ENT Ear Nose Throat: AIIMS May 2012

Q-1. Initial screening test to assess hearing loss in newborn
a) Visual Re-enforcement Audiometry
b) OAE
c) ABR
d) Free Field Audiometry

Answer: OAE
Explanation:
Tests used for screening newborns for hearing loss include Otoacoustic emissions (OAE) and automated Auditory Brainstem Response audiometry (aABR).
While OAE is cheap, quick, simple and reliable with a sensitivity of 100% and specificity of 99 %, aABR has the additional advantage of identifying neonates with auditory neuropathy unlike testing for OAE.
The most common sequence of tests is a two-step screening process in which OAEs are performed first, followed by ABR in those newborns that do not pass the OAEs.
Important point:
The most commonly used method in neonatal hearing screening programs is transient evoked otoacoustic emissions in the first stage of the process.
TOAE’s are commonly used to screen infant hearing, to validate auditory thresholds obtained via other techniques, and to assess the cochlear contribution to hearing.

Q-2. In Electro-cochleography
a) Probe, stimulation and outer cells
b) Summation of microphonics
c) AP of cochlear nerve
d) Evoked potential generated in cochlea and auditory nerve

Answer: Evoked potential generated in cochlea and auditory nerve
Explanation:
Electro-cochleography is a procedure to record the potentials generated by the cochlea and the auditory nerve.
There are three classes of potentials that can be recorded from the cochlea and auditory nerve in response to sound stimuli.
They are compound action potential of auditory nerve (AP), Summating potential (SP), and cochlear potential (CP) also known as cochlear microphonic.
Electro-cochleography is predominently used in the diagnosis, assessment and monitoring Meniere’s disease, and endo-lymphatic hydrops.

Q-3. Vestibular Evoked Myogenic Potential (VEMP) detects lesion of
a) Cochlear Nerve
b) Superior Vestibular Nerve
c) Inferior Vestibular Nerve
d) Inflammatory Myopathy

Answer: Inferior Vestibular Nerve
Explanation:
Vestibular-evoked myogenic potential (VEMP) testing is a vestibular function test used for evaluating saccular and inferior vestibular nerve function.

Q-4. Second Primary Tumor of Head & Neck most commonly suspected in malignancy of
a) Oral cavity
b) Larynx
c) Hypopharynx
d) Para-nasal sinuses

Answer: Oral cavity
Explanation:
Patients with head and neck squamous cell carcinoma are at increased risk for the development of second primary malignancies (New) compared with the general population.
These second primary malignancies typically develop in the aero-digestive tract.
People who have been treated for head and neck cancers have an increased chance of developing a new cancer, usually in the head, neck, esophagus, or lungs. The chance of a second primary cancer varies depending on the site of the original cancer, but it is higher for people who use tobacco and drink alcohol.

Q-5. In right handed person direct laryngoscope is held by which hand
a) Left
b) Right
c) Either of these
d) Both

Answer: Left
Explanation:
The laryngoscope handle is held in the left hand in right handed person. The fingers of the right hand are used to open the mouth and spread the lips apart.
The blade is inserted at the right side of the mouth. This reduces the likelihood of incisor teeth damage and helps push the tongue to the left.

Q-6. 6 year old child presented with recurrent URTI with mouth breathing, nasal obstruction and impaired hearing with high arched palate. Treatment is
a) Tonsillectomy
b) Adenoidectomy with grommet insertion
c) Grommet insertion
d) Myringoplasty with grommet insertion

Answer: Adenoidectomy with grommet insertion
Explanation:
Recurrent URTI with mouth breathing, nasal obstruction and impaired hearing- Adenoid hyperplasia with glue ear
Treatment of glue ear:
Tympanostomy tube insertion is the preferred initial procedure
Treatment of glue ear with nasal obstruction and mouth breathing:
Tympanostomy tube insertion with adenoidectomy