Neurotology

Question 1

For treatment of Meniere’s disease, which procedure should be avoided?
● A. Middle ear perfusion with gentamicin
● B. Bilateral selective vestibular neurectomy
● C. Salt restriction
● D. Vestibular suppressants (e.g., Valium, meclizine)
● E. Endolymphatic shunting

Answer 1

B. Bilateral selective vestibular neurectomy

Question 2

What is the most common cause of Bell’s palsy?
● A. Diabetes
● B. Herpes zoster infection
● C. Trauma/basal skull fracture
● D. Tumor
● E. Idiopathic

Answer 2

E. Idiopathic

Question 3

Which of the following diagnostic studies shows normal latencies in Meniere’s disease?
● A. ENG with bithermal caloric stimulation
● B. Audiogram
● C. BAER
● D. CT/MRI
● E. VDRL

Answer 3

C. BAER

Question 4

For Bell’s palsy, if there is complete paralysis of facial nerve at onset, what proportion of patients will have an incomplete recovery despite management?
● A. 30%
● B. 50%
● C. 80%
● D. 90%
● E. 95%

Answer 4

B. 50%

Question 5

A 70-year-old male presented in OPD with complaints of decreased hearing in right ear. On examination, he is having positive Rinne test (bilaterally AC > BC) and Weber is lateralizing to
left ear. What type of hearing loss he is having?
● A. Conductive hearing loss in right ear
● B. Sensorineural hearing loss in right ear
● C. Combined conductive + SNHL
● D. Combined sensorineural hearing loss
● E. Both A and B

Answer 5

B. Sensorineural hearing loss in right ear

Question 6

Regarding Bell’s palsy if treatment is administered, which of the following is the most widely accepted for improvement?
● A. Tarsorrhaphy
● B. Direct brow lift
● C. Transposition of the temporalis muscle
● D. Corticosteroids
● E. Eye ointment and tear drops

Answer 6

D. Corticosteroids

Question 7

Which of the following is a characteristic of grade IV Bell’s palsy?
● A. Eye closure is incomplete
● B. Forehead motion is slight to moderate
● C. A slightly weak mouth movement is noted with maximal effort
● D. Asymmetry is noted at rest
● E. Both A and B

Answer 7

E. Both A and B

Question 8

Which of the following is not a typical feature of Ménière’s disease?
● A. Insidious and progressive hearing loss
● B. Tinnitus
● C. Vertigo
● D. Otolithic crisis of Tumarkin
● E. Fluctuating deafness

Answer 8

A. Insidious and progressive hearing loss

Question 9

Which of the following is recommended regarding steroid treatment in patients with Bell’s palsy?
● A. Corticosteroids treatment in Bell’s palsy is only recommended within the first 24 hours after symptom onset
● B. Prednisolone 25 mg per oral, twice daily for 10 days
● C. Antiviral treatment should be given as monotherapy prior to steroid treatment
● D. Antiviral combined with prednisolone
● E. Steroid therapy is given along with ceftriaxone

Answer 9

B. Prednisolone 25 mg per oral, twice daily for 10 days

Question 10

A patient suffers injury to facial nerve during surgery for CP angle space occupying lesion (SOL). Primary repair is done. What is the expected failure rate in these cases?
● A. 13%
● B. 23%
● C. 33%
● D. 43%
● E. 53%

Answer 10

C. 33%

Question 11

A patient presents with vertigo (sensation of movement usually spinning) in neurosurgical OPD. Following should be kept in mind as differentials for this disease except?
● A. Inner ear dysfunction which can be caused by labyrinthitis, Meneire’s disease, trauma, drugs like aminoglycosides, syphilis, or vertebrobasilar insufficiency
● B. Vestibular nerve dysfunction which can include vestibular neuronitis, vestibular nerve compression by meningioma or schwannoma
● C. Brain stem dysfunction because of vertebrobasilar insufficiency, basilar artery migraine, or multiple sclerosis
● D. Dysfunction of dorsal proprioceptors as in osteoarthritis
● E. Vascular compression of vestibular nerve which can cause disabling positional vertigo

Answer 11

D. Dysfunction of dorsal proprioceptors as in osteoarthritis

Question 12

Complete loss of vestibular function from one side is thought to produce transient vertigo due to mismatch of vestibular input from the two ears. Unilateral selective vestibular neurectomy (SVN) may convert the fluctuating or partial loss to a
complete cessation of input and facilitate compensation. What surgical approach is adopted for SVN in case of Meniere’s disease?
● A. Retrosigmoid approach
● B. Retrolabyrinthine approach
● C. Middle fossa approach
● D. Translabyrinthine approach
● E. All of the above

Answer 12

B. Retrolabyrinthine approach

Question 13

Three surgical approaches for selective vestibular neurectomy (SVN) are retrolabyrinthine approach (which is anterior to sigmoid sinus and requires mastoidectomy with skeletonization of the semicircular canals and endolymphatic sac), retrosigmoid approach (posterior fossa suboccipital approach which is posterior to sigmoid sinus), and middle fossa approach (which is middle fossa extradural approach). Which approach is more suitable for complete section of vestibular nerve when other approaches fail?
● A. Retrolabyrinthine
● B. Retrosigmoid
● C. Translabyrinthine
● D. Middle fossa
● E. None of the above

Answer 13

D. Middle fossa

Question 14

A neurosurgeon is going to do selective vestibular neurectomy (SVN). He/she should have following points in mind to have safe surgery and achieve surgical goals except?
● A. The vestibular nerve is the superior half of eighth nerve and is slightly more gray in color than the cochlear nerve (due to less myelin)
● B. Facial nerve is whiter than the eighth nerve complex, lies anterior and superior to eighth nerve complex. EMG monitoring is also recommended while direct stimulation during surgery can also confirm facial nerve identification
● C. Any artery present on eighth nerve bundle may be sacrificed
● D. If no cleavage plane is identified between vestibular and cochlear division then superior half of nerve bundle is divided
● E. The ELC lies midway between posterior edge of external auditory meatus and the sigmoid sinus

Answer 14

C. Any artery present on eighth nerve bundle may be sacrificed

Question 15

A patient presents in OPD with attacks of violent vertigo, nausea, vomiting, diaphoresis, and tinnitus with progressive hearing loss which is fluctuating and low frequency. These attacks last for 5 to 30 minutes. What is most probable diagnosis
in this case?
● A. Meniere’s disease which is due to increased endolymphatic pressure
● B. Benign positional vertigo
● C. Vestibular neuronitis
● D. Vertebrobasilar insufficiency
● E. Disabling positional vertigo

Answer 15

A. Meniere’s disease which is due to increased endolymphatic pressure

Question 16

Diagnostic studies for Meniere’s disease are electronystagmography with bithermal caloric stimulation abnormal and audiogram with low frequency hearing loss. Its medical management include reduced intake of salt, diuretics including
acetazolamide, vestibular suppressants like diazepam, meclizine HCL, and vasodilators. What is the surgical treatment of Meniere’s disease for serviceable hearing loss?
● A. Endolymphatic shunting procedure to mastoid cavity or subarachnoid space
● B. Direct application of corticosteroids to inner ear
● C. Nonselective vestibular ablation like surgical labyrinthectomy, middle ear perfusion with gentamicin
● D. Selective vestibular neurectomy
● E. Both A and D

Answer 16

E. Both A and D

Question 17

Vestibular nerve section results in relief of vertigo in 90%, unchanged in 5%, and worse in 5%, while 9% incidence of facial paralysis in which 3% is permanent paralysis. On other hand selective vestibular nerve section results in improved hearing in 10%, unchanged in 28%, and worse in 48% while deafness in 14%. In postoperative failure, if ENG shows any vestibular nerve function on operated side then what is the next management step?
● A. Treatment only with medication
● B. Radiofrequency is done
● C. Chemotherapy is given
● D. Reoperation is considered
● E. All of the above

Answer 17

D. Reoperation is considered

Question 18

Which of the following statements regarding path of facial nerve is incorrect?
● A. The seventh nerve exits the brain stem at the pontomedullary junction and enters the supero-anterior portion of internal auditory canal to enter the geniculate ganglion
● B. The first branch from geniculate ganglion is greater superficial petrosal nerve which passes to the pterygopalatine ganglion, innervates nasal mucosa, palatine mucosa, and lacrimal gland of eye
● C. The second branch is branch to stapedius muscle, and lesions proximal to this produce hyperacusis
● D. Third is chordae tympani which joins the facial nerve bringing sensations from posterior one-third of tongue, and along chordae tympani are fibers to submandibular and sublingual glands
● E. Facial nerve exits skull through stylomastoid foramen where it enters parotid gland and splits into five terminal branches

Answer 18

D. Third is chordae tympani which joins the facial nerve bringing sensations from posterior one-third of tongue, and along chordae tympani are fibers to submandibular and sublingual glands

Question 19

What is the recommended management option for Bell’s palsy?
● A. General supportive measure
● B. Eye protection and steroid prednisolone 25 mg per oral BID for 10 days
● C. Acyclovir
● D. Surgical decompression
● E. All of the above

Answer 19

B. Eye protection and steroid prednisolone 25 mg per oral BID for 10 days