Ear Anatomy and Emergencies Practice Questions

30 multiple-choice questions on Ear anatomy and emergencies for paramedic and EMT students, from Chapter 20 (Diseases of the Eyes, Ears, Nose, and Throat). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. The external, visible part of the ear is called the:

   1. A. Eustachian tube
   2. B. Cochlea
   3. C. Pinna (auricle)
   4. D. Tympanum
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   Answer: C. Pinna (auricle)

   The pinna (auricle) collects sound and directs it into the external auditory canal. The cochlea is in the inner ear.

2. A 19-year-old had a new piercing high in the cartilage of her ear 5 days ago. The upper ear is now red, hot, swollen and very tender, but the earlobe looks normal. She has a fever. What is the main concern?

   1. A. Infection of the ear cartilage
   2. B. An allergy to the earring metal
   3. C. Normal healing of a new piercing
   4. D. An infected earlobe cyst
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   Answer: A. Infection of the ear cartilage

   Perichondritis is an infection of the cartilage of the outer ear, often caused by Pseudomonas after a high piercing. It spares the earlobe because the lobe has no cartilage, and without prompt antibiotics the cartilage can die and leave a deformed ear. An allergy to the earring metal causes itching and rash rather than fever, normal healing does not cause spreading heat and swelling, and an infected earlobe cyst would involve the lobe.

3. The three small bones of the middle ear are the malleus, incus, and:

   1. A. Ethmoid
   2. B. Hyoid
   3. C. Stapes
   4. D. Vomer
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   Answer: C. Stapes

   The ossicles (malleus, incus, and stapes) amplify vibrations from the tympanic membrane and transmit them to the oval window of the inner ear.

4. A 5-year-old pushed a dried bean deep into his ear canal. He is calm. His parent asks you to flush it out with water. Why should you not irrigate?

   1. A. Water will dissolve it into the ear
   2. B. Irrigation will rupture the eardrum
   3. C. Water causes immediate hearing loss
   4. D. The bean may swell and wedge
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   Answer: D. The bean may swell and wedge

   Dried beans, seeds and other plant matter absorb water and swell, which makes them more tightly wedged and more painful to remove. Leave it in place and transport for removal under direct vision. Water does not dissolve a bean, irrigation does not usually rupture a normal eardrum, and water in the canal does not cause immediate hearing loss.

5. A 40-year-old pushed a cotton swab too deep when someone bumped her arm. She has ear pain, a little blood in the canal, hearing loss and new spinning vertigo. What does the vertigo suggest?

   1. A. Possible inner ear injury
   2. B. A simple scratch of the canal
   3. C. Earwax pushed against the drum
   4. D. Anxiety after the injury
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   Answer: A. Possible inner ear injury

   A swab pushed through the eardrum can also strike the small bones or the inner ear. Vertigo and hearing loss after this kind of injury suggest the inner ear may be involved, which needs prompt ENT evaluation. Keep the ear dry and do not irrigate or instill drops. A simple scratch of the canal causes pain and slight bleeding without vertigo, earwax pushed against the drum muffles hearing but does not cause spinning, and anxiety does not explain new vertigo with hearing loss.

6. A 6-year-old has had fever and severe right ear pain for 2 days. Today the right side of her face droops, including the forehead, and she cannot close her right eye. What should you suspect?

   1. A. A left hemisphere stroke
   2. B. A normal finding with otitis media
   3. C. A tooth abscess spreading on the right
   4. D. A complication of the ear infection
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   Answer: D. A complication of the ear infection

   The facial nerve runs through the middle ear, so a middle ear infection can inflame it and cause weakness of the whole side of the face, including the forehead. This complication needs urgent evaluation and treatment. A left hemisphere stroke would usually spare the forehead and cause other deficits, facial weakness is never a normal part of otitis media, and a tooth abscess does not paralyze the face.

7. A 3-year-old has fever, is pulling at her ear, and has been fussy since a cold last week. What is most likely?

   1. A. Ruptured eardrum from trauma
   2. B. Mastoiditis
   3. C. Otitis externa
   4. D. Otitis media
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   Answer: D. Otitis media

   Otitis media, a middle ear infection, often follows an upper respiratory infection in young children because their eustachian tubes are short and more horizontal.

8. Why are young children more prone to middle ear infections?

   1. A. Absence of fully formed ossicles at birth
   2. B. Thicker, less flexible tympanic membranes
   3. C. Longer and narrower external ear canals
   4. D. Shorter, more horizontal eustachian tubes
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   Answer: D. Shorter, more horizontal eustachian tubes

   Children's eustachian tubes are shorter and more horizontal, allowing nasopharyngeal secretions and bacteria to reach the middle ear and drain poorly.

9. A competitive swimmer has ear pain that worsens when you gently pull on the pinna, with drainage from the canal. What is most likely?

   1. A. Otitis externa
   2. B. Labyrinthitis
   3. C. Otitis media
   4. D. Ménière's disease
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   Answer: A. Otitis externa

   Otitis externa (swimmer's ear) is an infection of the external canal. Pain with traction on the pinna or pressure on the tragus is a hallmark finding.

10. A patient with a recent untreated ear infection now has redness, swelling, and tenderness behind the ear, with the ear pushed forward. What is the concern?

    1. A. Otitis externa
    2. B. Mastoiditis
    3. C. Cerumen impaction
    4. D. Bell's palsy
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    Answer: B. Mastoiditis

    Mastoiditis is infection of the mastoid air cells behind the ear, usually from untreated otitis media. It can spread to the brain and requires antibiotics and sometimes surgery.

11. After an explosion, a patient has ear pain, hearing loss, and a small amount of blood from the canal. What is the most likely injury?

    1. A. Otitis externa
    2. B. Cerumen impaction
    3. C. Ruptured eardrum
    4. D. Labyrinthitis
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    Answer: C. Ruptured eardrum

    The tympanic membrane is highly susceptible to blast overpressure. Rupture causes pain, hearing loss, and possible bleeding; it also alerts you to look for other primary blast injuries.

12. Why is a ruptured eardrum after a blast clinically important beyond the ear itself?

    1. A. Lung or bowel injury may coexist
    2. B. It means no other organs were hurt
    3. C. It confirms no brain injury occurred
    4. D. It means hearing is lost for good
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    Answer: A. Lung or bowel injury may coexist

    Air-filled organs are injured by blast pressure; a ruptured tympanic membrane suggests significant exposure, so assess for pulmonary blast injury and abdominal injury. Its absence does not rule them out. It does not mean no other organs were hurt, it does not confirm there is no brain injury, and most ruptured eardrums heal, so hearing is not lost for good.

13. A 3-year-old just came inside after an hour in freezing weather. She feels hot, is lethargic, and her ear canal is partly blocked by wax. A tympanic thermometer reads 35.9 °C (96.6 °F). What is the best next step?

    1. A. Recheck it by another method
    2. B. Treat her for hypothermia
    3. C. Record the reading as normal
    4. D. Repeat the reading in the same ear
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    Answer: A. Recheck it by another method

    Tympanic readings can be falsely low when the ear canal is cold from the weather or partly blocked by wax, so a child who looks febrile and lethargic needs her temperature checked by another method, such as a rectal or temporal reading per protocol. Treating her for hypothermia or recording the low reading as normal would rely on a value that does not fit the patient, and repeating it in the same cold, blocked ear has the same problem.

14. How should you manage CSF or blood draining from the ear after head trauma?

    1. A. Irrigate the canal with saline
    2. B. Suction deep into the canal
    3. C. Cover loosely to absorb drainage
    4. D. Pack the canal tightly with gauze
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    Answer: C. Cover loosely to absorb drainage

    Blocking the drainage could increase intracranial pressure and raise infection risk. Apply a loose sterile dressing to absorb drainage.

15. A patient's ear was partially torn off in a dog attack. How should you care for the avulsed portion?

    1. A. Pack it directly in a bag of ice
    2. B. Discard it, since it cannot be saved
    3. C. Moist gauze, sealed bag, kept cool
    4. D. Submerge it in a cup of sterile water
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    Answer: C. Moist gauze, sealed bag, kept cool

    Like other avulsed parts, wrap the tissue in sterile gauze moistened with saline, seal it in a plastic bag, and keep it cool without direct contact with ice.

16. A wrestler has a swollen, fluid-filled bulge on the ear after repeated blows. If not drained, it may cause:

    1. A. Bell's palsy
    2. B. Cauliflower ear
    3. C. Permanent deafness
    4. D. Mastoiditis
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    Answer: B. Cauliflower ear

    An auricular hematoma separates cartilage from its blood supply. Without drainage, cartilage necrosis and fibrosis produce a deformed cauliflower ear.

17. A 4-year-old has a bead lodged in his ear canal. He is calm and in no distress. What is the most appropriate field action?

    1. A. Use a suction catheter to pull it
    2. B. Remove it with forceps
    3. C. Irrigate the canal forcefully
    4. D. Leave it and transport for removal
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    Answer: D. Leave it and transport for removal

    Foreign bodies in the ear rarely represent emergencies. Attempts at removal can push them farther in or damage the canal or eardrum; let the ED or ENT remove them.

18. A patient has a live insect in his ear canal and is extremely distressed by the buzzing. Per many protocols, what may be used before removal?

    1. A. An alcohol swab inserted deep
    2. B. Mineral oil in the canal
    3. C. High-pressure water irrigation
    4. D. Hydrogen peroxide drops
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    Answer: B. Mineral oil in the canal

    Per many protocols, instilling mineral or vegetable oil can kill or immobilize the insect, provided there is no suspicion of a ruptured eardrum. Removal is generally done in the ED.

19. A patient has hearing loss in one ear and a sensation of fullness. There is no pain or fever. The most common cause is:

    1. A. Mastoiditis
    2. B. Acoustic neuroma
    3. C. Cerumen impaction
    4. D. Basilar skull fracture
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    Answer: C. Cerumen impaction

    Impacted earwax is a common, benign cause of muffled hearing and fullness. It is not a field emergency.

20. A 45-year-old has recurring episodes of severe vertigo, tinnitus, fluctuating hearing loss, and ear fullness lasting hours. What is the likely diagnosis?

    1. A. Ménière's disease
    2. B. Otitis externa
    3. C. Ruptured eardrum
    4. D. Mastoiditis
    Show answer

    Answer: A. Ménière's disease

    Ménière's disease involves excess endolymph in the inner ear, producing episodic vertigo, tinnitus, hearing loss, and fullness. Nausea and vomiting are common.

21. During a helicopter transfer, an alert patient with a head cold develops sharp ear pain as the aircraft descends to land. What advice is most likely to help?

    1. A. Lie flat with the head down
    2. B. Pack the canal with cotton
    3. C. Breathe from the oxygen mask faster
    4. D. Swallow or yawn to equalize
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    Answer: D. Swallow or yawn to equalize

    During descent the outside pressure rises, and if a congested eustachian tube stays closed, the lower pressure in the middle ear pulls the eardrum inward and hurts. Swallowing, yawning, sipping water or a gentle Valsalva opens the tube and equalizes the pressure. Lying with the head down adds congestion, packing the canal does not change middle ear pressure, and breathing from the oxygen mask faster does not open the tube.

22. A 2-year-old with ear tubes has yellow drainage from one ear for a day. She is playful, eating well, afebrile and has no swelling behind the ear. What is the most likely explanation?

    1. A. Mastoiditis needing urgent surgery
    2. B. A basilar skull fracture
    3. C. Drainage through the ear tube
    4. D. Meningitis from the tube
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    Answer: C. Drainage through the ear tube

    Ear tubes let fluid from a middle ear infection drain out of the canal, so drainage in a well, playful, afebrile child is usually a routine tube infection treated with antibiotic ear drops by her doctor. Mastoiditis causes fever and swelling behind the ear, which she does not have, a basilar skull fracture needs trauma, and meningitis would cause fever, lethargy and a stiff neck.

23. Ear pain is documented as:

    1. A. Vertigo
    2. B. Otorrhea
    3. C. Tinnitus
    4. D. Otalgia
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    Answer: D. Otalgia

    Otalgia is ear pain. Otorrhea is drainage from the ear, and vertigo is a false sensation of spinning.

24. A 38-year-old had neck manipulation at a chiropractor this morning. Now he has a severe headache at the back of his head, neck pain, vertigo and trouble walking. What should you suspect?

    1. A. Benign positional vertigo
    2. B. A tear in a vertebral artery
    3. C. A muscle strain from the adjustment
    4. D. An inner ear infection
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    Answer: B. A tear in a vertebral artery

    Neck pain and a headache at the back of the head followed by vertigo, ataxia or other posterior circulation signs after neck manipulation or minor neck trauma suggest a vertebral artery dissection, which can cause a stroke and needs stroke evaluation. Benign positional vertigo causes brief spells with head movement and no headache or ataxia, a muscle strain does not cause vertigo and trouble walking, and an inner ear infection does not explain the headache.

25. A 50-year-old with known Ménière disease is having a typical attack of spinning vertigo with vomiting. His exam is otherwise normal, and he wants to drive himself to his doctor. What is your best advice?

    1. A. He should not drive during the attack
    2. B. Driving is safe if he keeps his eyes open
    3. C. He can drive once he stops vomiting
    4. D. Driving is fine with an antiemetic
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    Answer: A. He should not drive during the attack

    Ménière attacks cause intense vertigo that can last hours and return without warning, so driving during an attack is unsafe for him and others. Offer transport or arrange another driver, help him move to limit falls, and give an antiemetic per protocol. Keeping his eyes open does not stop the vertigo, stopping vomiting does not mean the attack is over, and an antiemetic can add drowsiness.

26. A scuba diver has ear pain and hearing loss after a rapid descent. What is the most likely cause?

    1. A. Middle ear barotrauma
    2. B. Decompression sickness
    3. C. Arterial gas embolism
    4. D. Otitis externa
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    Answer: A. Middle ear barotrauma

    Failure to equalize middle ear pressure during descent causes ear squeeze (barotrauma), with pain, hearing loss, and possible eardrum rupture.

27. Inflammation of the inner ear, often after a viral illness, causing vertigo and sometimes hearing loss, is:

    1. A. Mastoiditis
    2. B. Labyrinthitis
    3. C. Sinusitis
    4. D. Otitis externa
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    Answer: B. Labyrinthitis

    Labyrinthitis involves the inner ear labyrinth and causes vertigo, nausea, and possibly hearing loss. It often follows a viral upper respiratory infection.

28. A patient has sudden hearing loss in one ear over a few hours, without trauma or ear pain. What is the best guidance?

    1. A. It is earwax and needs no care
    2. B. It will clear after ear irrigation at home
    3. C. It can wait for a routine visit
    4. D. It needs prompt medical evaluation
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    Answer: D. It needs prompt medical evaluation

    Sudden sensorineural hearing loss is urgent; early treatment improves the chance of recovery, and stroke must be considered if other neurologic signs are present. Assuming it is earwax needing no care, irrigating the ear at home, or waiting for a routine visit all delay the evaluation that improves the outcome.

29. To look into the ear canal of a 30-year-old with ear pain, how should you straighten the canal?

    1. A. Pull the outer ear straight down
    2. B. Pull the outer ear up and back
    3. C. Push the tragus forward firmly
    4. D. Pull the earlobe down and forward
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    Answer: B. Pull the outer ear up and back

    In adults the ear canal curves forward, so pulling the outer ear (pinna) up and back straightens it for a view. In infants and young children the canal is shaped differently and the pinna is pulled down and back. Pulling the outer ear straight down or the earlobe down and forward does not straighten an adult canal, and pushing the tragus forward closes the opening and hurts if the canal is infected.

30. A child has ear drainage, fever, and sudden relief of severe ear pain. What most likely occurred?

    1. A. Onset of mastoiditis
    2. B. Eardrum perforation
    3. C. Cerumen impaction
    4. D. Ossicle dislocation
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    Answer: B. Eardrum perforation

    In otitis media, pressure behind the eardrum can rupture it, causing drainage and sudden pain relief. Most such perforations heal, but the child needs follow-up.