Ear and audiology: Langerhans cell histiocytosis of the temporal bone: practice question

A ENT 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.

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ENT · Ear and audiology: Langerhans cell histiocytosis of the temporal bone

Sample item

A 3-year-old has chronic ear discharge unresponsive to antibiotics and a postauricular swelling. CT shows a punched-out lytic lesion of the mastoid, and a skull radiograph shows other lytic areas. What is the most likely diagnosis?

ACholesteatomaBRhabdomyosarcomaCTuberculous mastoiditisDLangerhans cell histiocytosis

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

The answer and the reasoning

D. Langerhans cell histiocytosis

Langerhans cell histiocytosis in a young child can involve the temporal bone, presenting as a refractory aural polyp or discharge and a postauricular swelling, with punched-out lytic skull lesions. Biopsy confirms it by CD1a positivity and Birbeck granules.

Option by option

A. Cholesteatoma
Cholesteatoma gives scalloped bone erosion with a retraction pocket, not multiple lytic skull lesions.
B. Rhabdomyosarcoma
Rhabdomyosarcoma causes a bleeding polyp with rapid facial palsy and a soft tissue mass, not multiple skull lesions.
C. Tuberculous mastoiditis
Tuberculous mastoiditis gives painless discharge, sequestra and multiple drum perforations.
D. Langerhans cell histiocytosis (correct)
Correct. Refractory otorrhoea with a punched-out mastoid lesion and other lytic skull defects suggests Langerhans cell histiocytosis.

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.

Questions about this ENT question

What is the answer to this ENT question?

The best answer is D, Langerhans cell histiocytosis. Langerhans cell histiocytosis in a young child can involve the temporal bone, presenting as a refractory aural polyp or discharge and a postauricular swelling, with punched-out lytic skull lesions.

Why is "Cholesteatoma" not the answer?

Cholesteatoma gives scalloped bone erosion with a retraction pocket, not multiple lytic skull lesions.

Why is "Rhabdomyosarcoma" not the answer?

Rhabdomyosarcoma causes a bleeding polyp with rapid facial palsy and a soft tissue mass, not multiple skull lesions.

Why is "Tuberculous mastoiditis" not the answer?

Tuberculous mastoiditis gives painless discharge, sequestra and multiple drum perforations.

What concept does this question test?

It tests Ear and audiology: Langerhans cell histiocytosis of the temporal bone in ENT. Biopsy confirms it by CD1a positivity and Birbeck granules.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Ear and audiology: Langerhans cell histiocytosis of the temporal bone?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT 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.