Head and neck: middle ear: practice question

A Anatomy question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Anatomy · Head and neck: middle ear

Sample item

In a patient with facial palsy, the ipsilateral acoustic (stapedial) reflex is absent on impedance audiometry. Which nerve carries the efferent limb of this reflex?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Facial nerve to stapedius

Loud sound travels via the cochlear nerve to the brainstem, and the efferent limb returns through the facial nerve to stapedius, which pulls the neck of the stapes and dampens movement. Paralysis therefore gives hyperacusis and an absent reflex. Tensor tympani is supplied by the mandibular nerve and attaches to the malleus.

Option by option

  • A. Vagus nerve via the auricular branch

    The auricular branch is sensory from the external ear and does not carry the reflex.

  • B. Mandibular nerve to tensor tympani

    The mandibular branch supplies tensor tympani, which acts on the malleus and not on the stapes.

  • C. Glossopharyngeal nerve via the tympanic plexus

    The tympanic plexus carries sensation and secretomotor fibres to the parotid and does not supply a middle ear muscle.

  • D. Facial nerve to stapedius (correct)

    Correct. The facial nerve supplies stapedius, which stabilises the stapes.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Anatomy questions

Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is D, Facial nerve to stapedius. Loud sound travels via the cochlear nerve to the brainstem, and the efferent limb returns through the facial nerve to stapedius, which pulls the neck of the stapes and dampens movement.

Why is "Vagus nerve via the auricular branch" not the answer?

The auricular branch is sensory from the external ear and does not carry the reflex.

Why is "Mandibular nerve to tensor tympani" not the answer?

The mandibular branch supplies tensor tympani, which acts on the malleus and not on the stapes.

Why is "Glossopharyngeal nerve via the tympanic plexus" not the answer?

The tympanic plexus carries sensation and secretomotor fibres to the parotid and does not supply a middle ear muscle.

What concept does this question test?

It tests Head and neck: middle ear in Anatomy. Paralysis therefore gives hyperacusis and an absent reflex. Tensor tympani is supplied by the mandibular nerve and attaches to the malleus.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Head and neck: middle ear?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.