diseases of external ear ug dr.s.vijaya sundaram 01.02.16
TRANSCRIPT
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Diseases of External Ear
DR.S.VIJAYASUNDARAMASSOC,PROF
DEPT. OF. ENT,HNSMGMC&RI
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TerminologyTerminology
Otalgia- ear pain
Otorrhea- ear discharge
Tinnitus- sound perception without corresponding acoustic signal
Vertigo- hallucination of movement
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Congenital
Acquired
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Embryological development of the PinnaEmbryological development of the Pinna
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Preauricular SinusPreauricular Sinus Accessory Accessory AuricleAuricle
Telephone Cupped Telephone Cupped EarEar
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MicrotiaMicrotia
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ProblemsProblems
Hearing
Cosmesis
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Air Conduction Hearing AidAir Conduction Hearing Aid
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Bone Conduction Hearing AidsBone Conduction Hearing Aids
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Disadvantages of ConventionalDisadvantages of ConventionalBone AidsBone Aids
Poor quality of sound amplification
Discomfort & skin irritation
Stigma
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CosmesisCosmesis
Conventional approach
No treatment
Prosthetic ear glued to the head
Surgical reconstruction of pinna
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Universally poor results with rib cartilage graftsUniversally poor results with rib cartilage grafts
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Osseointegrated ImplantsOsseointegrated Implants
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Preauricular sinusPreauricular sinus
Asymptomatic: NO treatment
Infected: Antibiotics +/- Drainage if abscess
Definitive treatment: Excision
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Acquired Diseases of AuricleAcquired Diseases of Auricle
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Perichondritis/ perichondral Perichondritis/ perichondral abscessabscess
Infection involve the perichondrium
Severe pain, often associate with fever
Treated by i.v. antibiotics +/- drainage if pus
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Can lead to ear deformity
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Pinna lacerationPinna laceration
Wound cleaning, remove foreign body
Simple suture
Antibiotics if cartilage exposed
Need to rule out other injuries e.g. head injury
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Hematoma aurisHematoma auris
Caused by trauma
-Treatment: incision, drainage +pressure dressing
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Can lead to deformed ear if untreated—
The cauliflower ear
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TumorsTumors
Benign
Malignant
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Diagnosis: biopsy
Treatment: Surgery
RT
Surgery + RT
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Diseases of External Ear CanalDiseases of External Ear Canal
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Otitis externaOtitis externa
Clinical features:1. Otalgia/ Itchy ear2. Ear discharge3. Hearing loss- only in
severe cases4. Inflammed canal skin5. Canal exudates
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TypesTypes
Bacterial: Acute diffuse otitis externa
1. Trauma2. Prolonged water exposure
Common causal micro-organisms: Pseudomonas
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TreatmentTreatment
Aural toilet
Antibiotic ear drops
Systemic antibiotics usually not required
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Fungal:
1. Prolonged antibiotic ear drops
2. Immuno-compromnised
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Treatment of fungal OE
- remove predisposing factors
- Topical antifungal agent
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Otitis externaOtitis externaIn immunocompromised patientsi.e. DM, steroid, HIV, Chemotherapy
Beware of Malignant Otitis Externainvolve bone of skull base,severe painpotentially fataltreat by prolonged high dose i.v. antibiotics+/- surgery
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Impacted ear waxImpacted ear wax
Treatment needed when impaction causing symptoms:
1. Hearing loss
2. Otitis externa
3. Pain
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Impacted ear waxImpacted ear wax
Treatment:
1. NaHCO3 ear drops2. Syringing3. microsuction
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Foreign bodiesForeign bodies
• Syringing
• Removed under operating microscope
For living insects: killed with olive oil before retrieval attempt
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Small exostosis
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When large, can cause symptoms:
1. Impacted ear wax
1. Recurrent otitis externa
Treatment if symptomatic:
Surgical removal
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Malignant ear canal tumor:
Clinical:1. Blood stained otorrhea2. Pain3. Nerve palsy4. Trismus
Management:1. Biopsy 2. Imaging to define extent3. Treatment: Surgery
RTSurgery+RT