23-04-2025

ENT
OTORHINOLARYNGOLOGY

1
EnD

Which of the following middle ear pathologies is most likely to cause maximum conductive hearing loss?

A. Tympanosclerosis involving only the tympanic membrane

B. Adhesive otitis media (Grade IV retraction pocket with atelectasis)

C. Ossicular discontinuity involving incudostapedial joint

D. Otosclerosis with complete fixation of the stapes footplate

2
EnD

Which of the following is the most characteristic audiometric finding in noise-induced hearing loss?

A. Dip in bone conduction at 2000 Hz

B. Notch in audiogram at 4000 Hz

C. Low-frequency hearing loss

D. Complete loss of speech discrimination

3
EnD

A 68-year-old male presents with progressive bilateral hearing loss. He finds it difficult to follow conversations,
especially in noisy environments. His pure tone audiogram is shown below:

Identify the pattern of hearing loss shown in the audiogram:

A. Noise-induced hearing loss

B. Presbycusis

C. Meniere’s disease

D. Otosclerosis

4
EnD

A 2-day-old neonate fails the initial hearing screening test using Otoacoustic Emissions (OAE). What is the next
appropriate step in audiological evaluation?

A. Speech audiometry

B. Perform Pure Tone Audiometry (PTA)

C. Do BERA (Brainstem Evoked Response Audiometry)

D. Tympanometry (Impedance audiometry)

5
EnD

A 35-year-old male with chronic ear discharge and hearing loss undergoes the following surgical procedure

What is the procedure being performed?

A. Tympanoplasty

B. Ossiculoplasty

C. Mastoidectomy

D. Myringotomy

6
EnD

Which opening is located posterior to the marked structure in the image?

A. Eustachian tube

B. Onodi cell

C. Sphenopalatine foramen

D. Sphenoid sinus

7
EnD

A 5-year-old child with bilateral profound sensorineural hearing loss is being evaluated for cochlear
implantation. Which of the following is the most important factor in determining the eligibility for cochlear
implantation in this child?

A) Age of the child

B) Duration of hearing loss

C) Auditory nerve integrity

D) Parental support and motivation

8
EnD

Which of the following structures passes between the inferior and middle pharyngeal constrictors?

A) Eustachian tube

B) Glossopharyngeal nerve (IX cranial nerve)

C) Internal laryngeal branch of the superior laryngeal nerve (SLN)

D) Recurrent laryngeal nerve

9
EnD

A 6-year-old child presents with a history of recurrent nasal obstruction, snoring, and a persistent, non-painful
ear fullness. The child has a fluctuating conductive hearing loss but no signs of infection. On examination, the
adenoids are visibly hypertrophied. What is the most appropriate management for this child?

A) Myringotomy with grommet insertion and adenoidectomy

B) Myringotomy with grommet insertion alone

C) Corticosteroids and observation

D) Surgery for nasopharyngeal carcinoma

10
EnD

A 17-year-old boy presents with recurrent episodes of sneezing, nasal obstruction, and watery rhinorrhea
especially in the morning. He frequently rubs his nose in an upward manner, and has dark circles under his eyes.
On anterior rhinoscopy, the nasal mucosa appears pale and boggy. His serum IgE is elevated. Despite oral
antihistamines and intranasal steroids, he remains symptomatic. Which of the following is the most appropriate
next step in management?

A. Nasal decongestants (oxymetazoline)

B. Initiate anti-IgE monoclonal antibody therapy

C. Surgical reduction of inferior turbinates

D. Start oral antibiotics

11
EnD

A 6-year-old child presents with chronic mouth breathing, snoring, and recurrent episodes of earache. On
examination, he has a high-arched palate, crowded teeth, and a dull facial appearance. Which of the following is
the most likely underlying anatomical cause for his recurrent ear symptoms?

A. Obstruction of Eustachian tube by enlarged adenoids

B. Referred otalgia via glossopharyngeal nerve

C. Infection spreading from tonsillar crypts to middle ear

D. Reflux of nasopharyngeal secretions into the middle ear

12
EnD

A 14-year-old boy presents with recurrent episodes of profuse epistaxis and progressive nasal obstruction for the
past few months. His mother also reports a gradual swelling on one side of his cheek and bulging of his left eye.
On examination, a red, fleshy mass is visible in the nasal cavity. CT scan shows anterior bowing of the posterior
wall of the maxillary sinus. What is the most appropriate next step in management?

A. Diagnostic nasal biopsy under local anesthesia

B. Start oral antibiotics and nasal decongestants

C. Surgical planning with imaging studies

D. Radiotherapy to shrink the vascular tumor

13
EnD

A 20-year-old male from Southeast Asia presents with a 3-month history of painless neck swelling and recent
onset of nasal obstruction and decreased hearing in the right ear. He also reports denasal speech. On
examination, there is a firm, non-tender level II cervical lymph node on the right side. Otoscopy reveals a
retracted tympanic membrane. What is the most likely diagnosis?

A. Juvenile nasopharyngeal angiofibroma

B. Nasopharyngeal carcinoma

C. Tubercular lymphadenitis with middle ear effusion

D. Chronic allergic rhinitis with adenoidal hypertrophy

14
EnD

A 22-year-old man presents to the emergency department with severe sore throat, high-grade fever, difficulty
swallowing, and a muffled voice. He also reports pain while opening his mouth. On examination, there is
trismus, medial displacement of the right tonsil, and deviation of the uvula to the left. What is the most
appropriate next step in management?

A. Immediate tonsillectomy

B. Empirical IV antibiotics and observation

C. Incision and drainage of the abscess

D. Biopsy of the tonsil to rule out malignancy

15
EnD

A 30-year-old man undergoes surgery for cholesteatoma of the middle ear. The ENT surgeon explains that the
chosen approach involves preservation of the posterior canal wall, allowing the patient to swim and use a
hearing aid without difficulty, but it may require a second surgery in 6 months. Which of the following best
describes this surgical approach?

A. Canal-wall-down mastoidectomy

B. Radical mastoidectomy

C. Modified radical mastoidectomy

D. Canal-wall-up mastoidectomy

16
EnD

A 45-year-old patient with long-standing chronic suppurative otitis media (CSOM) presents with vertigo on
tragal pressure. On otoscopic examination, attic cholesteatoma is seen. Which of the following best explains the
positive fistula test in this case?

A. Hypermobile stapes footplate

B. Perilymphatic fistula due to lateral semicircular canal erosion

C. Fibrous attachment between membranous labyrinth and footplate

D. Dead labyrinth due to longstanding cholesteatoma

17
EnD

A 16-year-old boy with a history of chronic ear discharge now presents with high-grade fever with chills and
rigors, which subsides with sweating. On examination, he has edema over the posterior part of the mastoid
region. Fundoscopy shows bilateral papilledema. What is the most likely diagnosis?

A. Brain abscess

B. Lateral sinus thrombophlebitis

C. Acute mastoiditis

D. Otitic hydrocephalus

18
EnD

A 25-year-old woman presents with complaints of chronic nasal crusting, foul-smelling nasal discharge, and
progressive loss of smell. On anterior rhinoscopy, the nasal cavity appears roomy with pale mucosa and crusts
adherent to the turbinates. She does not perceive the bad odor emanating from her own nose. Which of the
following best explains this finding?

A. Involvement of olfactory bulb due to chronic infection

B. Merciful anosmia due to atrophy of olfactory nerve endings

C. Obstruction of nasal passages by hypertrophied turbinates

D. Ciliary hypertrophy due to chronic irritation

19
EnD

A 65-year-old diabetic male presents with severe ear pain for 2 weeks and foul-smelling ear discharge. On
otoscopic examination, granulation tissue is noted in the external auditory canal. He now has right-sided facial
weakness. Which of the following is the most likely diagnosis?

A. Chronic suppurative otitis media

B. Cholesteatoma

C. Malignant otitis externa

D. Ramsay Hunt syndrome

20
EnD

A 28-year-old woman presents with gradually progressive hearing loss, which improves in noisy surroundings.
Otoscopy reveals an intact tympanic membrane with a reddish hue over the promontory. Audiometry shows a
dip at 2000 Hz in the bone conduction curve. What is the most likely diagnosis?

A. Otitis media with effusion

B. Otosclerosis

C. Presbycusis

D. Noise-induced hearing loss

21
EnD

A 45-year-old man presents with recurrent brief episodes of vertigo that are triggered when he turns his head to
the right while lying down. The episodes last for less than a minute and are not associated with hearing loss or
tinnitus. Dix-Hallpike test is positive. What is the most likely underlying pathophysiological mechanism?

A. Inflammation of the vestibular nerve

B. Dislodgement of otoconia from utricle into posterior semicircular canal

C. Degeneration of macula in saccule

D. Lesion in cerebellar flocculus causing central vertigo

22
EnD

A 40-year-old man presents with recurrent episodes of vertigo lasting several hours, fluctuating sensorineural
hearing loss, tinnitus, and a sense of aural fullness. Otoscopy is normal, and audiometry shows low-frequency
sensorineural hearing loss. Electrocochleography shows SP/AP ratio > 0.3. Which of the following is the most
appropriate first-line treatment for this condition?

A. Systemic corticosteroids

B. Vestibular sedatives and diuretics

C. Surgical labyrinthectomy

D. Cochlear implantation

23
EnD

A lesion selectively affecting the posteroinferior quadrant of the internal auditory canal will most likely involve
which of the following nerve components?

A. Superior vestibular nerve

B. Cochlear nerve

C. Inferior vestibular nerve

D. Facial nerve

24
EnD

A 50-year-old woman presents with gradually progressive unilateral hearing loss and tinnitus. Audiometry
shows high-frequency sensorineural hearing loss. MRI with gadolinium contrast reveals a cerebellopontine
angle mass. Which of the following additional findings most strongly suggests a retrocochlear pathology?

A. Presence of recruitment and high SISI score

B. Normal BERA and preserved stapedial reflex

C. Poor speech discrimination with absent stapedial reflex and abnormal BERA

D. Improved hearing in noisy surroundings (Paracusis Willisii)

25
EnD

A 32-year-old pregnant woman in her third trimester presents with sudden-onset facial asymmetry, inability to
close her left eye, drooling from the corner of her mouth, and hypersensitivity to loud sounds. Examination
shows Bell’s phenomenon on attempted eye closure. Otoscopy is normal. Which of the following is the most
appropriate initial treatment?

A. High-dose intravenous antibiotics

B. Oral prednisolone with acyclovir

C. Immediate surgical decompression of the facial nerve

D. Observation only, as it is self-limiting

26
EnD

A newborn is diagnosed with congenital sensorineural hearing loss. Imaging reveals complete absence of both
bony and membranous labyrinths. Which of the following is the most likely diagnosis?

A. Mondini dysplasia
• Schiebe dysplasia – cochlea and saccule dysplasia seen.
B. Michel aplasia • Alexander dysplasia – basal turn of cochlea affected.
C. Schiebe dysplasia • Bing-Seibenmann dysplasia – complete absence of
membranous labyrinth.
D. Bing-Siebenmann dysplasia
• Michel aplasia – complete absence of bony and
membranous labyrinth.
• Mondini dysplasia – only basal coil present. Only 1.5
turns of cochlea formed.
• Maternal infections like Toxoplasma, Rubella, CMV,
Herpes, Syphilis {Mnemonic – TORCHES} cause
congenital hearing loss.
27
EnD

A 2-year-old boy is brought to the emergency department with a 2-day history of low-grade fever, hoarseness,
and a barking cough. On examination, he has inspiratory stridor and intercostal retractions. A neck X-ray shows
a tapering of the upper trachea resembling a steeple. What is the most likely diagnosis?

A. Acute epiglottitis

B. Foreign body aspiration

C. Acute laryngotracheobronchitis

D. Retropharyngeal abscess

28
EnD

Which of the following statements regarding the pediatric larynx is true?

A. The larynx in children is positioned lower in the neck than in adults

B. The epiglottis in infants is leaf-shaped and rigid

C. The narrowest part of the pediatric airway is the glottis

D. The pediatric larynx has a conical shape with the narrowest portion at the subglottis

29
EnD

A 2-month-old infant presents with inspiratory stridor that worsens when crying and improves when lying prone.
On flexible laryngoscopy, an omega-shaped epiglottis and collapse of supraglottic structures during inspiration
are seen. What is the most appropriate next step in management?

A. Immediate tracheostomy

B. Start oral corticosteroids

C. Observation and reassurance

D. Surgical supraglottoplasty immediately

30
EnD

A 55-year-old male chronic smoker presents with a 2-month history of hoarseness of voice. On laryngoscopy, a
lesion is seen involving the vocal cords. Biopsy confirms squamous cell carcinoma. Which of the following is
true regarding this condition?

A. It has a poor prognosis due to early lymphatic spread

B. It is usually diagnosed late due to lack of symptoms

C. It has better prognosis because of early presentation and limited lymphatic spread

D. It most commonly presents with stridor due to airway narrowing

31
EnD

A surgical microscope is being set up for a stapedectomy. Which of the following focal lengths is most
appropriate for optimal visualization during this ear surgery?

A. 100 mm

B. 200 mm

C. 300 mm

D. 400 mm

32
EnD

A 25-year-old patient presents with recurrent pus discharge from a small pit located just anterior to the external
ear. Examination reveals a sinus opening in the preauricular region. What is the most likely embryological basis
for this condition?
A. Malfusion of the 1st and 2nd pharyngeal arches
B. Malfusion of the 1st and 2nd pharyngeal clefts
C. Malfusion of the 1st and 2nd pharyngeal pouches
D. Overlapping of the 1st and 2nd pharyngeal arches

33
EnD

A patient undergoes a Rinne test with different tuning forks to assess hearing loss. The patient shows a negative
Rinne test at 256Hz, a negative result at 512Hz, but a positive Rinne test at 1024Hz. Based on this, what is the
approximate degree of hearing loss?

A. 15-25 Db

B. 20-30 dB

C. 30-45 dB

D. 45-60 dB

34
EnD

A 65-year-old man presents to the clinic complaining of difficulty hearing during conversations, especially when
speaking with family members in a normal setting. His hearing difficulty is less pronounced when someone
speaks loudly, but he often struggles with whispers. Based on this information, what is the patient's approximate
hearing threshold?

A. 20-30 dB

B. 30-60 dB

C. 60-90 dB

D. 90-120 dB

35
EnD

Identify the audiogram in the provided image:

A. Noise-induced hearing loss

B. Otosclerosis

C. Meniere’s disease

D. Acoustic neuroma

36
EnD

Identify the following sequence of otoendoscopic images from left to right.

a. Glomus tumor, serous otitis media, chronic suppurative otitis media (CSOM), normal eardrum
b. serous otitis media, chronic suppurative otitis media (CSOM), normal eardrum, Glomus tumor
c. Glomus tumor, chronic suppurative otitis media (CSOM), normal eardrum, serous otitis media
d. normal eardrum, Glomus tumor, serous otitis media, chronic suppurative otitis media (CSOM)

37
EnD

Match the following: Types of Tympanoplasty Characteristic

a. Type II 1. Fenestration tympanoplasty
a) a-1, b-2, c-3, d-4
b. Type III 2. Graft placed over the incus
b) a-2, b-3, c-4, d-1 c. Type IV 3. Cavum minor
d. Type V 4. Columella tympanoplasty
c) a-2, b-4, c-3, d-1

d) a-1, b-3, c-4, d-2

38
EnD

Mark the false statement/statements regarding Inner and Outer hair cells:
Options:
I. Outer hair cells are in a single row and transmit auditory impulses. A. I, III, and IV are false

II. Outer hair cells are in 3-4 rows and modulate the function of inner hair cells. B. I, II, and III are false
C. All are false
III. Inner hair cells are in a single row and modulate the function of outer hair cells.
D. I and III are false
IV. Outer and inner hair cells are present in the ratio of 1:3 respectively.

39
EnD

Arrange the following in the sequence of the auditory pathway:

Options:
Cochlear nucleus A. 1-2-3-4-5
Spiral ganglion B. B. 5-4-3-2-1
C. C. 2-1-3-4-5
Superior olivary nucleus
D. D. 3-4-5-1-2
Inferior colliculus

Medial geniculate body

40
EnD

A woman presents with impaired hearing. Her audiometry is given. Pick the correct combination of tuning fork
test results that would be seen in this patient.

a. Left Rinne's test negative, Weber's test lateralized to right ear

b. Left Rinne's test negative, Weber's test lateralized to left ear

c. Left Rinne's test positive, Weber's test lateralized to right ear

d. Left Rinne's test positive, Weber's test lateralized to left ear

41
EnD

In which of the following conditions is the Ad tympanogram seen?

a. Ossicular dislocation

b. Otosclerosis

c. Serous otitis media

d. Normal ear

42
EnD

Identify the otoendoscopy image. The black-headed spores in this image indicate which organism growth?

a. Aspergillus niger

b. Aspergillus fumigatus

c. Candida

d. None of the above

43
EnD

Type of perforation seen in the image ?

a. central
b. subtotal
c. marginal
d. attic

44
EnD

Which of the following does not require immediate surgical intervention ?

a. pinna hematoma
b. septal hematoma
c. nasal bone fracture
d. quinsy

45
EnD

A patient presents to the emergency department with profuse epistaxis. Initial nasal packing fails to control the
bleeding. Surgical ligation of the sphenopalatine and maxillary arteries is performed, but the patient continues to
bleed. What is the next appropriate step in the management of this patient?

A. Ligation of external carotid artery

B. Ligation of internal carotid artery

C. Ligation of sphenopalatine artery

D. Ligation of maxillary artery

46
EnD

In which radiographic view is the sphenoid sinus best visualized?

a) Water's view

b) Caldwell view

c) Pierre view

d) Rhese view

47
EnD

All of the following are related to CSF rhinorrhea except:

a) Trauma

b) Halo sign

c) Bilateral watery nasal discharge on bending forwards

d) Antibiotics and Acetazolamide

48
EnD

A 45-year-old woman presents with hoarseness of voice following thyroid surgery. During examination, it is
noted that her vocal cords are paralyzed on both sides. Which nerve is most likely damaged?

a) External branch of the superior laryngeal nerve (EBSLN)

b) Internal branch of the superior laryngeal nerve (IBSLN)

c) Recurrent laryngeal nerve (RLN)

d) Phrenic nerve

49
EnD

Identify the correct sequence of lesions in the larynx:

a. Vocal nodule, vocal granuloma, reinke oedema, vocal cyst
b. Vocal nodule, vocal cancer, reinke oedema, vocal cyst
c. Leukoplakia, vocal cancer, polypoid corditis, vocal polyp
d. Vocal nodule, vocal cancer, reinke oedema, vocal polyp

50
EnD

A 60-year-old man presented with unilateral hearing loss. Oto-endoscopic picture is

shown below. Rinne was negative and weber lateralised to the same ear. Clinically
next structure to be observed in the patient is

a b c d

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