High-Yield ENT Topics for NEET PG 2026: Key Questions & Revision Guide

A 35-year-old female who has a 6-month history of foul-smelling ear discharge reports sudden-onset facial nerve palsy. Otoscopy shows an attic perforation with pearly-white debris. Her pure tone audiogram indicates a 40 dB air-bone gap conductive hearing loss. What is your diagnosis, and why is this case an emergency surgical case? This case challenges your understanding of cholesteatoma and its complications - a perennial favourite in NEET PG ENT exams.

QUICK ANSWER

ENT (Otorhinolaryngology) provides about 10 questions for the NEET PG exam. CSOM with cholesteatoma, otosclerosis, BPPV, hearing loss classification, epistaxis management, nasal polyps, and laryngeal carcinoma staging are the highest-yield areas. ENT image-based questions have become more popular in recent articles.

NEET PG RELEVANCE

ENT has a high frequency in NEET PG, providing an approximation of 10 direct questions. High-yield focus: CSOM types and complications, hearing loss differentiation, BPPV diagnosis and treatment, laryngeal anatomy and carcinoma. Recent examinations have changed the focus to image-based otoscopy results and clinical vignettes that need a combined diagnosis.

In This Post:

• Why ENT is a Scoring Goldmine in NEET PG.
• Ear: The Big 5 Topics You Cannot Skip
• Nose: High-Yield Nasal & Sinus Topics
• Throat: Larynx, Pharynx & Must-Know Concepts
• CSOM Mucosal vs Squamous - Comparison Table.
• High-Yield Points for NEET PG
• FAQs

Why ENT is a Scoring Goldmine in NEET PG

ENT is one such topic where the payback is unbelievable. Having about 10 questions on a fairly small syllabus, a 2-week revision can guarantee you 8-9 of those marks. As a coach to the PG aspirants, I have observed that students who do not pay attention to ENT miss easy marks that they would have scored with minimal effort.

Pattern recognition is rewarded in the subject. You can answer in less than 30 seconds when you know that a pearly-white mass behind an intact tympanic membrane (TM) indicates congenital cholesteatoma, or that flamingo-pink blush on the promontory (Schwartze sign) is a sign of otosclerosis. ENT is not memorization of rare syndromes - it is classic presentations. I have observed residents in the wards having difficulties in ENT emergencies merely because they missed these basics during the preparation of their PG.

Download Free NEET PG Previous Year Question Papers PDF & Boost Your Prep!

Ear: The 5 Biggest Topics You Can not Afford to Miss

1. Chronic Suppurative Otitis Media (CSOM).

CSOM is a persistent infection of the middle ear cleft that takes over 12 weeks and is marked by the continuing discharge through a permanent perforation of the tympanic membrane. 

The most common distinction that has been tested is the two types: mucosal (tubotympanic/safe) and squanosal (atticoantral/unsafe).

The mucosal type is located in the anteroinferior middle ear, with a central perforation of the pars tensa, and mucoid or mucopurulent discharge. 

The squanosal type is located in the posterosuperior area or attic, and is characterized by a marginal or attic perforation, and by cholesteatoma, a sac of keratinized squamous epithelium that erodes bone. When foul-smelling discharge is observed with granulation tissue on otoscopy, the unsafe type should come to mind in clinical practice.

A NEET PG favourite is the complications of squamous CSOM. Keep in mind extracranial (mastoiditis, facial nerve palsy, labyrinthitis, subperiosteal abscess) and intracranial (extradural abscess, brain abscess - most commonly temporal lobe, sigmoid sinus thrombosis, meningitis). The triad of sixth cranial nerve palsy, retro-orbital pain, and otorrhoea (as a result of petrous apicitis) is known as Gradenigo syndrome, which is recurrently seen in exams.

2. Cholesteatoma

Cholesteatoma is a separate section since it is examined in various positions. Three types are important: congenital (pearly-white mass behind an intact TM, which is diagnosed according to the criteria of Levenson), primary acquired (retraction pocket in pars flaccida accumulating keratin), and secondary acquired (squamous epithelium migrates through a marginal perforation).

The HRCT temporal bone is the gold standard investigation that reveals scutum erosion as the first sign of primary acquired cholesteatoma. Canal wall up (CWU) vs canal wall down (CWD) mastoidectomy - is a high-yield comparison. CWU maintains the ear anatomy and the posterior canal wall, but with a higher recurrence rate. CWD eliminates it, leaving a mastoid cavity requiring lifelong cleaning and providing superior disease clearance.

On NEET PG, anticipate questions that associate otoscopic images of attic retraction pockets with the diagnosis of cholesteatoma.

3. Otosclerosis

Otosclerosis is an abnormal bone remodelling of the oval window, which fixes the stapes footplate, resulting in progressive conductive hearing loss in young adults, usually bilateral. The typical audiometric observation is the notch of Carhart, a low at 2000 Hz on bone conduction audiometry. Schwartze sign (flamingo-pink blush on promontory observed through intact TM) is a sign of an active otospongiotic stage.

Carhart notch

Surgical treatment: stapedotomy (better than stapedectomy) and insertion of prosthesis. Sodium fluoride medical management can delay disease in the otospongiotic stage. The audiometric pattern and the named clinical sign are usually examined by the audiometric pattern and named clinical sign examiners.

4. BPPV (Benign Paroxysmal Positional Vertigo)

The most frequent cause of peripheral vertigo is BPPV, which is due to the displacement of otoconia (calcium carbonate crystals) in the semicircular canals - most frequently the posterior semicircular canal. The diagnostic test is the Dix-Hallpike manoeuvre, which induces transient, fatigable, rotatory nystagmus with a latency of 2-5 seconds.

The Epley manoeuvre (canalith repositioning procedure) is the treatment of the posterior canal BPPV. In horizontal canal BPPV, the supine roll test is diagnostic, and the Lempert (BBQ roll) manoeuvre is therapeutic. I have observed BPPV being mistakenly diagnosed with Meniere disease on numerous occasions in clinical practice - the most important distinction is that BPPV causes short episodes (less than 1 minute) with no hearing loss or tinnitus.

5. Hearing Loss Classification

There is no compromise on understanding conductive and sensorineural hearing loss (SNHL). The tests of the tuning fork are conducted annually:

Rinne test: Air conduction (AC) = Bone conduction (BC) = positive (normal or SNHL). BC = AC = negative (conductive loss).

Weber test: Lateralizes to the affected ear in conductive loss; lateralizes to the better ear in SNHL.

Absolute bone conduction (ABC) test: Decreased in SNHL, normal in conductive loss.

An archetypal NEET PG trap is the false-negative Rinne in unilateral SNHL of severe type, where the bone conduction is better due to the sound being transduced by the other ear (the normal ear) through transcranial conduction. Always, always, always, always.

Also Read: Anatomy of the External Ear and its Diseases

Nose: High-Yield Nasal & Sinus Topics

Epistaxis

Little's area (Kiesselbach plexus) of the anteroinferior nasal septum is the most frequent location of epistaxis, with anastasis of branches of the sphenopalatine, anterior ethmoidal, superior labial, and greater palatine arteries. The sphenopalatine artery (Woodruff's plexus) causes posterior epistaxis, which is more frequent in hypertensive elderly.

The algorithm used by the management is as follows: anterior nasal packing, posterior nasal packing, sphenopalatine artery ligation, and external carotid artery ligation / angiographic embolization. Profuse posterior epistaxis in an adolescent male on the wards should be a cause of concern for juvenile nasopharyngeal angiofibroma (JNA) - a harmless yet locally aggressive vascular tumour. Always avoid biopsy of JNA intranasally because of the risk of torrential bleeding. Clinical diagnosis with CT/MRI (Holman-Miller sign) (anterior bowing of the posterior wall of the maxillary sinus).

Nasal Polyps & Allergic Rhinitis

The most common are ethmoidal polyps, which are bilateral, painless, and touch-insensitive and linked to Samter's triad (nasal polyps + aspirin sensitivity + asthma). 

Antrochoanal polyps develop out of the maxillary sinus, are unilateral and manifest as a single polyp in the nasopharynx. Endoscopic removal is the treatment.

Allergic rhinitis - sneezing, watery rhinorrhoea, nasal congestion, and itching - is treated with intranasal corticosteroids (first-line), including fluticasone or mometasone. Second-line are oral antihistamines (cetirizine, fexofenadine). In NEET PG, the differentiation between allergic rhinitis (pale, boggy mucosa) and vasomotor rhinitis (engorged turbinates, no history of allergy) is often examined.

Fungal Rhinosinusitis

Differentiate between allergic fungal rhinosinusitis (AFRS) - which is thick, peanut-butter-like allergic mucus containing eosinophils and fungal hyphae, diagnosed by the Bent and Kuhn criteria - and invasive fungal sinusitis in immunocompromised patients (uncontrolled diabetes, neutropenia). Invasive disease is an emergency in surgery. Most commonly, the organism is either Mucor or Aspergillus.

Throat: Larynx, Pharynx & Must-Know Concepts

Laryngeal Carcinoma

The most common malignancy of the larynx is glottic carcinoma. It is early and hoarse due to poor lymphatic drainage of the vocal cords - early voice change and late nodal metastasis. Supraglottic carcinoma, in its turn, is late onset (throat discomfort, referred otalgia) and early metastatic (rich lymphatic drainage).

The smallest section of the infant larynx is the subglottis - a fact that is examined in questions on airways in paediatrics. The TNM system is followed by staging. T1 glottic lesions with normal cord mobility can be treated with radiotherapy alone or endoscopic laser excision, while advanced disease requires total laryngectomy ± chemoradiation.

Vocal Cord Paralysis

Left recurrent laryngeal nerve (RLN) palsy is more frequent than right due to its longer course passing under the aortic arch (prone to mediastinal pathology, aortic aneurysm, and thoracic surgery). Unilateral RLN palsy has a breathy voice; bilateral palsy has stridor (surgical emergency).

In clinical practice, all patients with unexplained hoarseness over 3 weeks require flexible nasendoscopy to see the vocal cords. On NEET PG, you will be asked to name the nerve at risk during thyroidectomy (RLN) and the voice change that occurs.

Obstructive Sleep Apnoea (OSA).

OSA is diagnosed with polysomnography with an apnoea-hypopnoea index (AHI) of 5 events/hour and symptoms. 

• Mild OSA: AHI 5-15 
• Moderate: 15-30
• Severe: >30. 

Continuous positive airway pressure (CPAP) is the first-line therapy of moderate-to-severe OSA. In selected cases, surgical solutions are available, such as uvulopalatopharyngoplasty (UPPP). The Muller manoeuvre assists in determining the degree of obstruction.

Also Read: High-Yield ENT Tables for NEET PG

CSOM Mucosal vs Squamosal - Comparison Table

High-Yield Points for NEET PG

• CSOM unsafe type (squamosal) contains cholesteatoma and needs surgical treatment; the safe type (mucosal) may be treated conservatively initially.
• The notch of 2000 Hz on bone conduction in Carhart is pathognomonic of otosclerosis; Schwartze's sign is indicative of the active stage.
• BPPV is diagnosed by the Dix-Hallpike test; the treatment is the Epley manoeuvre. The supine roll test is for horizontal canal BPPV.
• False-negative Rinne occurs in severe unilateral SNHL - the sound is heard via the contralateral ear. Always, always, always.
• The most frequent location of anterior epistaxis is the area of Little (Kiesselbach's plexus); the origin of posterior epistaxis is the sphenopalatine artery.
• JNA - do not do an intranasal biopsy. Diagnosis: CT with Holman-Miller sign in a young boy with frequent epistaxis.
• The triad of Samter nasal polyps + aspirin sensitivity + bronchial asthma. Think ethmoidal polyps.
• Glottic carcinoma is an early onset with hoarseness (poor lymphatics → late metastasis). Supraglottic carcinoma has an early metastasis (rich lymphatics → late symptoms).
• Left RLN palsy is more common than right due to its longer intrathoracic course under the aortic arch.
• Mnemonic of complications of CSOM - "LAME BMS": Labyrinthitis, Abscess (brain), Mastoiditis, Extradural abscess, Bezolds abscess, Meningitis, Sigmoid sinus thrombosis.
• Image-based otoscopy findings are often examined by examiners in practice in recognising attic retractions, TM perforations and glomus tumours. An archetypal NEET PG pitfall is the conflation of congenital cholesteatoma (intact TM, pearly mass) and acquired cholesteatoma (perforated TM) caused by CSOM.

Also Read: 20 High-Yield ENT Flashcards for NEET PG 2026

Frequently Asked Questions

Q1. What is safe and unsafe CSOM?

Safe (mucosal) CSOM is characterized by the anteroinferior middle ear with a central pars tensa perforation and no cholesteatoma. Unsafe (squamous) CSOM is located in the attic or posterosuperior area, contains cholesteatoma, and is at high risk of complications such as facial nerve palsy and intracranial abscess. It is the difference that is caused by the presence of cholesteatoma.

Q2. When is otosclerosis to be surgically treated?

Surgery (stapedotomy) is recommended in cases of conductive hearing loss more than 25-30 dB with a large air-bone gap, and the patient has good cochlear reserve (as evidenced by speech discrimination scores of more than 60%). Sodium fluoride can be medically applied during the active otospongiotic stage.

Q3. Does BPPV pose a danger or threat to life?

BPPV is not life-threatening and benign. It is caused by displaced otoconia in the semicircular canals and is cured by canalith repositioning manoeuvres (Epley for posterior canal) in more than 80% in 1-2 sessions. The recurrence rate is about 15 per cent in a year.

Q4. Which drug is first-line for allergic rhinitis?

According to the ARIA guidelines, intranasal corticosteroids (fluticasone propionate, mometasone furoate) are the initial therapy of moderate-to-severe allergic rhinitis. Second-generation oral antihistamines (cetirizine, fexofenadine) are administered as an adjunct for mild disease.

Q5. What is the gold standard test of cholesteatoma?

The gold standard of assessing the extent of cholesteatoma and bony erosion is high-resolution computed tomography (HRCT) of the temporal bone. Diffusion-weighted imaging (DWI) MRI is becoming a more popular method of distinguishing residual or recurrent cholesteatoma and granulation tissue after surgery.

Q6. What is the testing of ENT topics in NEET PG?

ENT provides about 10 questions to NEET PG. The questions are mainly clinical vignette-based and image-based (otoscopic findings, audiograms, CT scans). CSOM with cholesteatoma, differentiating hearing loss through tuning fork tests, BPPV, epistaxis, and staging laryngeal carcinoma are the most frequently tested.

CLINICAL PEARL

In ENT, the ear with a foul smell is the ear to be operated on - foul-smelling discharge is virtually always cholesteatoma until proven otherwise.

The students who score best in ENT are not those who learn all the rare syndromes, but they are those who can look at an otoscopic picture and tell you the diagnosis in five seconds.