diseases of external ear
TRANSCRIPT
DISEASES OF EXTERNAL EARBy Lt Col Saeed Ullah, FCPSClassified ENT, Head and Neck Surgeon
Anatomy
Anatomy
Diseases of pinna Congenital Traumatic Inflammatory Neoplastic
Congenital Bat ear Pre auricular appendiges Pre auricular sinus Anotia Microtia Macrotia
Bat earAbnormal protrudingPinna without land marksPoorly formed antihelix and scaphaCan be corrected surgicallyAfter 6 years of age
Pre auricular appendiges
Skin covered tagsMay contain cartilage Removed surgically
Pre auricular sinus/pitsRoot of the helixIncomplete fusion of tuberclesRepeated infectionAbscess may also formSurgical excision of the entire track
Anotia
Absence of pinnaFirst arch syndrome
Microtia
•Major developmental anomaly•Associated with other deformities•Unilateral or bilateral•Hearing loss
Microtia
Degrees of microtia
Macrotia
•Excessively large pinna •Can be corrected surgically
Traumatic Laceration Avulsion Frost bite Heamatoma Keloid
Laceration
•Sharpe trauma•Many types•Chances of avascular necrosis if perichondrium is lost •Immediate repair
Avulsion •If attached repair immediately•Reimplantation can be done by microvascular techniques•Skin can be removed and the pinna implanted under the postauricular skin for later implantation
Frost bite•Rewarm with moist cotton pledgets•Silver nitrate for superficial infection•Systemic antibiotics for deep infection•Analgesics for pain•Don’t rupture the bullae•Delayed Surgical debridement
Heamatoma •Blunt shearing force•Boxers, wrestlers, sports injuries•Collection of blood between perichondrium and cartilage•Early Incision and drainage•Consequences
Cauliflower ear
Consequences of non drainage or delayed drainage of heamatoma
Keloid •Common in Black coloured personal•After trauma•Ear piercing•Surgical excision•Recurrence •Steroids/radiation
Inflammatory Perichondritis Relapsing perichondritis Chondrodermatitis nodularis chronica
helicis
Perichondritis •Secondary infection
• Trauma • Infection • Pseudo
monas •Red, hot, painfull pinna•Abscess formation may occur•Systemic antibiotics•I & D of abscess
Relapsing perichondritis
•Autoimmune disorder•Any cartilage can be involved•Tender & swollen cartlige•Systemic steroids
Chondrodermatitis nodularis chronica helicis
•Small, painfull nodules along the free border of helix•Old age•Surgical excision
Neoplastic Benign tumors
Heamangioma Dermoid cyst Sebaceous cyst Papilloma Keratoacanthoma Neurofibroma
Hemangioma •Benign tumor of the vessels•Detected in childhood•Bleeds frquently•Get infected•Surgical excision•Local injections of sclerosing agents
Dermoid cyst
•Developmental cysts•Surgical excision
Sebaceous cyst
•Cysts of sebaceous glands•Contains cheesy material•Surgical excision
Malignant tumors of pinna SCC BCC Malignant melanoma
SCC
•Arising from squamous epithelium•Malignant •Lymph nodes involvement •Surgical excision
BCC
•Benign tumor of the basal layer of skin•Old age•Sun exposed areas•Surgical excision
Diseases of external auditory canal
Congenital Traumatic Inflammatory Neoplastic
Atresia of the canal•Congenital •Different degree of severity•Associated deformity•Ossicular and inner ear anomelies•Hearing loss•CT scan•Surgical repaire/reconstruction
Traumatic Laceration Cotton buds Common pins Pencils Foreign bodies
Inflammatory Infective Reactive
Infective otitis externa Viral
Herpes zoster oticus Otitis externa hemorrhagica
Becterial Furunculosis Diffuse otitis externa Malignant otitis externa
Fungal Otomycosis
Viral infection•Herpes zoster oticus•herpes zoster virus•Shingles•Extreme pain•Local application•Analgesics •Antifungal
Ramsay Hunt syndrome•Herpes zoster infection•Associated with facial palsy and sensorineural hearing loss•Poor prognosis of facial palsy•Permanent hearing loss •Antifungal •Systemic steroids•Analgesics
Viral infection
Otitis externa hemorrhagica
Bullae formation on TM
Influenza epidemics
Pain
Blood stained discharge
Antibiotics
Bacterial infection
Furunculosis •Hair follicles infection•Painfull•Antibiotics •Analgesics
Bacterial infectionDiffuse otitis externa•Swimmer’s ear•Traumatic •Swelling of canal•Scanty discharge•Painfull•Antibiotics •Local drops •Packing •Aural toilet
Bacterial infectionMalignant otitis externa•Diabetics•Immunocompromised •Pseudomonas Aurogenosa•Behaives like malignancy•Can spread in any direction•Granulation tissues at the junction of cartilage and bone•CT scan•Prolonged anti pseudomonal drugs•Analgesics•Antibiotics drops •Local aural toilet
Fungal infectionOto mycosis•Hot and humid environment•Different species•Severe itching•Blockage of ears•Blotting paper like material•White or black or yellow spores•Aural toilet•Antifungal drops•Protection from water
Reactive otitis externa Eczematous Seborrhoeic Neurodermatitis
Eczematous otitis externa•Hypersensitivity reaction
• Drpos • Ornam
ents • Ear
rings •Withdrawl of the causative agents•Steroid cream
Neurodermatitis
•Psychological disorder•Compulsive scrathing•Intense itching•Secondary infection
Wax •Ceruminous glands•Cerumin•Itching•Blockage•Pain •Suction•Mopping out•Ear syringing
Foreign body
•Organic •Inorganic •Position in EAC•Impaction•Removal
Foreign body
Inorganic
Neoplastic Squamous cell carcinoma Melagnant melanoma