to widening of the meatus so much so that facial nerve may be exposed and paralyzed. Presenting symptoms may be a pain in the ear, hearing loss, tinnitus and sometimes ear discharge. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 58)

Desquamated epithelial cells and Cholesterol

Cholesterol crystals surrounded by calcium


Question: Weber's test lateralizing to the affected side means

Weber'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: Gutzmann&;s pressure test is done for

PUBERPHONIA (MUTATIONAL FALSETTO VOICE) 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 puberphonia. It is seen in boys who are emotionally immature, feel insecure and show excessive fixation to their mother. Psychologically, they shun to assume male responsibilities though their physical and sexual development is normal. Treatment:- Treatment is training the body to produce low-pitched voice. Pressing the thyroid prominence in a backward and downward direction relaxes the overstretched cords and low tone voice can be produced (Gutzmann's pressure test). The patient pressing on his larynx learns to produce low tone voice and then trains himself to produce syllables, words and numbers. Prognosis is good. Ref:- Dhingra; pg num:-314


Question: Diagnosis in a ten year old boy with recurrent epistaxis and a unilateral nasal mass is

Nasopharyngeal fibroma/Juvenile nasopharyngeal angiofibroma is a major cause for recurrent epistaxis in adolescent males. It is testosterone dependent. Benign tumour but locally invasive Ref - PL DHINGRA diseases of ear nose and throat, 6th edition


Question: The usual location of glomus jugulare tumour is

Glomus jugulare tumour arises from the dome of jugular bulb and invades hypotympanum and jugular foramen causing neurological signs of IX and XII cranial nerve involvement. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 121


Question: Most common cause of parapharyngeal abscess is

Infection of tonsillar fossa leads to the parapharyngeal abscess as a delayed complication of tonsillectomy. Infection of parapharyngeal space can occur from teeth, ear and other spaces like parotid and retropharyngeal spaces. In spite of it being the smallest space in relation to the pharynx, it is the most commonly infected space of the pharynx as infections from tonsil(most commonly), dental, parotid, retropharyngeal, preveebral and submandibular space can all lead to parapharyngeal abscess. (Ref: Scott Brown, 8th edition, VOL 3, Pg no. 551)


Question: Incisura terminals are between

There is no cailage between tragus and crus of the helix and an incision made in this area will not cut through the cailage and is used for the endaural approach in surgery of external auditory canal and mastoid. Reference: Dhingra 6th edition; page no 2


Question: In a child with hyperophied adenoids, the voice abnormality that is seen is

HYPONASALITY (RHINOLALIA CLAUSA) It is lack of nasal resonance for words which are resonated in the nasal cavity, e.g. m, n, ng. It is due to blockage of the nose or nasopharynx. Ref:- Dhingra; pg num:-315


Question: Antral sign is seen in

Anterior bowing of the posterior wall of maxillary sinus often called antral sign or Holman-Miller sign, which is pathognomic of angiofibroma. (Ref: Diseases of ear, nose and throat, PL Dhingra, 7th edition, page 281)


Question: The cadaveric position of vocal cords is

Positions of the vocal cord: 1. Median- cords touching the midline 2. Paramedian-1.5 mm from the midline 3. Intermediate (Cadaveric)- 3.5 mm from the midline 4. Slightly abducted- 7 mm 5. Fully abducted- 9 mm. Ref: Hazarika; 3rd ed; Pg 626


Question: Haplike's test is done for


Question: Recent studies suggest causative organism of Bells palsy is

(Herpes virus): (105- Dhingra 5th edition; 185- P. Hazarika 3rd/ed)Bell's palsyViral theory - Most of the evidence support the viral aetiology due to herpes simplex herpes zoster or the EB virus (105-D)* Viral infection like Herpes zoster, poliomyelitis and infectious mononucleosis which proves that facial nerve is very prone for viral infections (185- Hazarika)* Herpes simplex virus (HSV-1) has been known to cause fascial paralysisBell's phenomenon - The patient will not be able to close the eye on the affected side. The eyeball will roll up on every attempt of closure


Question: In the right middle ear pathology, Weber&;s test will be

Weber test: In this test, a vibrating tuning fork is placed in the middle of the forehead or the veex and the patient is asked in which ear the sound is heard. Normally, it is heard equally in both ears. It is lateralized to the worse ear in conductive deafness and to the better ear in sensorineural deafness. In weber test, sound travels directly to the cochlea bone. Lateralization of sound in weber test with a tuning fork of 512 Hz implies a conductive loss of 15-25 dB in ipsilateral ear or a sensorineural loss in the contralateral ear. Ref:- Dhingra; pg num:-22


Question: Decompression of endolymphatic sac is the treatment for

(A) (Meniere's disease) (104- Dhingra 6th)Surgical Treatment of Meniere's Disease1. Conservative procedures2. Destructive procedures3. IntermittentA. Decompression of Endolymphatic sacB. Endolymphatic shunt operationC. Sacculotomy (fick's operation)D. Section of vestibular nerveE. Ultrasonic destruction of vestibular labyrinthLabyrinthectomyLow pressure pulse therapy (Meniett device therapy)Meniere's Disease TreatmentA. GENERAL MEASURESB. MANAGEMENT OF ACUTE ATTACK1. Reasurance2. Cessation of smoking3. Low salt diet4. Avoid excessive intake of water5. Avoid over- indulgence in coffee, tea and alcohol6. Avoid stress and bring a change in life cycle7. Avoid activities requiring good body balance1. Reassurance - to allay worry and anxiety2. Bed rest with head supported on pillows3. Vestibular sedatives to relieve vertigo* Dimenhydrinate (Dramamine)* Promethazine theoclate (Avomine)* Prochlorperazine (stemetil)* Diazepam given intravenously* Atropine4. VasodilatorsA. Inhalation of carbogen (5% C02 with 95% O2)B. Histamine drip - Histamine diphosphate 2.75 mg dissolved in 500 ml of glucoseC. MANAGEMENT OF CHRONIC PHASE1. Vestibular sedative- prochlorperazine2. Vasodilators- Nicotinic acid, Betahistine3. Diuretics - furosemides4. Propantheline bromide - alone or combination with vasodilators or vestibular sedatives5. Elimination of allergen- food or inhalant allergen6. Hormones - endocrinal disorders such as hypothyroidism- Medical treatment* Intratympanic Gentamicin therapy (chemical Labyrinthectomy)* MICRO WICK - made up of polyvinyl acetate


Question: Epistaxis in elderly patient is commonest in

The major cause for epistaxis in an elderly person is hypeension. Ref: Dhingra 7e pg 198.


Question: Lombard&;s test is used in diagnosis of

Lombard&;s test: This test is based on "Lombard&;s principle". This principle says that one raises his / her voice when speaking in the noisy environment. While performing this test, the patient is allowed to read a book. Noise is introduced into the ear. The noise is gradually increased till the patient raises his / her voice or stops the process of reading. If there is no change in voice loudness level the patient does not have a functional hearing defect.


Question: In Bell's palsy, neurological lesion is seen in

C/f of Bell's Palsy : Onset is sudden. Patient is unable to close his eye. Neurological lesion is seen in Upper and lower pa of one half of face On attempting to close the eye, eyeball turns up and out (Bell's phenomenon). Saliva dribbles from the angle of mouth. Face becomes asymmetrical Tears flow down from the eye (epiphora). Pain in the ear may precede or accompany the nerve paralysis. Some complain of noise intolerance (stapedial paralysis) or loss of taste (involvement of chorda tympani). Paralysis may be complete or incomplete. Bell's palsy is recurrent in 3-10% of patients.

Upper and lower pa of opposite side of face


Question: Thornwaldt's abscess treatment does not include

Treatment includes- Antibiotics to treat infection Marsupialization of cystic swelling Adequate removal of its lining membrane Ref: Textbook of ENT, Dhingra; 6th edition; Pg no: 245 ref img


Question: Focal length of head mirror used in ENT OPD

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: Ohngren's line is seen in

A theoretic plane passing between the medial canthus of the eye and the angle of the mandible; used as an arbitrary dividing line in classifying localized tumours of the maxillary sinus; tumours above the line invade vital structures early and have a poorer prognosis, whereas those below the line have a more ourable prognosis. Growths of the maxillary sinus(carcinoma of maxillary sinus) situated above this plane(suprastructural) have a poorer prognosis than those below it(intrastructural). (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 233)


Question: During Acute tonsillitis referred pain from tonsil to the middle ear is along

Tonsils and tonsillar fossa are supplied by the glossopharyngeal nerve Any irritation or pain can be referred to the ear along the tympanic branch of the glossopharyngeal (Jacobson's) nerve.


Question: The best time of hearing assessment in an infant is

The American Academy of Pediatrics (AAP), Joint Committee on Infant hearing (2007), has recommended that all newborn infants be screened for hearing impairment either as a neonate or before 1 month of age and that those infants who fail newborn screening should have an audiological examination to verify hearing loss before age of 3 months.Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 132


Question: Loudness recruitment phenomenon is associated with

Ans. d (Cochlear deafness) (Ref. Dhingra 3rd ed., 4, 49; 29, 148)The rapid growth of loudness in ears with sensorineural hearing loss is known as loudness recruitment. Its presence helps signify that the hearing loss is caused by pathology within the cochlea. Recruitment is a symptom of cochlear pathology associated with hair cell damage, particularly to outer hair cells.ASSESSMENT OF HEARING LOSS1. Clinical testsa. Finger friction testb. Watch testc. Speech testd. Tuning fork tests2. Audiometric testsa. Pure tone audiometry (measures threshold of hearing by air and bone conduction and thus the degree and type of hearing loss)b. Speech audiometry (measures ability of patient to hear and understand speech)c. Bekesy audiometry (differentiates cochlear from retrocochlear and organic from functional hearing loss)d. Impedance audiometry, i.e., tympanometry and acoustic reflex measurements (particularly useful in children).3. Special testsa. Recruitment (seen typically in lesions of cochlea, e.g., Meniere's disease, presbycusis)b. Short increment sensitivity index (SISI test)c. Threshold tone decay (Carhart's) test (a decay more than 25dB is diagnostic of a retrocochlear lesion)d. Evoked response audiometry (e.g., BERA)e. Otoacoustic emissionsf. Central auditory testsAcoustic Reflex# Loud sound > 70 dB; causes bilateral contraction of stapedial muscles which can be detected by tympanometry.# Reflex mediated by VII and VIII nerves.# It is protective reflex against loud sound.# Normally, stapedial reflex is elicited at 70-100 dB SL. If patient claims total deafness but the reflex can be elicited, it indicates NOHL (non-organic hearing loss). Hyperacusis in Bell's palsy is due to the paralysis of the stapedius muscle.# Uses:1. Objective method to detect hearing in infants and children.2. To find malingering3. To detect cochlear pathology. Presence of Stapedial reflex at lower frequencies, instead of 70 dB indicates Recruitment and cochlear pathology.4. To detect VIII and VII nerve lesions.


Question: A chronic smoker with history of hoarseness of voice found to have fixation of vocal cords on examination. The most likely treatment he will require is

Fixation of vocal cords on examination is T3 lesion.Total laryngectomy. The entire larynx including the hyoid bone, pre-epiglottic space, strap muscles and one or more rings of trachea are removed. Pharyngeal wallis repaired and lower tracheal stump sutured to the skin for breathing. Laryngectomy may be combined with block dissection for nodal metastasis.Total laryngectomy is indicated in the following conditions:(i) T3 lesions (i.e. with cord fixed)(ii) All T4 lesions(iii) Invasion of thyroid or cricoid cailage(iv) Bilateral arytenoid cailage involvement(v) Lesions of posterior commissure(vi) Failure after radiotherapy or conservation surgery(vii) Transglottic cancers, i.e. tumours involving supraglottis and glottis acrossDhingra 6e pg: 310


Question: Bell's palsy is

B. i.e. (Ipsilateral LMN paralysis) (4- Dhingra 4th) (104 - Maqbool 11th)* BELL'S PALSY - Idiopathic infranuclear lesion of the facial nerve more common in diabetic (angiopathy) and pregnant women (retension of fluid)* BELL'S PHENOMENON - up and out rolling of the eyeball during forceful closure**Clinical presentation - LMN paralysis** patients is unable to close eye, saliva dribbles from the angle of mouth, face become asymmetrical, Tears flow down from the eye (epithora) stapedial reflex or loss of taste* Epiphora in bell's palsy is due to - lacrimal pump failure*** Melkersson's syndrome - Triad - Facial paralysis, swelling of lips, and fissured tongue* Recurrent facial palsy - causes - Melkersson's syndrome DM, sarcoidosis and tumoursPoor prognostic indicators - advanced age, hyperacusis, severe initial painBilateal facial paralysis - seen in GB syndrome sarcoidosis, sickle cell disease, acute leukemia, bulbar palsy, leprosy and sother systemic disorders.Supra nuclear (central) palsv primarily involves the lower part of face and emotional responses may be intact (eg- the patients not be able to show you his teeth but will smile to a Joke. Nuclear palsv affects all ipsilateral muscles of facial expression resulting in paralysis of the ipsilateral side (eg. mouth is pulled to the normal side and may droop on the affected side facial crease are effaced, eyelid may not close).

Hemiparesis with contralateral facial nerve palsy

Contralateral upper motor neuron lesions


Question: Infection of CNS spreads to the inner ear through

The scale tympani is closed by a secondary tympanic membrane. It is also connected with subarachnoid space through aqueduct of the cochlea


Question: In carcinoma of lower lip secondaries are seen in

Carcinoma Lip: Mostly, it is squamous cell carcinoma, often seen in males in the age group of 40-70 years. Lower lip is more often involved. Site of predilection is between the midline and commissure of the lip. Lesion is of exophytic or ulcerative type. Lymph node metastases develop late. Submental and submandibular nodes are the first to be involved; other deep cervical nodes may also get involved later. Treatment: It is surgical excision with adequate safety margin of healthy tissue and plastic repair of the defect. Lymph node metastases require block dissection. Radiotherapy also gives good results in early cases. Ref:- Dhingra; pg num:-226


Question: CSF rhinorrhea is most commonly seen in fracture of

CSF rhinorrhea occurs when there is a communication between the intracranial (intradural) and nasal cavities. CSF, rhinorrhea indicates a basal tear of dura mater along with a fracture involving the paranasal sinuses, frontal, ethmoid, or sphenoid bone. Cribriform plate of the ethmoid bone separates the anterior cranial fossa from the nasal cavity and is the most common site of fracture in CSF rhinorrhea because it is extremely thin. The cerebrospinal fluid has high glucose content, makes a dry hanky stiff, and if mixed with blood it classically produces a halo effect on the white bedclothes. Patients of CSF rhinorrhea are at increased risk of meningitis paicularly pneumococcal. The patient should be given prophylactic antibiotic (penicillin) followed by X-ray. Fractures of the middle 1/3rd of the face should be reduced and most of the times CSF rhinorrhea stops. Indications for anterior fossa explorations are the persistence of CSF rhinorrhea for> 10 days; the presence of a fracture involving the frontal or ethmoidal sinus; aerocele; an attack of meningitis that has been treated. Ref : Diseases of ENT by Dhingra 6th edition Pgno : 163-165


Question: Treatment of choice in nasopharyngeal carcinoma.

Radiotherapy: It is the treatment of choice for nasopharyngeal cancer. Stage I and II are treated by radiotherapy alone while Stage III and IV require concomitant radiation and chemotherapy or radiation followed by chemotherapy.


Question: Nerve involved in hyperacusis

Paralysis of stapedius muscle which is supplied by 7th cranial nerve causes hyperacusis or phonophobia Ref: Dhingra 7e pg 510.


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

FISCH classification is used for glomus tumours based on the extension into surrounding anatomic structures. Type A tumour - Tumour limited to the middle ear cleft (glomus tympanicum) Type B tumour - Tumour limited to the tympanomastoid area with no infralabyrinthine compament involvement Type C tumour - Tumour involving the infralabyrinthine compament of the temporal bone and extending into the petrous apex; Type C1 tumour - Tumor with limited involvement of the veical poion of the carotid canal; Type C2 tumour - Tumour invading the veical poion of the carotid canal; Type C3 tumour - Tumour invasion of the horizontal poion of the carotid canal Type D1 tumour - Tumour with an intracranial extension less than 2 cm in diameter; Type D2 tumour - Tumour with an intracranial extension greater than 2 cm in diameter


Question: Heimlich&;s maneuver is used in

Heimlich maneuverAbdominal thrusts also called the Heimlich maneuver, is a first aid procedure used to treat upper airway obstruction (or choking) by foreign objects. The Heimlich maneuver is named after Dr. Henry Heimlich, who first described it in 1974.Ref: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 367

Upper airway obstruction by foreign body


Question: High tracheotomy is done in

Only indication for high tracheostomy - Laryngeal carcinoma.


Question: In the Nodal "N" staging of laryngeal carcinoma, extranodal invasion is indicated by


Question: The preferred treatment of verrucouse carcinoma of the larynx is

Verrucous Carcinoma 1) Verrcous carcinoma makes up only 1-2% of laryngeal carcinomas. 2) The larynx is the second most common site of occurence in the head and neck after the oral cavity. 3) Most common site of involvement is vocal cord. 4) Grossly, verrucous carcinoma appears as a fungating, papillomatous, grayish white neoplasm. 5) Microscopically, it is well differentiated squamous cell carcinoma with minimal cytological atypia. 6) It has low metastatic potential . 7) Hoarseness is the most common presented symptom. Pain and dysphagia may occur but are less common. 8) Treatment of most verrucous tumors is primary surgery. Endoscopic laser surgery is appropriate as the tumor is less aggressive than usual squamous cell carcinoma. Ref:- Current otolaryngology; pg num:- 444


Question: Pinna develops from

Pinna

It develops from both 1st and 2nd brachial arches
Period of development starts from 4–6 weeks and adult configuration is attained by 20th week
From the


Question: Attenuation reflex is lost in case of

It is based on the fact that a loud sound, 70-100 dB above the threshold of hearing of a paicular ear, causes bilateral contraction of the stapedial muscles which can be detected by tympanometry. Stapedial reflex is elicited with a sound of 70-100 dB SL Absence of Stapedial reflex when hearing is normal indicates lesion of the facial nerve, proximal to the nerve to stapedius. Stapedial reflex becomes absent when stapes is fixed.


Question: The most common laser used in laryngeal surgery is

The LASER is an acronym for Light Amplification by Stimulated Emission of RadiationDepending upon the lasing medium, various types of lasers with differing wavelength can be created. The lasing medium can be solid (ruby, Nd: YAG or potassium titanyl phosphate); gas (CO2 or Helium-Neon) or liquid (pumped inorganic dye in a glass tube).CO2 laser: Wavelength 10,400 nm, invisible, requires an aiming beam of a helium-neon laser, cannot pass through flexible optical fibers and requires aiculated arm with a series of reflective mirrors to direct the beam to the target area.Clinically it has been used in laryngeal surgery to excise vocal nodules, polyps, cysts, granulomas or juvenile laryngeal papillomas.It cuts precisely and a spot size of 0.3 mm can be achieved; lesion is first delineated and then dissected with microlaryngeal instruments. Microflaps can be raised to treat Reinke's edema. It is also used for leukoplakia, T1 lesion of vocal cord or localized lesions of supraepiglottis and infraepiglottis. Transverse cordotomy and endoscopic paial or complete arytenoidectomy can also be done in bilateral abductor paralysis.CO2 does not penetrate into the deep tissue, hence there is decreased risk of scarring.Ref: Dhingra; 6th edition; Chapter 71; Page no: 357


Question: Most common malignancy arising in thyroglossal cyst is

Thvroglossal Cyst Contains clear to cloudy fluid with sparse cellularity. Cystic background contains few if any epithelial cells. Some inflammatory cells and crystals might be present. Rarely malignant transformation occurs in about 1% of the cases. Most common malignancy arising is papillary carcinoma followed by squamous cell carcinoma.


Question: Not a content of sphenopalatine fossa


Question: Muller's manoeuvre is used to

Muller's manoeuvre is used to find level and degree of obstruction in sleep-disordered breathing with flexible nasopharyngoscope Ref: Textbook of ENT, Dhingra; 6th edition; Pg no: 449 ref img

To find degree of obstruction in sleep disordered breathing


Question: Acute Otitis media in Children is most commonly due to

(C) Streptococcus pneumoniae # Causative Organisms of ASOM:> Most common organisms in infants and young children are Streptococcus pneumoniae (30%), Haemophilus influenzae (20%) and Moraxella catarrhalis (12%).> Other organisms include Streptococcus pyogenes, Staphylococcus aureus & sometimes Pseudomonas aeruginosa.> In about 18-20%, no growth is seen.> Many of the strains of H. influenzae & Moraxella catarrhalis are ft-lactamase producing.


Question: Acoustic reflex is lost in case of

ACOUSTIC REFLEX is the contraction of the stapedius muscle causing a change in impedance.The minimum sound intensity required to produce stapedial reflex is called stapedial reflex threshold(S). Reflexes are bilateral and can be measured on the ipsilateral and contralateral side. For ipsilateral the reflex is measured in the ear in which the tone is given while for contralateral the reflex is tested in the ear opposite to which the tone is given. Normally,the reflex occurs about 70-90 dB above the patient's threshold. ref:Hazarika 3rd edition,page no.63


Question: Menieres disease is characterized by the triad of

Meniere's disease is a disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of veigo and tinnitus and progressive hearing loss, usually in one ear. It is caused by lymphatic channel dilation, affecting the drainage of endolymph.


Question: Infection of CNS spreads in inner ear through

Ans. A Cochlear aqueductAs we know that cochlear aqueduct (Aqueduct of Cochlea) is a connection between scala tympani (containing perilymph) and the subarachnoid space (containing CSF). On occassions, paicularly in young children, the Cochlear aqueduct is large and open.Infection can spread to the inner ear from the infected CSF or vice versa, the cochlear aqueduct resulting in severe profound hearing loss (meningitic labyrinthitis).


Question: Ideal site for myringotomy and grommet inseion in serous otitis media is

In serous otitis media, a radial incision is made on the anteroinferior quadrant, in acute suppurative otitis media circumferential incision is made on the posteroinferior quadrant. Ref-ENT Dhingra textbook 6th edition, page no. 65.


Question: Fracture of mid face does not lead to

Proptosis is the forward protrusion or displacement of the eyeball. It does not occur in fracture of middle third of the face. It may occur in the fractures of the upper third of face especially fracture of the supraorbital ridge. Ref: Textbook of ENT; Dhingra; pg 181


Question: The length of the external auditory canal 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. Ref- Dhingraa textbook for ENT 6tg edition.pg- 57.


Question: Hiatus semilunaris is present in

Middle meatus: Uncinate process is a hook-like structure running in from anterosuperior to the posteroinferior direction in the middle meatus. It&;s postero superior border is sharp and runs parallel to the anterior border of bulla ethmoidalis. This gap between the two is called hiatus semilunaris .it is two-dimensional space of 1-2 mm width. (Ref: Diseases of Ear, Nose and Throat and head and neck surgery, Dhingra 7th edition, Pg no. 150)


Question: In Maxillary carcinoma of a 60 year old patient involving anterolateral pa of maxilla, the preferred treatment is

Paranasal sinus cancer is uncommon and represents only 0.2 to 0.8% of all malignancies. Cancer of paranasal sinus constitutes 3% of all carcinomas of the aerodigestive tract. The majority of paranasal sinus malignancies (50-80%) originate within the maxillary sinus antrum. Malignancies rarely occur within the other sinuses and originate in the ethmoid, frontal, and sphenoid sinuses in 10%, 1% and 1% respectively. The cause of parasinus malignancy is unknown. However several risk factors have been associated and therefore it is seen more commonly in people working in hardwood furniture industry, nickel refining, leather work, and manufacturer of mustard gas. More than 80% of the malignant tumours are of squamous cell variety. Rest are adenocarcinoma, adenoid cystic carcinoma, melanoma, and various type of sarcomas. Workers of furniture industry develop adenocarcinoma of the Ethmoids and upper nasal cavity. While those engaged in Nickel refining get squamous cell and Anaplastic carcinoma. Clinical features for maxillary carcinoma It is seen more commonly in the 7th decade of life. Males are affected more commonly than females. Early features of maxillary sinus malignancy are nasal stuffiness, blood-stained nasal discharge, facial paraesthesias or pain and epiphora. These symptoms may be missed or simply treated as sinusitis. Late features will depend on the direction of spread and extent of growth. Medial spread to nasal cavity gives rise to nasal obstruction, discharge and epistaxis. It may also spread into anterior and posterior ethmoid sinuses and that is why most antral malignancies are antroethmoidal in nature. Anterior spread causes swelling of cheeks. Inferior spread leads to expansion of alveolus with dental pain, loosening of teeth, poor fitting dentures, ulceration of gingiva. Superior spread invades the orbit causing proptosis, diplopia, ocular pain and epiphora. Posterior spread is into pterygomaxillary fossa, pterygoid plate and the pterygoid muscles causing trismus. Lymphatic spread in maxillary carcinoma is rare and occurs only in the late stages. Most commonly involved lymph node is submandibular lymph node followed by jugular nodes. Treatment of maxillary carcinoma For squamous cell carcinoma, the treatment of choice is a combination of radiotherapy and surgery. Radiotherapy can be given before or after surgery. Very often, a full course of pre-operative telecobalt therapy is given, followed 4 - 6 weeks later by surgical excision of the growth by total or extended maxillectomy.

Total/extended Maxillectomy followed by radiotherapy

Radiotherapy followed by total/extended maxillectomy


Question: Labyrinthine aery is a branch of

BLOOD SUPPLY OF LABYRINTH The entire labyrinth receives its aerial supply through labyrinthine aery, which is a branch of anterior-inferior cerebellar aery but sometimes from the basilar aery. Ref:- Dhingra; pg num:-10,11


Question: Not a surgical landmark for parotid surgery

surgical landmark of parotid surgery are : Tragal pointer Digastric posterior belly Styloid process tympansmastoid suture ref : hazarika 4th ed


Question: Apple jelly nodules on the nasal septum are found in case of

Lupus vulgaris is a low-grade tuberculous infection commonly affecting nasal vestibule or the skin of nose and face.
The skin lesions manifest characteristically as brown, gelatinous nodules called "apple -jelly" nodules.
In the vestibule, it presents as chronic vestibulitis.
Perforation may occur in the cartilaginous part of the nasal septum. Treatment is same as for tuberculosis.


Question: Ideal hearing aid for patient with anotia is

Anotia ("no ear") describes a rare, congenital deformity, that involves the complete absence of the pinna, the outer projected poion of the ear, and narrowing or absence of the ear canal. A bone-anchored hearing aid is an implantable device that allows the listener to hear by bone conduction without the inconvenience of a traditional bone conduction hearing aid. It's more comfoable, and the sound quality is better, paly because the device stays in place. Unlike a middle ear implant, which requires a normally functioning middle ear, this type of hearing aid is typically used by listeners who have conductive or mixed hearing loss. Bone conduction hearing aids have traditionally been used by people born without ear canals or with small, misshapen ears that can't suppo conventional hearing aids, or by people who have chronic middle ear disease that's aggravated by wearing a hearing aid or earmold in the ear canal (for example, people with draining ears).


Question: Postitional 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: Gutzmann pressure in pubuophonia is given


Question: Most common cause of fungal sinusitis is

Commonest cause of fungal sinusitis is Aspergillus fumigatusOther causes (Non-invasive form) - A.niger, A.flavus, CandidaNon-invasive fungal sinusitis presents as a fungal ball or allergic fungal rhinosinusitis (AFRS)Ref: Hazarika; 3rd ed; Pg 338


Question: Irvin Moore sign is positive in

Irwin-Moore sign:- Expression of cheesy material from the tonsil, on pressing anterior pillar seen in case of chronic tonsillitis. Ref:- Textbook of ENT, Hazarika; pg num:- 480


Question: Sensory supply of Larynk below vocal cord

Sensory supply larynx :

Above VC = Internal branch of superor laryngeal nerve.
Below VC = Recurent laryngael nerve.

Extereal branch of superior laryngeal nerve

Internal branch of Inferior laryngeal nerve


Question: Topical Mitomycin C is useful in treatment of

Dilation for laryngotracheal stenosis is typically done using serial dilation using various sizes of Jackson bronchoscopes. The various studies have showed that mechanical dilation used alone can have a recurrence rate of stenosis of greater than 90%. Thus, various adjunctive procedures have been developed in order to try to decrease the rate of restenosis. Mitomycin-C is an example of one of these adjunctive agents. Ref : Internet sources


Question: A 38 year old female complaining of decreased hearing in the right ear for the last two years. On testing with a 512 Hz tuning fork, the rinne's test without masking is negative on the right ear and positive on the left ear. With the weber's test, the tone is perceived as louder in the left ear. The most likely problem the patient has is

Patient is presenting with right sided deafness.Interpretation of Rinne's test in this patientRight side negative means : -i) Right sided conductive deafness.orii) Right sided severe sensorineural hearing loss which gives false negative results.Left side positive test means : -Normal left earLeft sided sensorineural hearing loss (However this is not the case in this patient as the patient is presenting with right sided hearing loss).Interpretation of Weber test in this patientWeber is lateralized to left ear. That means : -Right sided sensorineural hearing loss.Left sided conductive deafness (However, this is not the case as patient is presenting with right sided hearing loss).Thus , this patient is suffering from severe right side sensorineural hearing loss in which the Rinne's test is false negative and weber is lateralized to left ear.


Question: Goldring's criteria is used to diagnose


Question: Transverse fracture of maxilla is

Le Fo-I fracture or transverse fracture of maxilla runs above and parallel to the palate. It crosses the lower pa of nasal septum, maxillary antra and the pterygoid plates. Le Fo II fracture is a pyramidal fracture passing through the root of the nose, lacrimal bone, floor of the orbit, upper pa of the maxillary sinus and pterygoid plates. This fracture has some features common with zygomatico fractures. Le Fo III ( Craniofacial dysjunction)This is complete separation of facial bones from the cranial bones. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 207


Question: A suspected case of Dysphagia lusoria should be best investigated by

Barium swallow, bronchoscopy, or angiographies are investigations to diagnose but angiography is diagnostic. Ref : ENT textbook by Dhingra 6th edition Pgno : 447


Question: Artery that does not supply Tonsil is


Question: Otitic barotrauma results due to

Otitic barotrauma is a nonsuppurative condition resulting from the failure of the eustachian tube to maintain middle ear pressure at ambient atmospheric level. The usual cause is rapid descent during an air flight, underwater diving or compression in a pressure chamber. Reference: Diseases of Ear, Nose and Throat, PL Dhingra, Shruthi Dhingra,7th edition, pg no.71


Question: Commonest extracranial complication of CSOM

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


Question: Cauliflower ear is seen in

Hematoma of the auricle*It is the collection of blood between the auricular cailage and its perichondrium. It usually occurs due to blunt trauma and often seen in boxers, wrestlers and rugby players, therefore it is also called Boxer's ear *If hematoma gets infected severe perichondritis may set inRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 52


Question: Initial screening test for newborn hearing disorder is

OAEs are used as a screening test of hearing in neonates and to test hearing in uncooperative or mentally challenged individuals after sedation. Other uses of OAE: They help to distinguish cochlear from retrocochlear hearing loss. OAEs are absent in cochlear lesions, e.g. ototoxic sensorineural hearing loss. They detect ototoxic effects earlier than pure tone audiometry. OAEs are also useful to diagnose retrocochlear pathology, especially auditory neuropathy. Auditory neuropathy is a neurologic disorder of CN VIII. Audiometric tests, e.g. SNHL for pure tones, impaired speech discrimination score, absent or abnormal auditory brainstem response, show a retrocochlear type of lesion but OAEs are normal. Note: OAEs are absent in 50% of normal individuals Lesions of the cochlea Middle ear disorders (as sound travelling in the reverse direction cannot be picked up) and When hearing loss exceeds 30 dB Ref: Dhingra; 6th Edition; pg no 28


Question: Treatment of choice in central safe perforation is

Treatment of choice in Tubotympanic type of CSOM is tympanoplasty, which involves eradication of middle ear disease with ossiculoplasty or myringoplasty or both.Myringoplasty involves only repair of tympanic membrane perforation.Modified mastoidectomy is done along with tympanoplasty in selected cases.Ref: Hazarika; 3rd ed; Pg 154


Question: Thudichum speculum is used for visualizing

Thudichum speculum or vienna type speculum is used to visualize anterior nasal cavity (examination is called anterior rhinoscopy). Posterior nares can be visualized during posterior rhinoscopy using posterior nasal mirror.


Question: Pyramidal fracture of maxilla is

Pyramidal or Le Fo 2 fracture of maxilla passes through the root of nose, lacrimal bone, the floor of the orbit, the upper pa of the maxillary sinus and pterygoid plates. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 207


Question: Treatment of choice for T2 carcinoma of nasopharynx is

Radiotherapy is the treatment of choice for nasopharyngeal cancer. Stage I and II are treated by radiotherapy alone while stage III and IV require concomitant radiation and chemotherapy or radiation followed by chemotherapy. External beam radiation of 6000-7000 cGy can be delivered by the linear accelerator to the primary and both sides of the neck. More advanced techniques of radiotherapy such as three-dimensional conformal radiotherapy and intensity modulated radiotherapy (IM) are now being used more and more. (Ref: Diseases of Ear, Nose and Throat, P.L Dhingra, 7th edition, page 285)


Question: Complication of trauma to danger area of the face

The area of the upper lip and the low rent part of the nose is the danger area of the face. It is due to that this area is the common site of infection.
This area is drained by a facial vein which communicates with the cavernous sinus through the superior ophthalmic vein and pterygoid venous plexus through the emissary's vein,
In case of any infection of this area, it may spread to the cavernous sinus causing infection and/or thrombosis.


Question: Sense of gravity is detected by

Utricle and saccule are stimulated by displacement of the otolithic membrane during the head tilts.They are concerned with acceleration and deceleration. (Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra; 6th edition; page no.18)


Question: Paracusis Willisii is seen in

Paracusis Willisii. An otosclerotic patient hears better in noisy than in quiet surroundings. This is because a normal person will raise his voice in noisy surroundings.Ref: Dhingra; 6th edition; Chapter 13; Page no: 87


Question: Crypta magna is seen in

APPLIED ANATOMY OF PALATINE (FAUCIAL) TONSILS Medial surface of the tonsil is covered by nonkeratinizing stratified squamous epithelium which dips into the substance of tonsil in the form of crypts. Openings of 12-15 crypts can be seen on the medial surface of the tonsil. One of the crypts, situated near the upper pa of tonsil is very large and deep and is called crypta magna or intratonsillar cleft. It represents the ventral pa of second pharyngeal pouch. From the main crypts arise the secondary crypts, within the substance of tonsil. Crypts may be filled with cheesy material consisting of epithelial cells, bacteria and food debris which can be expressed by pressure over the anterior pillar. Ref:- Dhingra; pg num:-257


Question: Pott's puffy tumor is seen in

Ans. is 'b' i.e., Paranasal sinus Complications of sinusitis* Complications in properly managed sinusitis are uncommon.* Complication of sinus infection may be1) Local:- Mucocele / mucopyocele, mucous retention cyst, osteomyelitis.2) Orbital :- Periorbital cellulitis, orbital cellulitis, orbital abscess, subperiosteal abscess, cavernous sinus thrombosis, superior orbital fissure syndrome, orbital apex syndrome, edema of eye lids, retrobular neuritis with impaired vision.3) Intracranial :- Intracranial abscess (Epidural, subdural, parenchymal), meningitis, seizure, sepsis, focal neurological deficit.4) Descending infections :- Pharyngitis, laryngitis, tonsillitis, tracheobronchitis, otitis media.5) Systemic :- Toxic shock syndrome (very rare)* Osteomyelitis is more common in frontal sinusitis. Osteomyelitis of frontal bone can cause subperiosteal abscess known as Pott's puffy tumor.* Orbital cellulitis is particular^ common in ethmoid sinusitis.* Cavernous sinus thrombosis and intracranial complications are more common with sphenoid sinusitis.


Question: Keratinizing squamous cell carcinoma of nasopharynx is

WHO classification based on histopathology Present WHO terminology Former terminology Type I (25% Keratinizing carcinoma Squamous cell carcinoma Type II (12%) Nonkeratinizing differentiated carcinoma * Transitional cell carcinoma * Intermediate cell carcinoma * Lymphoepithelial carcinoma Type III (63%) Nonkeratinizing undifferentiated carcinoma * Anaplastic carcinoma * Clear cell carcinoma * Lymphoepithelial carcinoma (Schminke type is tumour with diffusely distributed malignant tissue) * Spindle cell carcinoma (Ref: Diseases of Ear, Nose and Throat, P.L Dhingra, 7th edition, page 283)


Question: The Eustachian tube is made up of

Eustachian tube Anatomy 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 fibrocailaginous, which is anteromedial, forms two-thirds (24 mm). The two pas meet at isthmus which is the narrowest pa of the tube. The fibrocailaginous pa of the tube is made of a single piece of cailage folded upon itself in such a way that it forms the whole of medial lamina, roof and a pa of the lateral lamina; the rest of its lateral Lamina is made of fibrous membrane. The tympanic end of the tube is bony, measures 5 x 2 mm and is situated in the anterior wall of middle ear, a little above the level of floor. The pharyngeal end of the tube is slit-like, veically. The cailage at this end raises an elevation called torus tubarius, which is situated in the lateral wall of the nasopharynx, 1-1.25 cm behind the posterior end of inferior turbinate. Ref : ENT textbook by Dhingra 6th edition Pgno : 57,58


Question: Not a differential Diagnosis for grey white membrane on Tonsil


Question: Paralysis of 3rd, 4th & 6th nerves with involvement of ophthalmic division of 5th nerve, localizes the lesion to

CAVERNOUS SINUS THROMBOSIS Aetiology Infection of paranasal sinuses, paicularly those of ethmoid and sphenoid and less commonly the frontal, and orbital complications from these sinus infections can cause thrombophlebitis of the cavernous sinus(es).The valveless nature of the veins connecting the cavernous sinus causes easy spread of infection. Clinical features Onset of cavernous sinus thrombophlebitis is abrupt with chills and rigors. Patient is acutely ill. Eyelids get swollen with chemosis and proptosis of eyeball. Cranial nerves III, IV and VI which are related to the sinus get involved individually and sequentially causing total ophthalmoplegia. Pupil becomes dilated and fixed, optic disc shows congestion and oedema with diminution of vision. Sensation in the distribution of V1 (ophthalmic division of CN V) is diminished. CSF is usually normal. Condition needs to be differentiated from orbital cellulitis. CT scan is useful for this. Treatment. It consists of i.v. antibiotics and attention to the focus of infection, drainage of infected ethmoid or sphenoid sinus. Blood culture should be taken before staing antibiotic therapy. Role of anticoagulants is not clear. Ref : ENT textbook by Dhingra 6th edition Pgno : 201


Question: In pure tone audiogram the symbol X is used to mark

No change in air conduction in right ear


Question: Prerequisite for Endoscopic sinus surgery

Recent research on inflammatory sinus disease has implicated a central role for the ethmoid labyrinth, which may influence changes in the maxillary and frontal sinuses. CT can provide an excellent definition of the paranasal sinuses and paicularly the ethmoids, which is a prerequisite for endoscopic surgery. Direct coronal CT can readily demonstrate disease in the infundibulum, frontal recess and posterior ethmoids in the same orientation confronting the endoscopist and helps in the planning of ethmoidal surgery.


Question: Not a supra hyoid muscle


Question: FISCH classification is used for

FISCH classification is used for glomus tumours based on the extension into surrounding anatomic structures. Type A tumour - Tumour limited to the middle ear cleft (glomus tympanicum) Type B tumour - Tumour limited to the tympanomastoid area with no infralabyrinthine compament involvement Type C tumour - Tumour involving the infralabyrinthine compament of the temporal bone and extending into the petrous apex; Type C1 tumour - Tumor with limited involvement of the veical poion of the carotid canal; Type C2 tumour - Tumour invading the veical poion of the carotid canal; Type C3 tumour - Tumour invasion of the horizontal poion of the carotid canal Type D1 tumour - Tumour with an intracranial extension less than 2 cm in diameter; Type D2 tumour - Tumour with an intracranial extension greater than 2 cm in diameter


Question: Membrane incised during hemilaryngectomy is

Ans. is 'b' i.e., Cricothyroid Steps in hemlaryngectomyIndications and containdications* Ideal for bulky lesions of the membranous true vocal cord* Normal or slightly impaired vocal cord mobility* No involvement of the supraglottis* Tumor may extend as far as the apex of the ventricle* Subglottic extension of no more than 5 mm posteriorly (10 mm anteriorly)* The body of the arytenoid is a contraindication, although the vocal process is not* No more than one third of the contralateral vocal cord involved (consider supracricoid partial laryngectomy)Technical points* Administer perioperative antibotics* Re-encloscope the patient* Perform a preliminary tracheostomy* Make a horizontal skin incision over the thyroid ala.* Raise the flaps superiorly and inferiorly while avoiding the tracheostomy incision* Incise the perichondrium from the thyroid notch down the midline over the ericothyroid membrane.* Elevate the perichonadrium with the attached overlying strap muscles.* Mark the cartilage incisions while retaining a 3 mm wide posterior strip.* Out with a saginal saw* Use a headlight* Incise the perichondrium along the superior border of the thyroid ala. Incise across the petiole of the spiglotis. This will provide panoramic view of the larynx.* Incise the cricothyroid membrane along the superior aspect of the circoid cartilage.* Using a no. 15 blade, cut down to the true vocal cord and examine and cut through the one vocal cord either in the midline or in lesions that cross the anterior commissure. 2 to 3 mm behind the visible tumor.* Using hooks, open the thyroid alae like a book.* STOP. Carefully evaluate the lesion and determine the ares to be excised.* Excise the tumor by incising along the apex of the aryepiglotic fold down around the arytenoid or through the vocal process of the arytenoid, depending on the posterior extent of the tumor.* Orient and examing the surgical specimen and select sites for frozen section examination of the margins* Obtain hemostasis* Suture the contralateral cord to the anterior end of the remaining cartilage or to the external perichondrium* An epiglotopex must be performed in cases of extended vertical partial laryngectomy.* Insert a nasogastric tube for feeding* Close the perichondrium with probable suture* Inferiorly based or pedicled muscle flaps may be used reconstrict the glottis but are probably not necessary* A cricopharyngeal myotomy is not required* Close the wound in layers over a chain* Apply a neck dressing


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


Question: Pink reflex through intact tympanic membrane in active otosclerosis is known as

Ans. is 'b' i.e., Schwartz sign * Schwartz sign is a pink reflex, seen through intact tympanic membrane, in the area of oval window. It indicates active otosclerosis usually during pregnancy.* Lyre's sign is splaying apart of internal and external carotid arteries on angiogram in cases of carotid body tumour of the neck.* Chvostek's sign seen in hypocalcaemia as after total thyroidectomy where parathyroids have also been removed. Tapping over the distribution of facial nerve produces a twitch.


Question: A 60 yr old lady presented with mild hearing loss & pulsatile tinnitus of right ear. Otoscopy revealed following findings. Most probable diagnosis is

FINDINGS OF GLOMUS TUMOR: Otoscopy shows a red reflex through intact tympanic membrane. "Rising sun" appearance is seen when tumour arises from the floor of middle ear. Sometimes,tympanic membrane appears bluish and may be bulging. "Pulsation sign" (Brown sign) is positive, i.e. when ear canal pressure is raised with Siegel's speculum, tumour pulsates vigorously and then blanches; reverse happens with release of pressure All these findings suggest diagnosis of Glomus tumor


Question: Common age group for otosclerosis is

Otosclerosis, more aptly called otospongiosis, is a primary disease of the bony labyrinth. In this, one or more foci of irregularly laid spongy bone replace pa of the normally dense enchondral layer of the bony otic capsule.Age of onset. Hearing loss usually stas between 20 and 30 years of age and is rare before 10 and after 40 years.Ref: Hazarika; 3rd ed; Pg 177


Question: Rinne's positive means

Ans: C (Normal hearing) Ref: Diseases of the Ear Nose and Throat by PL Dhingra. 5th edn .2010 page 26Explanation:Rinne's TestIt is a tuning fork test and is used to assess hearing status in a patientIn Rinne's test air conduction (AC) is compared with bone conduction (BC)Rinne's positive is AC>BC and is seen in normal hearing and SNHLRinne's negative is AC < BC and is seen in conductive hearing loss

Conductive hearing loss in ipsilateral ear


Question: Unsafe perforation of tympanic membrane is

Ans. b (Marginal).(Ref. Diseases of ENT, PL Dhingra, 2nd ed., 71, 3rd ed., 99)# Tubotympanic disease or central perforation remains localized to mucosa and that too mostly to anterioinferior part of middle ear cavity.# While atticoantral type or marginal or unsafe otitis media involves posteriosuperior part of middle ear cleft (attic, antrum, posterior tympanum and mastoid) and is associated with cholesteatoma, which due to its bone eroding property causes risk of serious complications and hence called unsafe or dangerous type.# Attic and posterosuperior marginal perforations are in dangerous type of CSOM and are often associated with cholesteatoma while central perforation is considered safe, as cholesteatoma is usually not associated with them.


Question: Most common fractured bone

Facial trauma, also called maxillofacial trauma, is any physical trauma to the face.

Commonly injured facial bones include the nasal bone, maxilla, and the mandible.

The mandible may be fractured at its symphysis, body, angle, ramus, and condyle.

Nasal fracture is the most common facial fracture and the third most common fracture of the skeleton overall.
Facial fractures occur for a variety of reasons related to sports participation:

contact between players (eg, a head, fist, elbow); contact with equipment (eg, balls, pucks, handle bars); or contact with the environment, obstacles, or a playing surface (eg, wrestling mat, gymnastic equipment, goalposts, trees).

Facial fractures may be associated with head and cervical spine injuries and it requires a significant amount of force.


Question: The Most common cause of vocal cord palsy is

Thyroid surgery is the most common cause when both recurrent and external laryngeal nerves of one side may be involved. It may also occur in lesions of nucleus ambiguous or that of the vagus nerve proximal to the origin of superior laryngeal nerve. Thus, the lesion may lie in the medulla, posterior cranial fossa, jugular foramen or parapharyngeal space. Ref: PL Dhingra Textbook of Ear, Nose and Throat, Edition 6, page - 301


Question: The causative agent for virulent external ear infection in a diabetic elderly is mostly by

Pseudomonas aeruginosa is the agent which is responsible for virulent external ear infection in diabetics, mainly Necrotizing otitis externa. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 55)


Question: The ideal time for Quinsy surgery after acute tonsillitis is

Tonsillectomy is usually advised 6 weeks after the quinsy attack (Interval tonsillectomy)Hot tonsillectomy- Tonsillectomy during the active abscess stageIn Quinsy, pus collects lateral to the capsule of the tonsil, in the peritonsillar space containing loose areolar tissueRef: Hazarika; 3rd ed; Pg 487


Question: Caloric test assesses the function of

Ans. c (Lateral semicircular canal) (Ref. Bhargava 5th Ed, 36; Dhingra 4th ed., 43)CALORIE TEST (HALLPIKE TEST)# To test vestibular function by stimulating the Labyrinth by water of 30degC (cold) and 44degC (hot).# Position of patient: Head raised to 30deg from horizontal in supine position to bring horizontal semicircular canal in vertical position.# Inference: Nystagmus produced (COWS).WaterNystagmusCold (30degC)Opposite SideWarm (44degC)Same SideInterpretationa) Normal: Time taken from start of irrigation to end point of Nystagmus is taken and it is 80-120 seconds.b) Canal paresis:Duration of Nystagmus shortened, i.e., < 80 sec.Indicates depressed function of ipsilateral Labyrinth, vestibular nerve and vestibular nuclei.Seen in:1. Meniere's disease; 2. Acoustic neuroma; 3. Vestibular neuritis 4. Vestibular nerve section; 5. Postural vertigoDirectional preponderance: Duration of Nystagmus increases, i.e., > 120 sec.


Question: Drug of choice for treatment of epiglottitis is

Ampicillin or third generation cephalosporins are effective against H. influenzae and are given by parenteral route (i.m. or i.v.) without waiting for results of throat swab and blood culture. Ref: PL Dhingra 7th edition of Ear, Nose and Throat; Pg no 328


Question: Tracheostomy is not indicated in

Friends, it is quite obvious that pneumothorax can be a complication of tracheostomy (if not performed properly) rather than an indication.


Question: After tonsillectomy, secondary haemorrhage occurs on

COMPLICATIONS OF TONSILLECTOMY Secondary haemorrhage:- Usually seen between the fifth to tenth postoperative day. It is the result of sepsis and premature separation of the membrane. Usually, it is heralded by bloodstained sputum but may be profuse. Simple measures like removal of clot, topical application of dilute adrenaline or hydrogen peroxide with pressure usually suffice. For profuse bleeding, general anaesthesia is given and bleeding vessel is electrocoagulated. Ligation of bleeding vessel is difficult due to friable tissue. Sometimes, approximation of pillars with mattress sutures may be required. External carotid ligation may also be required if bleeding is uncontrollable. Transfusion of blood or plasma, depending on blood loss, is given. Systemic antibiotics are given for control of infection. Ref:- Dhingra; pg num:-430


Question: Most superior sinus in the face

Frontal sinus: They are situated between the inner and outer tables of frontal bones, above and deep to the supraorbital margin. Maxillary sinus: It occupies the body of the maxilla. Ethmoid sinus: They are thinned walled air cavities int he lateral wall of the ethmoid bones. Spehnoid sinus: it occupies the body of the sphenoid. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 209 and 210)


Question: M/C nerve injured in ligation of superior thyroid artery


Question: Associated with objective tinnitus

Objective tinnitus is less frequent. Vascular lesions, such as glomus tumours or carotid aery aneurysm cause swishing tinnitus synchronous with the pulse and can be temporarily abolished by pressure on the carotid aery. Ref: PL DHINGRA diseases of ear nose and throat,7th edition, page no 121


Question: low tracheostomy is incision below


Question: Acinic cell carcinoma of the salivary gland arise most often in the

ACINIC CELL CARCINOMA It is a low-grade tumour which appears similar to a benign mixed tumour. It presents as a small, firm, movable and encapsulated tumour, sometimes bilateral. Metastases are rare. A conservative approach of superficial or total parotidectomy is adopted. Ref:- Dhingra; pg num:-235


Question: Unilateral conductive hearing loss in a patient with history of head injury. On examination, tympanic membrane is normal and mobile. The cause for deafness could be

Acquired causes of conductive hearing loss include: Perforation of tympanic membrane Fluid in the middle ear-acute otitis media, serous otitis media, hemotympanum Mass in the middle ear (benign/malignant) Disruption of ossicles-trauma to ossicular chain, CSOM, cholesteatoma Fixation of ossicles-otosclerosis, tympanosclerosis Eustachian tube blockage

Dislocation of the incudostapedial joint


Question: A high tracheostomy may be indicated in

A high tracheostomy may be indicated only in carcinoma of larynx because in such cases, total larynx anyway would ultimately be removed and a fresh tracheostomy made in a clean area lower down A high tracheostomy is done above the level of thyroid isthmus Re: Textbook of Ear, Nose and Throat, Dhingra, 6th Edition; Pg no: 316


Question: Cailaginous pa of external auditory canal is

Lateral 1/3rd of the external auditory canal is cailaginous and medial 2/3rd is bony.Ref: Hazarika; 3rd ed; Pg 9


Question: Nerve arising by two roots that surround middle meningeal Artery


Question: Mc Ewans triangle is located on

MacEwen's triangle is bounded by temporal line,posterosuperior segment of bony external auditory canal and the line drawn as a tangent to the external canal. It is an impoant landmark to locate the mastoid antrum in mastoid surgery. Reference-Dhingra 6/e,p 6.


Question: Most common mode of treatment for laryngomalacia is

Mostly, treatment is conservative. Tracheostomy may be required for some cases of severe respiratory obstruction. Supraglottoplasty is required in cases of severe laryngomalacia. Ref: PL Dhingra 7th edition of Ear, Nose and Throat; Pg no 333


Question: Otomycosis is most commonly caused by

Fungal (otomycosis):- Caused by Aspergillus (most common) and candida (2nd most common)Rare causative fungus are Phycomycetes, Rhizopus, Actinomyces, PenicilliumRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 55


Question: Nasopharyngeal carcinoma causes deafness by

Due to the obstruction of the eustachian tube, there is a conductive hearing loss with serious or suppurative otitis media. Tinnitus and dizziness may occur. Presence of unilateral serous otitis media in an adult should raise suspicion of nasopharyngeal growth. Rarely, the tumour grows up the tube into the middle ear. (Ref: Diseases of Ear, Nose and Throat, P.L Dhingra, 7th edition, page 284)


Question: Cochlear implants are used for

(C) Moderate and severe hearing loss # Cochlear implant stimulate auditory system with electrical impulses, while hearing aid use surviving hair cells.# Indications of cochlear implant:> Postlingually deaf patient (hearing loss after development of language)> Bilateral severe sensorineural deafness who do not respond to amplified sound stimuli.> Inability to benefit from hearing aid.> In order to select the patient for cochlear implant following tests are done to evaluate the degree of deafness and to assess the quality of surviving neuron. Pure tone audiometry, Electrocochleography, Promontory stimulation


Question: Treatment of leukoplakia is

Management of Leukoplakia : (i) Many of the lesions will disappear spontaneously if the causative agent is removed.(ii) In lesions with higher potential for malignant change, a biopsy is taken to rule out malignancy.(iii) In suspicious small lesions, surgical excision or ablation with laser or cryotherapy can be done. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 253)


Question: The mucoperichondrial flap in septoplasty is made on

The mucoperichondrial flap is elevated on one side over the quadrangular septal cailage.Indication for surgery in DNS- Symptomatic DNS- nasal obstruction, epistaxis, headache, recurrent sinusitis.In SMR, the mucoperichondrial flap is elevated on both the sides of the septal cailage.Incision- Freer`s incision in septoplasty, Killian`s in SMR.Ref: Hazarika; 3rd ed; Page no: 283


Question: Flick's operation and Cody Track's procedure is for

Fick's operation for sacculotomy is puncturing the saccule with a needle through stapes footplate. Cody's tack procedure consists of placing a stainless steel track through the stapes footplate. The tack would cause periodic decompression of the saccule when it gets distended. Both these operations were claimed to have shown good results but they could not be reproduced by others and this abandoned. Cochleosacculotomy is another similar procedure in which, instead of the saccule, the cochlear duct is punctured and drained into perilymph(otic- periotic shunt)This is done as a conservative procedure of surgical treatment of Meniere's disease. Ref: Diseases of EAR, NOSE and THROAT by PL Dhingra; 7th Edition; page no.115


Question: Telefono is

TELEFONO consists of repeated slapping of the sides of the head by open palms of the assailant this may cause rupture of ear drums. Ref : internet sources


Question: Saccule develops from


Question: Prussak&;s space is situated in

Prussak&;s space: Prussak&;s space lies medial to pars flaccida, lateral to the neck of malleus and above the lateral process of malleus. Anteriorly, posteriorly and superiorly, it is bounded by lateral malleal ligament. Posteriorly, it also has a gap through which the space communicates with epitympanum. Ref:- Dhingra; pg num:-449


Question: Le Fo classification involves fracture of

Le Fo classification involves the fractures of maxilla which includes transverse fracture, pyramidal fracture and craniofacial dysfunction. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 207


Question: Gold standard surgical procedure for prevention of cheonic aspiration is

Tracheal diversion and permanent tracheostomy


Question: Trench mouth is caused by


Question: Delta sign in CT scan is characteristic of

Contrast-enhanced CT scan can show sinus thrombosis by typical delta sign. It is a triangular area with rim enhancement and the central low-density area is seen in posterior cranial fossa on axial cuts. MR imaging better delineates thrombus. "Delta sign" may also be seen on contrast-enhanced MRI. MR venography is useful to assess the progression or resolution of thrombus. Ref : Diseases of ENT by Dhingra 6th edition Pgno : 84,85


Question: Cricothyrotomy is converted to tracheostomy at an early stage to

Answer: a) Avoid subglottic stenosis (DHINGRA 6th ED, P-320)Cricothyrotomy or Laryngotomy or Mini-tracheostomy:* This is a procedure for opening the airway through the cricothyroid membrane.* Patient's head and neck is extended, lower border of thyroid cartilage and cricoid ring are identified.* Skin in this area is incised vertically and then cricothyroid membrane cut with a transverse incision.* This space can be kept open with a small tracheostomy tube or by inserting the handle of knife and turning it at right angles if tube is not available.* It is essential to perform an orderly tracheostomy as soon as possible because perichondritis, subglottic oedema and laryngeal stenosis can follow prolonged laryngotomy

Prevent damage to epiglottis and vocal cords


Question: Bell's palsy patient comes on day 3. Treatment given would be

Steroids prevent synkinesis and crocodile tears and shoen recovery time of facial paralysis. Acyclovir reduces incidence of herpes zoster oticus. Ref: Dhingra 6th edition pg. 95


Question: Abscess related to sternocleidomastoid is

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 neck. The abscess may (i) lie deep to sternocleidomastoid, pushing the muscle outwards, (ii) follow the posterior belly of digastric and present as a swelling between the tip of mastoid and angle of jaw, (iii) be present in upper pa of posterior triangle, (iv) reach the parapharyngeal space or (v) track down along the carotid vessels Ref: https://en.m.wikipedia.org/wiki/Bezold%27s_abscess


Question: Schwartz sign is seen in

Ans. is 'a' i.e., Otosclerosis FINDINGS IN OTOSCLEROSISSymptoms of otosclerosiso Hearing loss Bilateral conductive deafness which is painless and progressive with insidious onset. In cochlear otosclerosis sensorineural hearing loss also occur along with conductive deafness,o Paracusis willissii An otosclerotic patient hears better in noisy than quiet surroundings.o Tinnitus More common in cochlear otosclerosis.o Speech Monotonous, well modulated soft speech,o Vertigo is uncommon.Signs in otosclerosiso Tympanic membrane is quite normal and mobile.o In 10% of cases flamingo - pink blush is seen through the tympanic membrane called as Schwartze sign,o Various tests show conductive hearing loss.Tuning fork tests in otosclerosiso As otosclerotic patients have conductive deafness, the tuning fork tests results will be as followsRinnes NegativeWebers Lateralized to the ear writh greater conductive loss.Absolute bone conduction (ABC) Normal (can be decreased in cochlear otosclerosis).4) Gelles testNo change in the hearing through bone conduction when air pressure of ear canal is increased by Siegle's speculum.Audiometry in otosclerosiso Audiometry is one of the important tools in evaluation of a patient of otosclerosis. Various audiometric tests are1) Pure tone audiometry# Shows loss of air conduction. more for lower frequencies with characteristic rising pattern. Bone conduction is normal. However in some cases, there is a dip in bone conduction curve which is maximum at 2000 Hz (2 KHz) and is called the Carhart's notch.Remembero Dip in bone conduction in otosclerosis (Carhart's notch)o Dip in noise induced hearing loss (Acoustic dip)- 2000 Hz- 4000 Hz2) Impedance audiometry# Impedance audiometry showsTympanometryo Patient with early disease may show type A tympanogram (because middle ear areation is not affected) Progressive stapes fixation results in classical As type tympanogram.Acoustic (stapedial reflex)o It is one of the earliest sign of otosclerosis and preceedes the development of airbone gap. In early stage, diphasic on-off pattern is seen in which there is a brief increase in compliance at the onset and at the termination of stimulus occurs. This is pathognomonic of otosclerosis. In later stage the reflex is absent.


Question: Potato tumor is

Rhinophyma (Potato tumor)Rhinophyma is a benign tumor of the tip of the nose due to hyperophy of sebaceous glandIt is caused by granulomatous infiltration and occurs as a complication of long-standing acne rosaceaAlcoholism is mistakenly attributed as a cause of this disease, but heavy alcohol consumption does aggravate the conditionThe usual presentation is due to cosmetic appearance or obstructionTreatment of choice is debulking of the tumor by carbon dioxide laserRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 161 - 162


Question: Ear is sensitive to

External auditory canal 3000 Hz Tympanic membrane 800-1600 Hz Middle ear 800 Hz Ossicular chain 500-2000 Hz Thus the greatest sensitivity of sound transmission is between 500- 3000 Hz Ref: Dhingra 7e pg 17.


Question: Traumatic epistaxis is not a cause in

Trauma is not a course for posterior epistaxis. It can occur spontaneously, often due to hypeension or aeriosclerosis. Mostly seen after the age of 40 years Ref: Dhingra 7e pg 199.


Question: Mucoepidermoid carcinoma of parotid arises from

MUCOEPIDERMOID CARCINOMA It is slow-growing tumor but can invade the facial nerve. Histologically, there are areas of mucin-producing cells and the squamous cells, and hence the name. Greater the epidermoid element, more malignant is the behaviour of the tumour. The tumours have been fuher classified as low grade and high grade. Low-grade tumours have good prognosis. Low-grade tumours are more common in children. Low-grade tumours of the parotid are treated by super ficial or total parotidectomy, depending on the location of the tumour. Facial nerve is preserved. High-grade tumours being more aggressive are treated by total parotidectomy. Facial nerve may be sacrificed if invaded by the tumour. Some surgeons also combine radical neck dissection because of high incidence of microscopic spread of the tumour. Ref:- Dhingra; pg num:-235


Question: Caloric test is done for

Ans. (a) Semicircular canalRef. Dhingra's ENT 5th ed. / 48* Caloric test is used to assess vestibular function. The basis of this test is to induce nystagmus by thermal stimulation of the vestibular system.* Done by taking water of 2 temperatures, cold (30degC) and hot (44degC).* Position of the test: Supine then lift head at 30deg forward or patient sitting with bending backwards 60*.* This position is used in order to make lateral/ horizontal SCC in vertical position.* Cold water elicits nystagmus in opposite eye and warm water elicit nystagmus in same eye (Mn: COWS).* Interpretation:# Normal: Time taken from start of irrigation to end point of Nystagmus is taken and it is 80 seconds --120 seconds.# Canal paresis: Duration of Nystagmus shortened i.e. < 80 sec.* Indicates depressed function of ipsilateral Labyrinth, vestibular nerve and vestibular nuclei.* It is seen in:# Meniere's disease# Acoustic neuroma# Vestibular neuritis# Vestibular nerve section# Postural vertigo


Question: Rose's position is extension at


Question: Not  a Tests for Eustachian Tube


Question: The most common presentation of adult rhinosporidiosis is

Most common presentation of adult rhinosporidiosis is the protruding polypoidal mass through the nares and multiple site involvement. In the early stages, the patient may complain of nasal discharge which is often blood tinged and nasal stuffiness. Sometimes, frank epistaxis is the only presenting complaint.


Question: Paranasal sinuses present at birth 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.


Question: Cochlear basal turn dysplasia is known as

Congenital malformations of the inner ear Complete labyrinthine aplasia (Michel), Complete membranous labyrinthine dysplasia (Siebenmann-Bing), Cochleosaccular dysplasia (Scheibe), Cochlear basal turn dysplasia (Alexander) Alexander dysplasia : It affects only the basal turn of membranous cochlea. Thus only high frequencies are affected. Residual hearing is present in low frequencies and can be exploited by amplification with hearing aids. Ref : Diseases of ENT by Dhingra 6th edition Pgno : 115


Question: Earliest sign of laryngeal tuberculosis is

Laryngeal examination of tuberculosis of the larynx Hyperaemia of the vocal cord in its whole extent or confined to posterior pa with impairment of adductor is the first sign. Swelling in the Interarytenoid region giving a manipulated appearance. Ulceration of vocal cord giving the mouse-nibbled appearance. Superficial ragged ulceration on the arytenoids and Interarytenoid region. Granulation tissue in the Interarytenoid region or vocal process of arytenoid. Pseudoedema of the epiglottis " turban epiglottis ". Swelling of ventricular bands and aryepiglottic folds. The marked pallor of the surrounding mucosa. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 331

Erythema of vocal cords and loss of adduction


Question: Earliest symptom of glomus tumour is

The earliest symptoms are hearing loss and tinnitus. The earliest symptom of a glomus tumour is pulsatile tinnitus which is of swishing character and synchronous with pulse. Ref: Dhingra 7th edition pg. 121


Question: Treatment of choice for glue ear is

Ans. is 'c' i.e. Myringotomy with ventilation tube insertion * Treatment of choice for glue ear is - Myringotomy and aspiration of effusion with placement of ventilation tube. Glue ear or Otitis media with effusion (OME) (also k/a serous otitis media, secretory otitis media, Mucoid otitis media) OME is characterized by a non-purulent effusion of the middle ear that may be either mucoid or serous. Symptoms usually involve hearing loss or aural fullness but typically do not involve pain or fever. In children hearing loss is generally mild and is often detected only with an audiogram. The fluid is nearly sterile. The condition is commonly seen in school-going children. It is the leading cause of hearing loss in children. Pathogenesis Two main mechanisms are thought to be responsible. Eustachian tube dysfunction Increased secretory activity of middle ear mucosa Treatment Treatment may be medical or surgical Medical measures are controversial and involve Decongestants Antiallergic measures Antibiotics Middle ear aeration Valsalva manoeuvre politzerisation or eustachian tube catheterization chewing gum Surgical Myringotomy and aspiration of fluid Grommet or ventilation tube insertion Surgical t/t of causative factor - adenoidectomy, tonsillectomy, and/or wash out of maxillary antra.

Conservative treatment with analgesics & antibiotics


Question: Cochlear implant done in


Question: Laryngofissure is

Laryngofissure Opening the larynx in midline. Ref:- Stedman Dictionary; pg num:- 937


Question: Electrode of cochlear implant is placed at

Principles of cochlear implants The electrical impulses are sent from the processor to the transmitting coil which in turn sends the signal to the surgically implanted receiver/stimulator radiofrequency. The receiver/stimulator decodes the signal and transmits it to the electrode array. Current day implants are multichannel processors with the electrode having a linear array of electrode contacts used to deliver multiple channels of current to different places along the basilar membrane. The electrode array which has been placed in the scala tympani of the cochlea stimulates the spiral ganglion cells. The auditory nerve is thus stimulated and sends these electrical pulses to the brain which are finally interpreted as sound. Ref : Dhingra 7e pg 139.


Question: Patient following peanut consumption presented with laryngeal edema, stridor, hoarseness of voice and swelling of tongue. Most likely diagnosis is

Allergic angloedema: Most common type and usually affects those with some kind of food allergy. It can also be caused by insect bites, contact with latex, and some medications, such as penicillin or aspirin. In severe cases the throat can swell, making it hard for the patient to breath.


Question: Not a premalignant lesion of oral cavity


Question: Stapedial reflex is mediated by

Stapedial reflex: Afferent : Vestibulo-cochlear N. Efferent: Facial N. Note: A person who feigns total deafness and does not give any response on pure tone audiometry but shows a positive stapedial reflex is a malingerer. Ref: Dhingra; 6th Edition; pg no 24


Question: Craniofacial dissociation is seen in

In Le Fo 3 fracture there is a complete separation of facial bones from the cranial bones. The fracture line passes through the root of nose, ethmofrontal junction, superior orbital fissure, lateral wall of the orbit, frontozygomatic and temporozygomatic sutures and the upper pa of pterygoid plates Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 207


Question: Most common organism causing laryngotracheobronchitis is

Para-influenza virus I and II is the most common organism causing laryngotracheobronchitis. Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 328


Question: Spontaneous veical nystagmus is seen in the lesion of

Veical downbeat nystagmus indicates lesion at craniocervical region such as Arnold-Chiari malformation or degenerative lesion of the cerebellum. Veical upbeat nystagmus is seen in lesions at the junction of pons and medulla or pons and midbrain. Ref: Dhingra 7e pg 43.


Question: Gelle&;s test is done in

Gelle's test: It is also a test of bone conduction and examines the effect of increased air pressure in ear canal on the hearing. Normally, when air pressure is increased in the ear canal by Siegel's speculum, it pushes the tympanic membrane and ossicles inwards, raises the intralabyrinthine pressure and causes immobility of basilar membrane and decreased hearing, but no change in hearing is observed when ossicular chain is fixed or disconnected. Gelle's test is performed by placing a vibrating fork on the mastoid while changes in air pressure in the ear canal are brought about by Siegel's speculum. Gelle's test is positive in nor- mal persons and in those with sensorineural hearing loss. It is negative when ossicular chain is fixed or disconnected. It was a popular test to find out stapes fixation in otosclerosis but has now been superceded by tympanometry. Ref:- Dhingra; pg num:- 22,23


Question: Length of the external auditory canal is

EXTERNAL AUDITORY CANAL

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


Question: Fluctuating, recurring, variable sensorineural deafness is seen in

Sensorineural hearing loss is also seen in presbycusis, ototoxicity, Meniere&;s disease, acoustic neuroma, also been associated with diabetes, hypothyroidism, kidney disease, autoimmune disorders, multiple sclerosis and blood dyscrasias. Ref: PL DHINGRA diseases of ear nose and throat, 6th edition, page no 33


Question: Ohgren's line passes from

A theoretic line passing between the medial canthus of the eye and the angle of the mandible; used as an arbitrary dividing line in classifying localized tumours of the maxillary sinus; tumours above the line invade vital structures early and have a poorer prognosis, whereas those below the line have a more ourable prognosis. It is an imaginary plane drawn, extending between medial canthus of eye and angle of the mandible. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 233)


Question: A 2 years old male is brought to the hospital there is a compressible swelling at the root of nose, likely diagnosis is

Ans. is 'a' i.e.meningoencephalocele It is herniation of the brain along with meninges through a congenital bony defectSwelling shows cough impulse*.It may be reducible.


Question: Nerve damaged in radical mastoidectomy is

Facial nerve is involved in radical mastoidectomy Facial paralysis is the complication Ref: Dhingra 7e pg 460


Question: Most common site of sinusitis in children

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


Question: Most common malignancy arising in the thyroglossal cyst is

Thyroglossal CystContains clear to a cloudy fluid with sparse cellularityThe cystic background contains few if any epithelial cellsSome inflammatory cells and crystals might be presentRarely malignant transformation occurs in about 1% of the casesMost common malignancy arising is papillary carcinoma followed by squamous cell carcinomaRef: PL Dhingra, Diseases of Ear, Nose & Throat, 7th edition, pg no. 378 - 379


Question: The unilateral sensorineural hearing loss may occur in

Mumps(epidemic parotitis) may result in a profound sensorineural hearing loss (90 dB or more), unilaterally (one ear) or bilaterally (both ears). Coronavirus and Rotavirus are associated with diarrhoea.


Question: Early tonsillectomy is not done in

INDICATIONS They are divided into: A. ABSOLUTE 1. Recurrent infections of throat. This is the most common indication. Recurrent infections are fuher defined as: (a) Seven or more episodes in 1 year, or (b) Five episodes per year for 2 years, or (c) Three episodes per year for 3 years, or (d) Two weeks or more of lost school or work in 1 year. 2. Peritonsillar abscess. In children, tonsillectomy is done 4-6 weeks after abscess has been treated. In adults, second attack of peritonsillar abscess forms the absolute indication. 3. Tonsillitis. It causes febrile seizures. 4. Hyperophy of tonsils. It causes: (a) airway obstruction (sleep apnoea), (b) difficulty in deglutition and (c) interference with speech. 5. Suspicion of malignancy. A unilaterally enlarged tonsil may be a lymphoma in children and an epidermoid carcinoma in adults. An excisional biopsy is done. B. RELATIVE 1. Diphtheria carriers, who do not respond to antibiotics. 2. Streptococcal carriers, who may be the source of infection to others. 3. Chronic tonsillitis with bad taste or halitosis which is unresponsive to medical treatment. 4. Recurrent streptococcal tonsillitis in a patient with valvular hea disease. Ref: Dhingra 7e pg 487.


Question: Sensory supply of middle ear is provided by

Tympanic plexus provide the nerve supply It is formed by Tympanic branch of glossopharyngeal nerve Sympathetic fibres from plexus around the internal carotid aery Reference-Dhingra 6/e, p 8.


Question: Endolymphatic decompression is seen in

Surgical management of Meniere&;s disease-Conservative Surgeries-1.Endolymphatic sac decompression2.Cochleostomy3.Sacculotomy4.Cervical sympathectomyDestructive surgeries-1.Vestibular nerve section2.Labyrinthectomy3.Laser destruction of inner earRef: Hazarika; 3rd ed; Pg 196


Question: Most commonly used tuning fork in ear examination is

512Hz is used normally Note: These tests are performed with tuning forks of different frequencies such as 128, 256, 512, 1024, 2048 and 4096 Hz, But for routine clinical practice, tuning fork of 512 Hz is ideal. Forks of lower frequencies produce a sense of bone vibration while those of higher frequencies have a shoer decay time and are thus not routinely preferred. Ref: Dhingra; 6th Edition; pg no 21


Question: Third window effect is seen in

Ans. b. Dehiscent superior semicircular canal Dehiscence of bone overlying the superior semicircular canal can cause a constellation of vestibular and auditory symptoms and signs. These abnormalities can be understood in terms of the effect of the dehiscence in creating a third mobile window into the inner ear.


Question: Otospongiosis is inherited as

aetiology Anatomical basis Heredity: Autosomal dominant trait with the incomplete penentrance. Race: Whites are affected more than blacks. Sex: Females are affected twice as often as males. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no.95)


Question: Commonest complication of CSOM is

50% of brain abscesses in adults and 25% in children are otogenic in origin. In adults, an abscess usually follows CSOM with cholesteatoma. (Ref: Textbook of diseases of ENT, PL Dhingra, 7th edition, pg no. 90)


Question: Lyre sign in seen in

Lyre sign is an angiographic finding seen in carotid body tumour of the neck. There is splaying apa of internal and external carotid aeries on angiogram. Ref: Diseases of Ear, Nose and Throat by P.L. Dhingra, 9th edition, p460.


Question: Laryngocele arises from herniation through

Ans:A.)Thyrohyoid Membrane Laryngocele It is an air-filled cystic swelling due to dilatation of the saccule. Laryngoceles can be classified into three types: Internal - A laryngocele is defined as internal if the dilatation of Sacculeof the ventricle lies within the limits of the thyroid cailage. External - If the laryngocele extends beyond the thyroid cailage and protrudes through the thyrohyoid membrane producing a lateral neck mass, it is considered external. Combined - In which both internal and external components are seen.


Question: The location of schatzki&;s ring is

SCHATZKI'S RING It occurs at the junction of squamous and columnar epithelium at the lower end of oesophagus and has also been called lower oesophageal ring. Usually seen in patients above 50 years of age. Cause is unknown. Symptomatic patients complain of intermittent dysphagia and some may even present with bolus obstruction. It may be associated with hiatus hernia. Treatment is oesophageal dilatation. Ref:- Dhingra; pg num:-345