Correct Answer - C
Ans. is 'c' i.e., Atelectasis
Tympanic membrane retraction
The retracted segment of eardrum is often known
as a retraction pocket.
The terms "atelectasis" or sometimes "adhesive otitis media" can
be used to describe retraction of a large area of the pars tensa.

Correct Answer - D
Ans. is'd' i.e., Two nasal bones
External nose has an osteocartilaginous framework of which upper
one - third is bony and lower two-third is cartilaginous.
1. Bony part :- Consists of two nasal bones.
2. Cartilagenous part :- Consists of two upper lateral cartilages, two
lower lateral cartilages, two or more lessar alar (or sesmoid)
cartilages and a septal cartilage. So, there are 3 paired and 1
unpaired cartilages.

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Correct Answer - B
Ans. is 'b' i.e., Posterior [Ref Dhingra S
th
/e p. 51]
BPPV is thought to be caused by displacement of otoconia (mineral
crystals) from the vestibule of inner ear into the semicircular canals.
The posterior semicircular canal is most commonly involved, though
superior and horizontal canals canal can also be affected.
Otoconia or ear rocks are small crystals of calcium carbonate
derived structure in the utricle which migrate into semicircular canals
and cause BPPV. While saccules also contains otoconia, they are
not able to migrate into the semicircular canals.

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Correct Answer - A
Ans: A. Auricular branch Vagus nerve.
>Auricular branch of Vagus (Arnold's nerve) and Facial nerve
continues inwards to supply the posterior wall and floor of the EAC.
> The cough response caused while stimulating the ear canal is
mediated by the vagus which also supplies the larynx.
(Re/. Shambaugh, 6th ed., page 45)

Correct Answer - B
Ans. is 'B' i.e., Presbycusis
Information in this question are :- (i) Old age (65 years), (ii) Hearing
loss, and (iii) Preserved speech discrimnation.
Diagnosis is Presbycusis.
Presbycusis
Presbycusis refers to sensorineural hearing loss in elderly
individuals
Characteristically, presbycusis involves bilateral high
frequency hearing loss associated with difficulty in speech
discrimination and central auditory processing information.
Four pathological types of presbycusis have been identified :-
Sensory presbycusis There is epithelial atrophy with loss of sensory
hair cells and supporting cells in the organ of corti. This
process starts in the basal turn of cochlea and slowly progress
towards the apex. Higher frequencies are affected but speech
discrimination is preserved.
Neural presbycusis :- There is atrophy of nerve cells in the cochlea
and central neural pathways. Atrophy occurs throughout the
cochlea, with the basilar region only slightly more predisposed than the remainder of the cochlea. Therefore, no precipitous drop in
threshold on audiometry is observed. Speech discrimination is poor.
Metabolic (strial) presbycusis ;;- There is atrophy of stria vascularis.
Atrophy results in hearing loss represented by flat audiogram, but
speech discrimination is preserved.
Mechanical (cochlear conductive) presbycusis :- There is thickening
and secondary stiffening of the basilar membrane of the cochlea.
The thickening is more severe in the basal turn of cochlea where the
basilar membrane is narrow. This correlates with a gradually sloping
high frequency sensorineural hearing loss. Speech discrimination is
average.

Correct Answer - C
Ans. is 'c' i.e., Extreme pain [Ref Dhingra 5th/e p. 77; Pediatric
otolaryngology 2"/e p. 478]
Clinical features of tubotympanic CSOM
Profuse mucopurulent discharge which is not foul smelling, i.e., non-
foul smelling discharge
Hearing loss (conductive type). If sensorineural component also
occurs (i.e., mixed type), it arouses the suspicion of toxic deafness.
Sometimes, patient reports a paradoxical effect, i.e., hears better in
the presence of discharge than when the ear isdry. This is due to
round window shielding effect produced by discharge which helps to
maintain phase differential.
There is no pain, if it occurs it is due to associated otitis externa not
due to otitis media.
Since the infected area is open at both ends, discharge does not
accumulate in the middle ear cavity
Ossicular chain is mostly uninvolved, if involved only long process of
incus is involved.