1.

A 24-year-old lady came with the complaints of left sided earache, foul-smelling ear discharge and reduced hearing since 3 years. She has seen multiple doctors and has taken medications but have been lost to follow-up after a few visits. Recently she has grown overly anxious about her disease and wants to get treated. You perform an otoscopy of the ear and find the following picture:

Questions :-

1. Enumerate three more symptoms that might be associated with this condition.
2. What imaging investigation would you consider for this patient?
3. What type of hearing loss is expected to be found in this patient?
4. What would be the management for this patient?

2.

A 55-year-old woman complains of sudden eruptions on the left pinna for 2 days. These lesions are extremely painful and the patient has never experienced anything of this sort before. She started developing left-sided facial weakness from yesterday and is getting worried. She has been referred to you by her family physician on an urgent basis for management of her condition. Her pinna looks like the following:

Questions:

1. What is the most likely diagnosis?
2. What is the specific serological test that you would perform for this patient to confirm the diagnosis?
3. What could be the other possible symptoms of this patient?
4. Enumerate the management you would perform for this patient.

3.

A 22-year-old man came to the ENT OPD with an alleged history of a fall from a bike yesterday after meeting with a road traffic accident. He is complaining of reduced hearing from the right side following the incident. You advise an urgent HRCT scan of the Temporal Bone and find the following picture:

a. What is the abnormality being shown in the imaging?
b. What is the type of hearing loss that this patient is more likely to be suffering from given this abnormality?
c. Mention 4 other symptoms that the patient might experience.
d. Mention one late complication of this injury.

4.

A lady comes to the ENT OPD with the complaint of hearing loss on the right ear. She has a history of recurrent upper respiratory tract infections and allergy since childhood. You perform otoscopy for this patient and find the following picture. You ask the patient to perform Valsalva maneuver, but there is no mobility on otoscopy.

a. What is the most likely diagnosis from the above otoscopic image?
b. What is the classification system used for this type of conditions?
c. What is the Tos classification used for and elaborate the grades of the Tos classification.
d. How do you manage this case?

5.

An elderly man presents to your ENT Clinic with the complaint of aural fullness, pulsatile tinnitus and hearing loss on the right side. The symptoms started from last one year and have been progressing since. There is no history of trauma in this patient. On performing an otoscopy, you get the following image of the tympanic membrane:

a. What is the most likely diagnosis from this image?
b. What is the origin of these kinds of disease entities?
c. Name one classification system commonly used for these.
d. Mention three management modalities for this condition.

6.

A 33-year-old boy is brought to the ENT OPD with the complaint of inability to respond to loud sounds. His parents are worried as they have realised that the child cannot speak like his friends. You advise a high-resolution CT scan of the Temporal Bones for the child and receive the following images as below:

1. Identify the deformity from the CT scan sections being shown.
2. Label the abnormalities shown in sections 1,2 and 3.
3. What is the most common intraoperative complication expected in this child for which you must take special precautions?
4. Which special type of electrode may be used during the cochlear implantation of this child with the anticipated complication asked above?

7.

An 8-year-old girl presented to the ENT clinic. She has been suffering from cardiac disorders since birth. She has the following appearance of her face as given below. Observe the figures given below and answer the following questions:

1. Identify the syndrome being shown in these photographs.
2. Enumerate 3 typical clinical features of this.
3. Name the classification system and its components used for this spectrum of syndromes.
4. Mention one recently identified gene whose mutation is responsible for this condition.

8.

A 3-year-old girl presented with congenital bilateral profound sensorineural hearing loss with no benefit from hearing aid usage. She underwent a surgical procedure for this condition. Her photograph is attached below with the device being worn:

1. What is the device being worn by this patient known as?
2. Name two surgical techniques that can be used for placing this device.
3. Name two most important imaging investigations that must be performed for planning the candidacy and surgical road-map of this patient.
4. Name one surgical complication of this procedure.

9.

A 33-year-old woman presents to the ENT outpatient department with the complaint of hearing loss. She speaks in a very low tone and recalls that the problem started during her pregnancy. You order a Pure Tone Audiometry to be performed. The following image shows her audiogram:

1. What is the type of hearing loss being shown in the audiogram above?
2. What is the classical finding being shown here?
3. Mention briefly the reason why this finding occurs.
4. Give 2 probable diagnoses from the audiogram above.

10.

The following shows the coronal section through the external canal and middle ear at the level of the malleus handle.

1. Label the structure marked (A). What is the nerve marked as (B)?
2. From which nerve does structure (B) originate?
3. What is the sign for loss of sensation in the postero-superior part of the external auditory canal and in what condition does it occur?
4. Name one condition in which there is “sagging” of the postero-superior part of the deeper external canal wall.