Otologic Surgery and Implants (Tympanoplasty, Mastoidectomy, Cochlear/BAHA Implants) MCQs

ENT · 62 free questions with answers & explanations.

1. A 35-year-old patient undergoes tympanoplasty for a large central perforation. The surgeon uses temporalis fascia graft placed medial to the tympanic membrane remnant. Which type of tympanoplasty technique is this?
2. During canal wall down mastoidectomy, the surgeon creates a meatoplasty. The primary purpose of enlarging the external auditory meatus in this procedure is to:
3. A 5-year-old child with bilateral profound sensorineural hearing loss is evaluated for cochlear implantation. Imaging reveals bilateral cochlear aplasia (Michel deformity). The most appropriate management is:
4. A BAHA (bone-anchored hearing aid) functions on the principle of:
5. In cochlear implant surgery, the electrode array is inserted into the cochlea. The most commonly used surgical approach for electrode insertion is via the:
6. The Wullstein classification of tympanoplasty is based on:
7. During a canal wall down mastoidectomy for cholesteatoma, the surgeon must create a meatoplasty. The primary purpose of meatoplasty in modified radical mastoidectomy is to:
8. A patient undergoes tympanoplasty type III. In this procedure, the neotympanum is placed directly on the:
9. A 5-year-old child with bilateral profound sensorineural hearing loss is evaluated for cochlear implantation. Which of the following is an absolute contraindication to cochlear implantation?
10. A Bone-Anchored Hearing Aid (BAHA) works by transmitting sound vibrations through the skull bone to the cochlea. The principal mechanism of hearing achieved by BAHA is:
11. During cortical mastoidectomy for acute mastoiditis, the surgeon identifies the solid angle (trautmann's triangle). The boundaries of the posterior fossa dural plate (Trautmann's triangle) in mastoidectomy are all EXCEPT:
12. A 35-year-old man with bilateral profound sensorineural hearing loss (aided thresholds >70 dB HL) and absent open-set sentence recognition despite optimal hearing aids is evaluated for cochlear implantation. Which additional audiological criterion best identifies him as a cochlear implant candidate?
13. During cortical mastoidectomy for chronic suppurative otitis media with cholesteatoma, the surgeon identifies the lateral semicircular canal (LSCC) as the key surgical landmark. Which relationship of the LSCC to the facial nerve (second genu) is correct?
14. A Bone-Anchored Hearing Aid (BAHA) is best indicated in which of the following clinical scenarios?
15. In Wullstein's classification of tympanoplasty, a Type III repair (myringostapediopexy) is performed when which middle ear structure is intact?
16. A 28-year-old woman undergoes canal wall up mastoidectomy for atticoantral disease. Postoperatively she develops sensorineural hearing loss and severe vertigo. Imaging shows a perilymph fistula at the oval window. Which surgical step most likely caused this complication?
17. Which of the following is a contraindication to cochlear implantation?
18. During stapedectomy for otosclerosis, a 'floating footplate' occurs. What is the most appropriate next step?
19. An underlay tympanoplasty graft is placed medial to the tympanic membrane remnant. Which material is considered the gold standard graft for this technique?
20. During tympanoplasty, the graft is placed in the 'underlay' technique. Which anatomical landmark guides correct placement of the anterior margin of the fascia graft?
21. A posterior canal wall-up mastoidectomy (CWU) is performed for cholesteatoma. The surgical principle of leaving the posterior canal wall intact is BEST justified by which advantage?
22. For cochlear implantation, the electrode array is inserted through which opening?
23. A patient with single-sided deafness (SSD) and intact contralateral hearing is best rehabilitated with which device?
24. During mastoid surgery, the surgeon identifies the 'fossa incudis' as a landmark. This structure marks the lateral boundary of which space?
25. Type III tympanoplasty (myringostapediopexy) is indicated when which ossicle(s) are absent?
26. A 45-year-old patient develops post-auricular fistula 3 months after canal wall-up mastoidectomy for cholesteatoma. The most likely cause is:
27. The minimum sentence-level speech perception score (in quiet) typically required for cochlear implant candidacy in post-lingually deafened adults under current guidelines is:
28. A 35-year-old patient with safe CSOM undergoes Type I tympanoplasty. The temporalis fascia graft is placed using the underlay technique. Which of the following best describes the anatomical rationale for preferring the underlay technique over overlay?
29. During a canal wall-up mastoidectomy for unsafe CSOM with cholesteatoma, which surgical landmark is used to identify the level of the tegmen plate and prevent intracranial entry?
30. A 5-year-old child with bilateral profound sensorineural hearing loss from connexin-26 mutation is evaluated for cochlear implantation. Which finding on preoperative high-resolution CT temporal bone would most likely alter the surgical approach?
31. A BAHA (bone-anchored hearing aid) is most appropriately indicated in which of the following clinical scenarios?
32. In a modified radical mastoidectomy, which structure must be preserved to allow open cavity to drain freely and is also called the 'meatoplasty' target?
33. During a cortical mastoidectomy for acute mastoiditis, the surgeon identifies the tegmen mastoideum superiorly and the sigmoid sinus posteriorly. The 'MacEwen's triangle' is used as a surface landmark to locate which structure?
34. A patient with bilateral severe-to-profound sensorineural hearing loss (pure-tone average >90 dB HL) undergoes cochlear implantation. Post-activation, the most important prognostic factor for speech perception outcomes in a prelingually deaf adult implanted at age 35 years is:
35. A Wullstein type III tympanoplasty is characterized by:
36. A Bone-Anchored Hearing Aid (BAHA) achieves sound amplification through which mechanism?
37. In modified radical mastoidectomy, which structure forms the 'facial ridge' that must be reduced to adequately exteriorize the mastoid cavity?
38. A 35-year-old patient with a central tympanic membrane perforation and intact ossicular chain undergoes type I tympanoplasty. Intraoperatively, the anterior canal wall is found to be overhanging, limiting graft placement. Which grafting technique is most appropriate in this situation?
39. During canal wall down mastoidectomy, the surgeon identifies the 'sentinel cell' (Koerner's septum). What is the surgical significance of this structure?
40. A 4-year-old child with bilateral profound sensorineural hearing loss and absent otoacoustic emissions is evaluated for cochlear implantation. High-resolution CT of the temporal bone shows bilateral Mondini malformation (incomplete partition type II). Which of the following is the most significant implant-related risk in this patient?
41. A bone-anchored hearing aid (BAHA) is being considered for a child with bilateral microtia and atresia. The recommended minimum age for osseointegrated implant placement in children and the minimum skull thickness required for direct bone anchoring are respectively:
42. A patient undergoes intact canal wall (canal wall up) mastoidectomy with ossiculoplasty for chronic otitis media with cholesteatoma. Six months postoperatively, she presents with recurrent cholesteatoma confirmed on MRI. What is the specific MRI sequence most useful for detecting residual/recurrent cholesteatoma after canal wall up mastoidectomy?
43. A 35-year-old woman with bilateral severe-to-profound sensorineural hearing loss (>90 dB HL) undergoes cochlear implantation. During surgery, the surgeon notes that the round window membrane is absent and there is severe cochlear ossification. Which surgical approach is most appropriate in this situation?
44. During a modified radical mastoidectomy for cholesteatoma, the surgeon encounters a dehiscent facial nerve at the second genu. The nerve is stretched over the cholesteatoma matrix. The most appropriate intraoperative action is:
45. A BAHA (bone-anchored hearing aid) system works on the principle of:
46. A type III tympanoplasty (myringostapediopexy) is indicated when:
47. The minimum duration of successful bilateral hearing aid trial before cochlear implantation candidacy is assessed in postlingually deafened adults (as per most guidelines) is:
48. A 35-year-old man undergoes canal wall down mastoidectomy for cholesteatoma. Post-operatively, he develops a cavity that requires regular cleaning every 3 months. Which surgical modification at the time of primary surgery most effectively reduces the cavity maintenance burden?
49. During tympanoplasty, the surgeon uses an underlay technique with temporalis fascia graft. At 3-month follow-up the graft appears blunted anteriorly at the tympanomeatal angle. Which intraoperative step best prevents this anterior blunting?
50. A patient with bilateral profound sensorineural hearing loss and absent auditory brainstem response has cochlear implant evaluation. Pre-operative high-resolution CT shows bilateral cochlear ossification following bacterial meningitis. What is the surgical implication of this finding?
51. A bone-anchored hearing aid (BAHA) is being considered for a child with bilateral aural atresia and conductive hearing loss of 60 dB. What is the minimum age recommended for surgical implantation of the titanium fixture in most guidelines?
52. In canal wall up (intact canal wall) mastoidectomy for cholesteatoma, the most significant advantage over canal wall down surgery is:
53. A 34-year-old man undergoes canal wall down mastoidectomy for extensive cholesteatoma. Post-operatively, he is found to have a moist cavity with granulations at 6 months. The most appropriate next step in management is:
54. In cochlear implantation, the most important factor determining post-implantation speech perception outcome is:
55. A 7-year-old child with bilateral profound sensorineural hearing loss is being evaluated for cochlear implantation. High-resolution CT shows bilateral incomplete partition type II (Mondini deformity) cochleae. Which of the following is a recognized complication specific to this anatomy during surgery?
56. The Wullstein type III tympanoplasty (columella effect) is used when:
57. A BAHA (bone-anchored hearing aid) is contraindicated in which of the following conditions?
58. During tympanoplasty for a large subtotal tympanic membrane perforation, the surgeon uses an underlay technique with temporalis fascia graft. Which anatomical landmark ensures the graft does not migrate anteriorly into the eustachian tube orifice?
59. A patient with bilateral severe-to-profound sensorineural hearing loss who has pure-tone thresholds of 95 dB HL at 500 Hz and 100 dB HL at 2000 Hz gets negligible benefit from hearing aids. The best candidacy criterion that most specifically determines cochlear implant eligibility in adults (as per current guidelines) is:
60. In a canal wall up (CWU) mastoidectomy for chronic otitis media with cholesteatoma, the posterior tympanotomy approach is used to achieve adequate exposure. Which structure defines the posterior tympanotomy boundaries superiorly and inferiorly respectively?
61. A bone-anchored hearing aid (BAHA) is ideally indicated in a patient with:
62. Which type of tympanoplasty involves reconstruction of the ossicular chain using an intact stapes with malleus handle present, along with tympanic membrane repair (Type IIIa as per Austin-Kartush modification)?