ear disease presentation (manchester g ps)
DESCRIPTION
Management of external ear diseaseTRANSCRIPT
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Ear DiseaseSimon Lloyd
Consultant ENT Surgeon
Manchester Royal Infirmary
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Anatomy
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Tympanic MembraneLeft ear
Pars flaccida
Handle of malleus
Light reflex
Long process of incus
Pars tensa
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Middle Ear
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Inner Ear
Consists of: Semi-circular canals Vestibule Cochlea
Function: Balance Hearing
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Clinical Assessment
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Symptoms
5 symptomsOtalgiaOtorrohoeaHearing impairmentTinnitusVertigo
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Investigation
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Pure Tone Audiometry
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Familiar Sounds
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External Ear
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Otitis externa
Inflammation of ear canal skin
Aetiology:Bacterial – Staph. aureus, Pseudomonas, ProteusFungal – Aspergillus niger, Candida albicansViral – Herpes simplex,Herpes zosterReactive – Eczema, Psoriasis
Predisposing factors:Bathing, humidityTraumaCanal stenosisEczema
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Symptoms & Signs - Bacterial
Otalgia - severe
Purulent otorrhoea
Deafness
Inflammation of ear canal +/- pinna
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Treatment
Swab for sensitivities
Aural toilet
Splinting of ear canal (Pope wick)
Topical antibiotics eg. Sofradex, Gentasone
Keep dry
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Malignant Otitis Externa
Osteomylitis of temporal bone
Immunocompromised patients eg. Diabetes
Usually pseudomonas
Extremely painful
May be associated with cranial nerve palsy
Have a high index of suspicion
Treat aggressively with IV antibiotics for at least 6 weeks
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Symptoms & Signs - Fungal
Itching
Mild otalgia
Fullness
Greyish white debris +/- fungal spores
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Treatment
Aural toilet
Topical antifungal agents eg. Canestan
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Furunculosis
Staph. infection of hair follicle causing abscess formation
Severe otalgia
Requires I&D
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Ramsey Hunt Syndrome Herpes zoster
Geniculate ganglion of facial nerve
Vesicular rash of pinna and ear canal (+/- mouth and tongue)
Facial nerve palsy
Painful
Vertigo
Treatment Analgesia Antivirals eg. Acyclovir Protect the eye
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Perichondritis
Inflammation of perichondrium
Aetiology: Ear piercing Laceration Surgery CT disease
Treatment: Antibiotics I & D (if abscess)
Sequelae: Cauliflower ear
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Foreign body in ear
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Hyperostosis
ExostosisMultiple bony swellings in
deep canalCold waterAsymptomatic
No treatment unless large
OsteomaSingle benign bony tumour
outer bony meatusNo treatment unless large
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Embryology
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First Branchial Cleft AnomaliesPre-auricular sinus
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First Branchial Cleft AnomaliesAccessory Auricle
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Benign Skin Pathology
Seborrhoeic Keratosis
Gouty Tophi
Solar keratosis
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Benign Skin Pathology
Chondrodermatitis helicis nodularis chronica
Keloid ScarringDarwin’s tubercle
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Malignant Skin Pathology of The Pinna
Basal Cell Carcinoma
Squamous Cell Carcinoma