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ABOHNS Otolaryngology study materials
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ABOHNS Otolaryngology practice questions

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Question 1General Otolaryngology – Head and Neck Surgery

A 45-year-old man presents with a unilateral, painless neck mass just below the angle of the mandible that has enlarged over three months. Fine-needle aspiration suggests squamous cell carcinoma in a cervical lymph node. Which is the most appropriate next step in management?

  1. Reassurance and repeat examination in one year
  2. Empiric antibiotics and observation for six weeks
  3. Simple excision of the neck mass for diagnosis
  4. Complete head and neck mucosal examination with directed biopsies Correct answer.

Explanation

A unilateral neck mass with squamous cells on FNA in an adult represents a presumed mucosal primary until proven otherwise. The standard is a full panendoscopy with directed biopsies of the upper aerodigestive tract to locate the primary. Excision of the mass before identifying the primary can compromise later neck dissection planning.

Question 2General Otolaryngology – Head and Neck Surgery

Which paranasal sinus is most commonly involved in acute invasive fungal rhinosinusitis in immunocompromised patients?

  1. Maxillary sinus
  2. Sphenoid sinus
  3. Ethmoid sinus Correct answer.
  4. Frontal sinus

Explanation

Acute invasive fungal rhinosinusitis typically begins in the nasal cavity and ethmoid sinuses, where it spreads along vascular channels. Ethmoid involvement is characteristic because of its proximity to the orbit and skull base.

Question 3General Otolaryngology – Head and Neck Surgery

A patient reports a spinning sensation that begins when rolling over in bed and lasts under one minute, with no hearing loss or neurologic symptoms. Dix-Hallpike testing reproduces the vertigo with a torsional upbeating nystagmus. What is the most likely diagnosis?

  1. Vestibular neuritis
  2. Meniere disease
  3. Vestibular schwannoma
  4. Benign paroxysmal positional vertigo Correct answer.

Explanation

Brief positional vertigo with a positive Dix-Hallpike maneuver producing torsional upbeating nystagmus is the classic picture of posterior canal benign paroxysmal positional vertigo. The short duration and positional trigger distinguish it from continuous vestibular syndromes.

Question 4General Otolaryngology – Head and Neck Surgery

Which of the following is the most common site of origin for laryngeal squamous cell carcinoma?

  1. Supraglottis
  2. True vocal cord Correct answer.
  3. Subglottis
  4. Posterior commissure

Explanation

The glottic region, particularly the true vocal cord, is the most common site of laryngeal carcinoma. Glottic tumors also present earlier with hoarseness, which affects prognosis.

Question 5General Otolaryngology – Head and Neck Surgery

A 60-year-old woman has a 2 cm firm, mobile mass in the tail of the parotid gland. FNA shows a benign pleomorphic adenoma. Which management is most appropriate?

  1. Radical parotidectomy with facial nerve sacrifice
  2. Superficial parotidectomy with margin of normal tissue Correct answer.
  3. Observation with annual ultrasound
  4. Antibiotics and warm compresses

Explanation

Pleomorphic adenoma is a benign but locally recurrent tumor with malignant potential, and complete excision with a cuff of normal tissue is the standard to prevent recurrence. Enucleation alone leads to recurrence, so superficial parotidectomy preserving the facial nerve is preferred.

Question 6General Otolaryngology – Head and Neck Surgery

A 4-year-old child has recurrent otitis media with persistent middle ear effusion and a 30 dB conductive hearing loss. Which is the most appropriate initial surgical intervention after failed medical management?

  1. Tympanostomy tube placement Correct answer.
  2. Ossicular chain reconstruction
  3. Tympanoplasty
  4. Mastoidectomy

Explanation

For persistent otitis media with effusion and hearing loss in a child after medical management fails, tympanostomy tube insertion is the standard initial surgical step. It ventilates the middle ear and resolves the effusion.

Question 7General Otolaryngology – Head and Neck Surgery

Which cranial nerve is most commonly affected by a glomus jugulare tumor?

  1. Optic nerve
  2. Hypoglossal nerve
  3. Vagus nerve Correct answer.
  4. Facial nerve

Explanation

Glomus jugulare tumors arise from paraganglia in the jugular foramen and commonly cause lower cranial nerve deficits, especially of the vagus and glossopharyngeal nerves. Hoarseness and dysphagia are typical presenting symptoms.

Question 8General Otolaryngology – Head and Neck Surgery

A patient has sudden unilateral sensorineural hearing loss of 40 dB across three contiguous frequencies with onset 3 days ago. What is the most appropriate initial treatment?

  1. Observation alone
  2. High-dose oral corticosteroids with intratympanic steroids as adjunct Correct answer.
  3. Vestibular suppressants
  4. Oral antibiotics

Explanation

Idiopathic sudden sensorineural hearing loss is treated urgently with corticosteroids, typically high-dose oral therapy, with intratympanic steroids as adjunct or salvage. Early treatment improves the chance of hearing recovery.

Question 9General Otolaryngology – Head and Neck Surgery

Which of the following best describes the most common cause of epistaxis requiring medical attention in adults?

  1. Anterior septal bleeding from Kiesselbach plexus Correct answer.
  2. Sphenopalatine artery pseudoaneurysm
  3. Posterior ethmoid artery bleeding
  4. Internal carotid artery rupture

Explanation

Most epistaxis originates from the anterior nasal septum at Kiesselbach plexus, where small vessels are exposed. This location is accessible and typically controlled with pressure, cautery, or packing.

Question 10General Otolaryngology – Head and Neck Surgery

A 55-year-old man has progressive hoarseness and a 2 cm exophytic lesion on the true vocal cord with normal cord mobility. What T stage does this represent?

  1. T1 Correct answer.
  2. T3
  3. T2
  4. T4

Explanation

A glottic tumor confined to the vocal cord with normal mobility is T1. Impairment of cord mobility would upgrade to T2.

Question 11General Otolaryngology – Head and Neck Surgery

Which is the most common benign tumor of the parapharyngeal space?

  1. Paraganglioma
  2. Schwannoma
  3. Pleomorphic adenoma Correct answer.
  4. Lipoma

Explanation

Pleomorphic adenoma arising from minor salivary gland tissue or deep parotid lobe is the most common benign parapharyngeal space tumor. It typically presents as a painless medial displacement of the lateral pharyngeal wall.

Question 12General Otolaryngology – Head and Neck Surgery

A 30-year-old woman has a pulsatile tinnitus and a reddish retrotympanic mass on otoscopy. Imaging shows a vascular mass confined to the middle ear without extension beyond the tympanic cavity. What is the most likely diagnosis?

  1. Acoustic neuroma
  2. Cholesteatoma
  3. Glomus tympanicum Correct answer.
  4. Otosclerosis

Explanation

A red pulsatile middle ear mass with pulsatile tinnitus is characteristic of a glomus tympanicum tumor. Confinement to the middle ear distinguishes it from glomus jugulare.

Question 13General Otolaryngology – Head and Neck Surgery

Which of the following is the most appropriate initial imaging study for a suspected deep neck space abscess?

  1. MRI without contrast
  2. Ultrasound of the thyroid
  3. Plain radiograph of the neck
  4. Contrast-enhanced CT of the neck Correct answer.

Explanation

Contrast-enhanced CT of the neck is the preferred initial study for a suspected deep neck abscess because it defines the extent, identifies airway compromise, and distinguishes abscess from cellulitis.

Question 14General Otolaryngology – Head and Neck Surgery

A patient presents with a rapidly enlarging, painful, fluctuant mass in the submandibular region with fever and trismus. Which organism is most commonly implicated in a dental-origin deep neck infection?

  1. Streptococcus pneumoniae
  2. Pseudomonas aeruginosa
  3. Staphylococcus aureus
  4. Anaerobic oral flora including Prevotella Correct answer.

Explanation

Dental infections causing deep neck space abscesses are typically polymicrobial with anaerobic oral flora such as Prevotella and Fusobacterium. Empiric therapy should cover anaerobes.

Question 15General Otolaryngology – Head and Neck Surgery

Which of the following is the most common cause of unilateral vocal cord paralysis?

  1. Thyroid surgery Correct answer.
  2. Lung cancer
  3. Viral neuritis
  4. Cerebrovascular accident

Explanation

Iatrogenic injury during thyroid surgery is the most common cause of unilateral vocal cord paralysis. The recurrent laryngeal nerve is at risk near the inferior thyroid artery.

Question 16General Otolaryngology – Head and Neck Surgery

A 2-year-old child has noisy breathing that is worse on inspiration, and flexible laryngoscopy shows inspiratory collapse of the supraglottic structures. What is the most likely diagnosis?

  1. Tracheomalacia
  2. Vocal cord paralysis
  3. Laryngomalacia Correct answer.
  4. Subglottic stenosis

Explanation

Laryngomalacia is the most common cause of stridor in infants, with inspiratory collapse of supraglottic structures and worsening with feeding or lying supine. It typically resolves by 12-18 months.

Question 17General Otolaryngology – Head and Neck Surgery

Which of the following is a classic feature of a branchial cleft cyst?

  1. Midline neck mass that moves with swallowing
  2. Bilateral neck masses with fever
  3. Mass at the angle of the mandible with multiple fistulae
  4. Lateral neck mass anterior to the sternocleidomastoid muscle Correct answer.

Explanation

Second branchial cleft cysts, the most common type, present as a lateral neck mass along the anterior border of the sternocleidomastoid muscle. They may become tender or enlarge with upper respiratory infection.

Question 18General Otolaryngology – Head and Neck Surgery

A patient has a midline neck mass that moves upward with tongue protrusion. What is the most appropriate surgical procedure?

  1. Modified radical neck dissection
  2. Simple excision of the mass
  3. Sistrunk procedure Correct answer.
  4. Total thyroidectomy

Explanation

A thyroglossal duct cyst classically moves with tongue protrusion. The Sistrunk procedure removes the cyst, the central hyoid bone, and the tract to the foramen cecum to reduce recurrence.

Question 19General Otolaryngology – Head and Neck Surgery

Which of the following is the most common site of distant metastasis from head and neck squamous cell carcinoma?

  1. Bone
  2. Brain
  3. Liver
  4. Lung Correct answer.

Explanation

The lungs are the most common site of distant metastasis in head and neck squamous cell carcinoma. Screening chest imaging is part of staging.

Question 20General Otolaryngology – Head and Neck Surgery

A 50-year-old man has a painless, slowly growing mass in the submandibular region. FNA shows a low-grade mucoepidermoid carcinoma. What is the appropriate management?

  1. Incision and drainage
  2. Observation with serial ultrasound
  3. Submandibular gland excision with margin and neck evaluation Correct answer.
  4. Antibiotics

Explanation

Low-grade mucoepidermoid carcinoma is treated with complete surgical excision with negative margins and appropriate neck staging. Observation risks progression and recurrence.

Question 21General Otolaryngology – Head and Neck Surgery

A patient has a lesion on the lateral tongue that is biopsy-proven squamous cell carcinoma. Which of the following is the most important prognostic factor?

  1. Patient age
  2. Presence of leukoplakia
  3. Tumor thickness and depth of invasion Correct answer.
  4. Tumor color

Explanation

Depth of invasion and tumor thickness are the strongest predictors of nodal metastasis and survival in oral cavity squamous cell carcinoma. These guide elective neck dissection decisions.

Question 22General Otolaryngology – Head and Neck Surgery

Which of the following is the most appropriate initial management for a peritonsillar abscess in a patient with trismus and uvular deviation?

  1. Immediate tonsillectomy
  2. Oral antibiotics alone
  3. Observation
  4. Needle aspiration or incision and drainage with antibiotics Correct answer.

Explanation

Peritonsillar abscess is treated with drainage by needle aspiration or incision and drainage plus antibiotics. Immediate tonsillectomy is reserved for recurrent or complicated cases.

Question 23General Otolaryngology – Head and Neck Surgery

A patient with a history of treated head and neck cancer presents with a new, firm, fixed mass in the previously irradiated neck. What is the most appropriate next step?

  1. Reassurance
  2. Antibiotics
  3. FNA with imaging and consideration for salvage surgery Correct answer.
  4. Observation for six months

Explanation

A new fixed mass in a previously treated neck raises concern for recurrence or a new primary. FNA and imaging guide salvage surgery planning.

Question 24General Otolaryngology – Head and Neck Surgery

Which of the following best describes the most common cause of unilateral nasal obstruction with epistaxis in a young adult male in endemic regions?

  1. Inverted papilloma
  2. Antrochoanal polyp
  3. Juvenile nasopharyngeal angiofibroma Correct answer.
  4. Nasopharyngeal carcinoma

Explanation

Juvenile nasopharyngeal angiofibroma is a benign but locally aggressive vascular tumor occurring almost exclusively in adolescent males, presenting with unilateral nasal obstruction and recurrent epistaxis.

Question 25General Otolaryngology – Head and Neck Surgery

A patient has a unilateral clear rhinorrhea that worsens with leaning forward and is positive for beta-2 transferrin. What is the most likely diagnosis?

  1. Cerebrospinal fluid leak Correct answer.
  2. Vasomotor rhinitis
  3. Allergic rhinitis
  4. Choanal atresia

Explanation

Beta-2 transferrin is highly specific for cerebrospinal fluid, confirming a CSF leak. Unilateral clear rhinorrhea worsening with forward leaning supports this diagnosis.

Question 26General Otolaryngology – Head and Neck Surgery

A 45-year-old woman presents with a 6-month history of progressive nasal obstruction, hyposmia, and recurrent epistaxis. Endoscopy reveals a pale, polypoid mass filling the left nasal cavity. Biopsy shows a benign proliferation of glands and stroma. What is the most likely diagnosis?

  1. Inverted papilloma Correct answer.
  2. Nasal polyp
  3. Antrochoanal polyp
  4. Rhinosporidiosis

Explanation

Inverted papilloma typically presents as a unilateral nasal mass with obstruction and epistaxis, and histology shows epithelial invagination into the stroma. It is benign but has a risk of malignant transformation and recurrence. Nasal polyps are usually bilateral and inflammatory, while antrochoanal polyps arise from the maxillary sinus and extend posteriorly.

Question 27General Otolaryngology – Head and Neck Surgery

A 60-year-old man undergoes total laryngectomy for squamous cell carcinoma of the larynx. Postoperatively, he develops a pharyngocutaneous fistula. Which of the following is the most important initial step in management?

  1. initiation of oral feeding to promote healing
  2. Administration of broad-spectrum antibiotics and wound care Correct answer.
  3. Immediate surgical closure of the fistula
  4. Placement of a salivary bypass tube

Explanation

Most pharyngocutaneous fistulas are managed conservatively with wound care, antibiotics, and nutritional support, as many heal spontaneously. Surgical closure is reserved for fistulas that persist despite conservative measures. Oral feeding is typically withheld to reduce saliva flow and allow healing.

Question 28General Otolaryngology – Head and Neck Surgery

A 25-year-old man presents with a painless, fluctuant swelling in the anterior floor of the mouth that increases in size when he cries or strains. He reports occasional clear fluid discharge. What is the most likely diagnosis?

  1. Submandibular sialadenitis
  2. Ludwig's angina
  3. Dermoid cyst
  4. Ranula Correct answer.

Explanation

A ranula is a mucocele arising from the sublingual gland, presenting as a painless, fluctuant swelling in the floor of the mouth that may enlarge with increased salivary flow. Dermoid cysts are usually midline and doughy, while sialadenitis is painful and often associated with stones.

Question 29General Otolaryngology – Head and Neck Surgery

A 35-year-old woman presents with a 2-cm firm, mobile mass in the tail of the parotid gland. Fine-needle aspiration suggests a benign pleomorphic adenoma. Which of the following is the most appropriate management?

  1. Radiation therapy
  2. Observation with annual ultrasound
  3. Superficial parotidectomy Correct answer.
  4. Total parotidectomy with facial nerve sacrifice

Explanation

Pleomorphic adenoma is the most common benign salivary gland tumor and is treated with surgical excision, typically superficial parotidectomy, to prevent recurrence and malignant transformation. Observation is not recommended because of the risk of growth and malignancy. Radiation is not primary therapy for benign tumors.

Question 30General Otolaryngology – Head and Neck Surgery

A 50-year-old man presents with a rapidly enlarging, painless mass in the neck. Examination reveals a firm, mobile lymph node in level II. Fine-needle aspiration is consistent with squamous cell carcinoma. He has no history of head and neck cancer. What is the next most appropriate step?

  1. Excisional biopsy of the lymph node
  2. Empiric antibiotics and observation
  3. Radical neck dissection
  4. Panendoscopy with directed biopsies and imaging Correct answer.

Explanation

In a patient with a neck mass and FNA showing squamous cell carcinoma but no obvious primary, the next step is panendoscopy with directed biopsies to locate the primary tumor, along with imaging. Excisional biopsy is contraindicated as it may seed the neck and complicate subsequent surgery. Antibiotics and observation are inappropriate for a malignant mass.

Question 31General Otolaryngology – Head and Neck Surgery

Which of the following is the most common cause of acquired subglottic stenosis in adults?

  1. Prolonged endotracheal intubation Correct answer.
  2. Amyloidosis
  3. Wegener's granulomatosis
  4. Radiation therapy

Explanation

Prolonged endotracheal intubation is the leading cause of acquired subglottic stenosis in adults, due to pressure necrosis and scarring. Wegener's granulomatosis and amyloidosis are rare causes. Radiation can cause stenosis but is less common than intubation.

Question 32General Otolaryngology – Head and Neck Surgery

A 28-year-old man presents with a gradually enlarging, painless mass in the lateral neck. Ultrasound shows a cystic lesion. Fine-needle aspiration yields fluid with elevated amylase. What is the most likely diagnosis?

  1. Lymphangioma
  2. Thyroglossal duct cyst
  3. Branchial cleft cyst Correct answer.
  4. Warthin tumor

Explanation

A branchial cleft cyst typically presents as a lateral neck mass and may contain fluid with high amylase if lined by respiratory epithelium. Thyroglossal duct cysts are midline and move with swallowing or tongue protrusion. Warthin tumors are solid and occur in the parotid tail, and lymphangiomas are usually present in childhood and multiloculated.

Question 33General Otolaryngology – Head and Neck Surgery

A 55-year-old woman presents with a 3-month history of progressive hoarseness. Flexible laryngoscopy shows a smooth, submucosal mass in the supraglottis. Biopsy reveals a well-differentiated chondrosarcoma. What is the most appropriate treatment?

  1. Radical neck dissection
  2. Chemotherapy
  3. Radiation therapy alone
  4. Partial laryngectomy with clear margins Correct answer.

Explanation

Laryngeal chondrosarcoma is a rare, slow-growing malignancy that is best treated with surgical excision with clear margins, often partial laryngectomy, to preserve laryngeal function. It is relatively radioresistant, so radiation alone is not curative. Neck dissection is not indicated because lymphatic spread is rare.

Question 34General Otolaryngology – Head and Neck Surgery

A 40-year-old man presents with recurrent episodes of severe vertigo, fluctuating hearing loss, tinnitus, and aural fullness. Audiometry shows a low-frequency sensorineural hearing loss. Which of the following is the most appropriate initial management?

  1. Intratympanic gentamicin
  2. Low-salt diet and diuretics Correct answer.
  3. Endolymphatic sac decompression
  4. Vestibular nerve section

Explanation

Meniere's disease is initially managed conservatively with dietary salt restriction, diuretics, and sometimes betahistine. Surgical and ablative treatments are reserved for patients who fail conservative therapy. Vestibular nerve section and intratympanic gentamicin are destructive options for refractory cases.

Question 35General Otolaryngology – Head and Neck Surgery

A 65-year-old man presents with a 2-cm ulcerated lesion on the lower lip and a palpable submental lymph node. Biopsy confirms squamous cell carcinoma. Which of the following is the most important prognostic factor?

  1. Presence of inflammation
  2. Tumor thickness Correct answer.
  3. Tumor location
  4. Patient age

Explanation

Tumor thickness (or depth of invasion) is a strong prognostic factor in lip squamous cell carcinoma, correlating with risk of nodal metastasis and recurrence. Age and location are less important, and inflammation is not a standard prognostic factor.

Question 36General Otolaryngology – Head and Neck Surgery

A 30-year-old woman presents with a 1-cm pigmented lesion on the nasal tip that has been present since childhood and has recently darkened. Dermoscopy shows a homogeneous blue-gray pigmentation. What is the most likely diagnosis?

  1. Blue nevus Correct answer.
  2. Basal cell carcinoma
  3. Seborrheic keratosis
  4. Melanoma

Explanation

Blue nevus is a benign melanocytic lesion that presents as a blue-gray papule, often on the face, and is characterized by dermal melanocytes. Melanoma can also be blue but usually shows irregular features and change. Basal cell carcinoma is typically pearly with telangiectasias, and seborrheic keratosis is verrucous and stuck-on.

Question 37General Otolaryngology – Head and Neck Surgery

A 70-year-old man has a resectable parotid carcinoma confirmed on biopsy, involving both lobes and grossly invading the facial nerve. He has preoperative facial paralysis. Which operation best addresses the primary tumor?

  1. Observation with serial imaging
  2. Radical neck dissection alone
  3. Total parotidectomy with resection of the involved facial nerve Correct answer.
  4. Superficial parotidectomy with facial nerve preservation

Explanation

Confirmed parotid carcinoma with gross facial nerve invasion and preoperative palsy requires resection of the primary tumor and involved nerve. Preserving invaded tissue would compromise clearance; reconstruction and additional treatment are planned according to the disease extent.

Question 38General Otolaryngology – Head and Neck Surgery

A 45-year-old woman presents with a 1-cm, smooth, mobile mass in the midline of the neck that moves upward with tongue protrusion. Ultrasound shows a cystic lesion. What is the most appropriate surgical procedure?

  1. Total thyroidectomy
  2. Sistrunk procedure Correct answer.
  3. Simple excision
  4. Neck dissection

Explanation

A thyroglossal duct cyst is treated with the Sistrunk procedure, which involves excision of the cyst, the central portion of the hyoid bone, and the tract up to the foramen cecum, to minimize recurrence. Simple excision has a high recurrence rate. Thyroidectomy and neck dissection are not indicated.

Question 39General Otolaryngology – Head and Neck Surgery

A 50-year-old man presents with a 2-month history of unilateral nasal obstruction and recurrent epistaxis. Endoscopy shows a fleshy, vascular mass in the nasal cavity. Biopsy reveals a proliferation of small blood vessels with atypical endothelial cells. What is the most likely diagnosis?

  1. Capillary hemangioma
  2. Inverted papilloma
  3. Juvenile nasopharyngeal angiofibroma
  4. Angiosarcoma Correct answer.

Explanation

Angiosarcoma is a malignant vascular tumor that can present in the nasal cavity with epistaxis and obstruction, and histology shows atypical endothelial cells. Capillary hemangiomas are benign and common in children. Juvenile angiofibromas occur in adolescent males and arise in the nasopharynx, and inverted papillomas are epithelial tumors.

Question 40General Otolaryngology – Head and Neck Surgery

A 60-year-old woman undergoes total thyroidectomy for papillary thyroid carcinoma. Postoperatively, she develops hoarseness. Which of the following is the most likely cause?

  1. Superior laryngeal nerve injury
  2. Tracheal stenosis
  3. Hypocalcemia
  4. Recurrent laryngeal nerve injury Correct answer.

Explanation

Hoarseness after thyroidectomy is most commonly due to recurrent laryngeal nerve injury, which can occur unilaterally or bilaterally. Superior laryngeal nerve injury affects pitch but not vocal cord mobility. Hypocalcemia causes perioral numbness and tetany, not hoarseness.

Question 41Otology and Neurotology

A 45-year-old man has a unilateral pulsatile tinnitus that is synchronous with his heartbeat and is suppressed by ipsilateral neck compression. Which diagnosis is most consistent with this presentation?

  1. Glomus tympanicum tumor
  2. Palatal myoclonus
  3. Patulous eustachian tube
  4. Objective venous hum Correct answer.

Explanation

Pulsatile tinnitus that is synchronous with the pulse and abolished by gentle ipsilateral neck compression is characteristic of a venous hum from turbulent flow in the jugular system. Arterial etiologies such as glomus tumors or dural arteriovenous fistulas are not typically suppressed by neck compression. The key discriminating feature is the response to compression of the cervical vessels.

Question 42Otology and Neurotology

Which of the following best describes the classic audiometric pattern of otosclerosis in its early stage?

  1. Mixed loss with a maximal conductive component at 4 kHz
  2. Low-frequency conductive hearing loss with a Carhart notch at 2 kHz Correct answer.
  3. Flat sensorineural loss with poor speech discrimination
  4. High-frequency sensorineural loss with a rising contour

Explanation

Otosclerosis typically produces a conductive loss that is greatest at the low frequencies, and the fixation of the stapes creates an apparent bone-conduction dip at 2000 Hz known as the Carhart notch. This notch is an artifact of stapes fixation rather than true cochlear disease. Recognition of this pattern distinguishes otosclerosis from other conductive losses.

Question 43Otology and Neurotology

A patient reports brief episodes of vertigo triggered by rolling over in bed, each lasting under one minute. The Dix-Hallpike maneuver reproduces the vertigo with a torsional upbeating nystagmus after a short latency. What is the most appropriate first-line treatment?

  1. Epley canalith repositioning maneuver Correct answer.
  2. Vestibular nerve section
  3. Daily betahistine
  4. Intratympanic gentamicin

Explanation

The presentation is classic for posterior canal benign paroxysmal positional vertigo, and canalith repositioning (Epley) is the first-line therapy with high success. It is a mechanical maneuver that returns displaced otoconia to the utricle. Ablative and medical therapies are reserved for refractory or different diagnoses.

Question 44Otology and Neurotology

Which cranial nerve is most at risk of injury during the middle ear portion of a mastoidectomy when the surgeon works near the oval window?

  1. Hypoglossal nerve
  2. Facial nerve Correct answer.
  3. Optic nerve
  4. Glossopharyngeal nerve

Explanation

The facial nerve courses through the temporal bone and its tympanic segment runs just superior to the oval window, making it the structure most vulnerable during middle ear and mastoid surgery. Injury produces facial palsy. The other listed nerves do not course through the middle ear.

Question 45Otology and Neurotology

A 62-year-old woman has sudden unilateral sensorineural hearing loss that began 2 days ago. Which of the following is the most appropriate initial management?

  1. Observation with repeat audiogram in 3 months
  2. Hearing aid fitting
  3. High-dose oral corticosteroids started promptly Correct answer.
  4. Tympanostomy tube placement

Explanation

Sudden sensorineural hearing loss is treated as an otologic emergency, and prompt high-dose corticosteroids (oral or intratympanic) offer the best chance of recovery. Delay in treatment reduces the likelihood of hearing recovery. Observation, surgery, and amplification do not address acute cochlear injury.

Question 46Otology and Neurotology

Which of the following is the most common cause of conductive hearing loss in children?

  1. Otosclerosis
  2. Acoustic neuroma
  3. Cholesteatoma
  4. Otitis media with effusion Correct answer.

Explanation

Otitis media with effusion is the most frequent cause of conductive hearing loss in the pediatric population, producing a fluid-filled middle ear that impairs sound transmission. It is far more common in children than otosclerosis or cholesteatoma. Recognition guides management toward tympanostomy tubes or watchful waiting.

Question 47Otology and Neurotology

A patient with long-standing unilateral Meniere disease has disabling vertigo despite dietary salt restriction and medical therapy. Which surgical option preserves hearing while reducing vertigo attacks?

  1. Cochlear implantation
  2. Labyrinthectomy
  3. Translabyrinthine vestibular nerve section
  4. Endolymphatic sac decompression Correct answer.

Explanation

Endolymphatic sac decompression is a hearing-preserving procedure used for medically refractory Meniere vertigo. Labyrinthectomy and translabyrinthine approaches sacrifice hearing and are reserved for patients with non-serviceable hearing. The clinical decision hinges on residual hearing status and attack severity.

Question 48Otology and Neurotology

A 30-year-old presents with a painless, pearly white mass behind an intact tympanic membrane and a conductive hearing loss. Imaging shows a soft tissue mass confined to the middle ear. Which diagnosis is most likely?

  1. Otosclerosis
  2. Congenital cholesteatoma Correct answer.
  3. Facial nerve schwannoma
  4. Glomus jugulare

Explanation

A pearly white mass behind an intact tympanic membrane in a young patient with conductive loss is characteristic of congenital cholesteatoma. The lesion arises from embryonic epithelial rests and is confined to the middle ear initially. Early surgical excision prevents extension and complications.

Question 49Otology and Neurotology

Which feature on temporal bone imaging most reliably distinguishes a superior semicircular canal dehiscence from other causes of sound- or pressure-induced vertigo?

  1. Absence of bone over the superior semicircular canal on high-resolution CT Correct answer.
  2. Thickening of the stapes footplate
  3. Enhancement of the cochlea on T1 MRI
  4. Dilation of the endolymphatic duct

Explanation

Superior semicircular canal dehiscence syndrome is confirmed by high-resolution CT showing a bony defect over the superior canal in a patient with compatible symptoms such as Tullio phenomenon or autophony. The imaging finding must be correlated with clinical signs because asymptomatic dehiscence can occur. Other listed findings do not define the syndrome.

Question 50Otology and Neurotology

A patient develops a facial palsy 3 days after a stapedotomy. What is the most appropriate immediate management?

  1. Urgent surgical exploration with removal of the prosthesis Correct answer.
  2. Corticosteroid injection into the parotid
  3. Reassurance and observation
  4. Oral antibiotics alone

Explanation

Facial palsy after stapes surgery may indicate prosthesis displacement, reactive edema, or herpetic reactivation, but early postoperative palsy warrants urgent exploration to exclude a correctable mechanical cause. Delay risks permanent facial nerve injury. Observation and nonsurgical measures do not address a displaced prosthesis.