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.

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Correct Answer - D
Ans. is 'd' i.e., CSF Rhinorrhoea [ Ref: Logan Turner 10(
h
/e p.
28, Dhingra 5
th
/e p. 179]
Detection of site of CSF leak in CSF Rhinorrhoea
1. HRCT : - HRCT with or without godolinium is the most helpful study
for identifying the site of leak, i.e., investigation of choice.
2. MRI : - MRI with heavy T2 weighted image may highlight CSF
sufficiently to show the leak.
3. CT cisternography : - CT scan after injection of contrast dye is
effective in patients with an active leak.
4. Radioisotope cisternography : - Radioisotope injected intrathecally
and measured.
5. Fluorescin dye : - Intrathecal fluorescin with endoscopic
visualization.

Correct Answer - B
Ans. is 'b' i.e., Sphenopalatine artery [Ref Scott Brown 7
h
/e Vol-
2p. 1597; Dhingra 5
th
/e p. 190]
Woodruff's area : ?
It is situated under the posterior end of inferior turbinate.
Sphenopalatine artery anastomoses with posterior pharyngeal artery
here. Posterior epistaxis occurs in this area.