Otosclerosis and Sensorineural Hearing Loss MCQs

ENT · 43 free questions with answers & explanations.

1. A 30-year-old woman presents with progressive bilateral conductive hearing loss. Tympanometry shows an 'As' (shallow) curve. Audiometry reveals a characteristic notch at 2 kHz on bone conduction. The most likely diagnosis is:
2. An elderly patient presents with gradual, symmetric high-frequency sensorineural hearing loss that is worse in noisy environments. Audiometry shows downward-sloping hearing loss from 2 kHz onwards. The most likely type of presbycusis is:
3. Fluoride therapy in otosclerosis acts by which mechanism?
4. Sudden sensorineural hearing loss (SSNHL) is defined as ≥30 dB SNHL over at least 3 consecutive frequencies occurring within 72 hours. The first-line treatment according to current guidelines is:
5. In otosclerosis, the Carhart notch on pure tone audiogram is a MECHANICAL (not cochlear) artefact. It is most pronounced at which frequency, and what is the physiological explanation?
6. A 32-year-old woman with bilateral conductive hearing loss worsening during pregnancy is found to have a flamingo-pink blush of the promontory on otoscopy (Schwartze sign). On tympanometry, type A trace is obtained. Which treatment has the best long-term outcomes for this condition?
7. Autoimmune inner ear disease (AIED) is characterized by rapidly progressive bilateral SNHL. Which immunological marker is MOST specific for AIED, and which treatment is first-line?
8. The Carhart notch in otosclerosis is a characteristic dip in bone conduction at 2000 Hz. The mechanism of this notch is:
9. Sodium fluoride is used in medical treatment of otosclerosis. Its mechanism is:
10. Age-related hearing loss (presbyacusis) is classified into four histopathological types by Schuknecht. The most common type, characterised by gradual high-frequency sloping loss with loss of outer hair cells in the basal cochlear turn, is:
11. A 30-year-old woman presents with progressive bilateral conductive hearing loss worse during pregnancy. Otoscopy shows a flamingo pink hue of the promontory through the tympanic membrane (Schwartze sign). This positive Schwartze sign indicates:
12. Noise-induced sensorineural hearing loss (NIHL) preferentially affects which frequency on pure tone audiogram, and what pathological change underlies this?
13. A patient with otosclerosis is not a candidate for surgery. Which of the following is the MOST appropriate hearing rehabilitation device, and why is a BAHA (Bone-Anchored Hearing Aid) NOT preferred over conventional amplification?
14. In stapedectomy for otosclerosis, the prosthesis is placed from the long process of the incus to the vestibule (oval window). The Carhart's notch seen in the bone conduction audiogram of otosclerosis patients at 2000 Hz improves after successful stapedectomy because:
15. Sodium fluoride is used as a medical treatment for otosclerosis. Its mechanism involves inhibition of which process in the otosclerotic focus?
16. Sodium fluoride therapy in cochlear otosclerosis works by which primary mechanism?
17. A patient with bilateral profound SNHL receives a cochlear implant. During programming, the audiologist finds that the patient requires extremely high stimulation levels. Which electrode position within the cochlea leads to this finding?
18. Auditory neuropathy spectrum disorder (ANSD) is characterized by which combination of findings?
19. Carhart's notch in otosclerosis is a depression in bone conduction thresholds at 2000 Hz. This finding is best described as:
20. Noise-induced hearing loss (NIHL) characteristically produces a 4 kHz notch on audiometry. The primary mechanism for this selective frequency vulnerability is:
21. Current adult cochlear implant candidacy criteria (per AAO-HNS/ASHA guidelines) have been expanded from historical thresholds. Which best reflects current candidacy?
22. A 30-year-old woman with bilateral conductive hearing loss is diagnosed with otosclerosis. She is pregnant (12 weeks) and asks about treatment. Which of the following is MOST accurate regarding management during pregnancy?
23. In patients with bilateral severe-to-profound SNHL who receive cochlear implants, which of the following anatomical structures is the electrode array stimulating to restore hearing?
24. In stapedectomy for otosclerosis, the small fenestra technique is preferred over total footplate removal. The prosthesis is placed between the incus long process and the oval window. Which characteristic audiometric finding BEFORE surgery distinguishes otosclerosis from ossicular fixation due to other causes?
25. A 30-year-old woman presents with progressive bilateral hearing loss. Audiometry shows bilateral conductive hearing loss with a characteristic dip at 2000 Hz on bone conduction audiogram. Tympanometry shows Type As (reduced compliance). The pathological process causing this 2000 Hz bone conduction dip is:
26. A 30-year-old woman is diagnosed with clinical otosclerosis. She declines surgery and requests medical management. Which agent is used to slow the progression of the sensorineural component (cochlear otosclerosis)?
27. In a patient with sudden sensorineural hearing loss (SSNHL) presenting within 24 hours, the initial treatment of choice according to current AAO-HNSF guidelines is:
28. During stapedectomy for otosclerosis, the surgeon encounters a perilymph 'gusher' — a forceful flow of perilymph from the oval window after stapedotomy. The most likely underlying abnormality causing this complication is:
29. Sudden sensorineural hearing loss (SSNHL) is defined as a rapid loss of ≥30 dB in three contiguous frequencies over 72 hours. The first-line treatment and the evidence basis for intratympanic steroid injection as salvage therapy are:
30. In stapedectomy for otosclerosis, the Carhart notch is a characteristic audiometric finding. It refers to a dip in bone conduction thresholds at:
31. Sudden SNHL (≥30 dB over ≥3 consecutive frequencies within 72 hours) is considered a medical emergency. The first-line treatment according to AAO-HNS guidelines is:
32. A patient undergoing stapedectomy for otosclerosis develops sensorineural hearing loss in the immediate postoperative period. The most common cause of this 'cochlear dead ear' following stapedectomy is:
33. A 35-year-old woman on long-term furosemide therapy develops sudden bilateral symmetric high-frequency sensorineural hearing loss. The mechanism of furosemide-induced ototoxicity is:
34. A 32-year-old woman with bilateral progressive conductive hearing loss is noted to have bilateral absent acoustic reflexes and Carhart's notch (mechanical BC notch at 2 kHz) on audiometry. Tympanogram shows shallow Type As (stiffness) pattern. Which medical treatment may slow progression of otosclerosis?
35. In stapedotomy for otosclerosis, a piston prosthesis is inserted from the incus long process to a small fenestration in the footplate. What is the MOST feared early complication specific to this procedure?
36. A 32-year-old woman with bilateral progressive conductive hearing loss for 5 years, paracusis Willisii, and tinnitus undergoes audiometry. Findings include air-bone gap, type As tympanogram, absent stapedial reflexes, and Carhart's notch. Schwartze sign is positive. The finding of Schwartze sign indicates:
37. A 30-year-old woman presents with progressive bilateral conductive hearing loss. Audiometry shows bilateral low-frequency conductive loss with a Carhart's notch at 2000 Hz. Tympanometry shows Type As (stiff) curve. The most likely diagnosis and the underlying mechanism are:
38. Which drug is implicated in causing irreversible cochleotoxicity with a predilection for outer hair cell damage, especially in the basal turn of the cochlea, causing high-frequency hearing loss first?
39. A 30-year-old woman presents with progressive bilateral conductive hearing loss. Audiometry shows bilateral conductive hearing loss with a characteristic notch in bone conduction at 2000 Hz. Tympanometry shows a type As pattern. This notch is called:
40. A 70-year-old presents with symmetric high-frequency sensorineural hearing loss affecting frequencies above 2000 Hz, with poor word recognition. Histopathologically, this corresponds to loss of which cochlear structure?
41. A patient with otosclerosis is planned for stapedectomy. Intraoperatively, a persistent stapedial artery is identified crossing the footplate. What is the appropriate management?
42. Carhart's notch on audiometry in otosclerosis is a sensorineural dip seen at which frequency and is caused by:
43. Sudden sensorineural hearing loss (SSNHL) is defined as a loss of ≥30 dB over at least 3 consecutive frequencies occurring within what time frame?