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Ear drum perforation and treatment:: MSRA MCQs

Updated: Aug 4

Q1. A 7-year-old boy presents with right ear pain and discharge. Examination reveals a perforated tympanic membrane. Which of the following is the most appropriate topical antibiotic?

Choose the correct answer

  • A. Gentamicin

  • B. Neomycin

  • C. Ofloxacin

  • D. Chloramphenicol


✅ Answer: C. Ofloxacin 

🧾 Aminoglycosides (gentamicin, neomycin, framycetin) are ototoxic if they enter the middle ear through a perforated TM. Ofloxacin is safe and effective.


Chloramphenicol is not preferred in cases of perforated tympanic membrane because it has limited activity against common pathogens like Pseudomonas aeruginosa, is often formulated in an oil base that doesn't penetrate the middle ear well, and is less effective compared to Ofloxacin. Ofloxacin, a non-ototoxic fluoroquinolone, is safe for use with a perforated eardrum and offers broad-spectrum bactericidal coverage, making it the recommended choice.



Q2. A 10-year-old child has a history of recurrent middle ear infections. You perform Rinne’s and Weber’s tests. Rinne is negative on the left side, and Weber lateralises to the left. What type of hearing loss is this?

Choose the correct answer

  • A. Normal

  • B. Sensorineural in the left ear

  • C. Conductive in the left ear

  • D. Sensorineural in the right ear


✅ Answer: C. Conductive in the left ear


 🧾 Rinne negative = Bone > Air (conductive).

Weber lateralising to same side = conductive loss on that side.



Q3. Which of the following children is most appropriate for referral for grommet insertion?

Choose the correct answer

  • A. A 2-year-old with single episode of acute otitis media

  • B. A 4-year-old with unilateral glue ear for 4 weeks

  •  C. A 3-year-old with glue ear >3 months and hearing defect

  • D. A 5-year-old with cerumen impaction


✅ Answer: C. A 3-year-old with glue ear >3 months and hearing impairment 

🧾 This meets NICE criteria for grommets: persistent bilateral OME >3 months + hearing loss.


Q4. Which of the following is a common long-term complication of grommet insertion?

Choose the correct answer

  • A. Meningitis

  • B. Sensorineural hearing loss

  • C. Recurrent otitis externa

  • D. Persistent tympanic membrane perforation


✅ Answer: D. Persistent tympanic membrane perforation 

🧾 Rare but known complication; most grommets fall out spontaneously, but some leave behind a perforation.


Q5. Which of the following is the most appropriate reason to perform a myringotomy without grommet insertion?

Choose the correct answer

  • A. Recurrent glue ear

  • B. Recurrent barotrauma

  • C. Acute otitis media with severe bulging and fever

  • D. Chronic otitis media


✅ Answer: C. Acute otitis media with severe bulging and fever 

🧾 Myringotomy alone can be used for acute decompression; grommets are placed if recurrent or chronic issues exist.

Q6. A 4-year-old boy is brought in with poor speech development. He is otherwise well. Otoscopy shows a retracted, dull tympanic membrane with visible fluid level behind it. What is the most likely diagnosis?

Choose the correct answer

  • A. Otitis externa

  • B. Acute otitis media

  • C. Otitis media with effusion (glue ear)

  • D. TM perforation E. Cholesteatoma


✅ Answer: C. Otitis media with effusion (glue ear) 

🧾 Commonest cause of hearing loss in children; retracted/dull TM with fluid suggests OME.


Q7.A child with persistent glue ear undergoes audiometry. Which of the following tympanogram findings is most consistent with the diagnosis?

Choose the correct answer

  • A. Type A

  • B. Type As

  • C. Type Ad

  • D. Type B


✅ Answer: D. Type B 

🧾 Type B = flat curve → classic for middle ear fluid as seen in OME.


Here’s a short explanation for each tympanogram type:

  • Type A: Normal peak and pressure → normal middle ear function (seen in healthy individuals).

  • Type As ("shallow"): Normal pressure but reduced compliance → suggests stiff middle ear (e.g., otosclerosis).

  • Type Ad ("deep"): Normal pressure but excessive compliance → indicates hypermobile tympanic membrane (e.g., ossicular discontinuity).

  • ✅ Type B: Flat curve with no peak → indicates fluid in the middle ear, classic for otitis media with effusion (glue ear).

  • Type C: Peak present but at negative pressure → suggests Eustachian tube dysfunction.


Q8. A 3-year-old has had bilateral otitis media with effusion (OME) for 3 months. Audiology confirms 25 dB hearing loss bilaterally. What is the next best step?

Choose the correct answer

  • A. Watchful waiting

  • B. Start oral antibiotics

  • C. Start topical decongestants

  • D. Refer to ENT for grommets


✅ Answer: D. Refer to ENT for grommets 

🧾 NICE: persistent bilateral OME >3 months + ≥25–30 dB loss → ENT referral.


The normal hearing range in children is typically:

  • 0 to 20 dB HL (Hearing Level) across speech frequencies.

In this question, the child has a 25 dB bilateral hearing loss, which is just above the normal range, indicating a mild conductive hearing loss due to persistent fluid in the middle ear (OME).

According to NICE guidelines, persistent bilateral OME for over 3 months plus a hearing loss of ≥25–30 dB is an indication for ENT referral for grommet (ventilation tube) insertion, as it may impact speech and language development.


Q9.You see a child who had a grommet inserted 1 week ago. The parents ask whether they can fly to Spain. What is the best advice?

Choose the correct answer

  • A. Air travel is contraindicated for 3 months

  • B. They can fly without restriction

  • C. Advise against flying due to risk of ear barotrauma

  • D. Delay flying until the grommet falls out


✅ Answer: B. They can fly without restriction

 🧾 Grommets equalise middle ear pressure — patients can fly safely.


Q10. A 25-year-old boxer presents with sudden hearing loss and clear ear discharge after being punched during a match. Otoscopy reveals a small central perforation of the tympanic membrane. What is the most appropriate immediate management?

Choose the correct answer

  • A. Oral antibiotics and ear syringing

  • B. Immediate ENT referral

  • C. Reassurance and advice to keep ear dry

  • D. Tympanoplasty in ED


✅ Answer: C. Reassurance and advice to keep ear dry 

🧾 Most traumatic TM perforations heal spontaneously. No antibiotics unless signs of infection.

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