Diseases of the external ear By, Dr. Vanitha Palanisamy ENT,HTAR 8 th of April 2011.
External ear
Consists of the auricle and EAM Skin-lined apparatus Approximately 2.5 cm in length Ends at tympanic membrane AURICLE Auricleelastic cartilage+skin Cone shape Ear lobuleno cartilage
External auditory canal Outer 1/3 cartilage , ceruminous gland , seabaceous gland , hair Inner 2/3 bone (tympanic and squamous portion of temporal bone) , anteroposteriorly , only epithelial lining on the periostium Self-cleaning property Tympanic membrane Epithelial layer squamous epithelium Fibrous layer circumferential and radial fiber Mucosal layer
Tympanic membrane
Symptom
Otalgia Otorrhea Tinnitus aurium
Vertigo
Cause
Congenital Trauma Inflammation and infection Tumor Malignant Miscellaneous condition
Congenital
Complete or partial absence of auricle Preauricular sinus and/or cyst Accessory auricle Abnormalities in size or shape of auricle
Complete absence of auricle and Abnormalities in size or shape of auricle
1.Anotia 2. Microtia 3.Bat ear 4.Lop-ear 5.Macrotia
Anotia : Total absence of the pinna
Microtia
Microtia,Anotia .
Abnormalities in size or shape of auricle
Treatment Minor defect : plastic surgery Major defect : prothesis
Preauricular sinus and/or cyst
-seen at root of helix
-due to incomplete fusion of tubercles. -repeated infections causes purulent discharge, may lead to abscess formation.
TREATMENT-surgical excision of the track.
Preauricular sinus and/or cyst
Accessory auricle/Preauricular appendages.
Trauma
Laceration Blows Foreign body
Laceration
Post trauma, assault, industrial injuries. Must be repaired as early as possible. Perichondrium is stitched with absorbable sutures, skin closed with non-absorbable sutures. Cover with oral antibiotics for 1 week.
Laceration
Blows/ Hematoma of the auricle
Collection of blood between the auricular cartilage and its perichondrium. Results from blunt trauma,ex: boxers. Blood may clot and organise,results in deformity- Cauliflower ear if hematoma gets infected, Perichondritis sets in.
Hematoma of pinna
Cauliflower ear
Treatment.
Aspiration of hematoma under aseptic technique, and pressure dressing. If aspiration fails, incision and drainage done, then apply pressure by dental rolls tied with through and through sutures. Cover with prophylactic antibiotics.
Foreign body 1) Non-living: seeds, pencil tip, vegetables, beads -removed by forceps, suction syringing, postaural approach. 2) Living: mosquito, beatles, cockroach -kill first by instilling oil, then remove. Maggots- instill chloroform to kill, then remove.
Foreign body in EAC
Inflammation and Infection Infective group BACTERIAL Furuncle of external meatus Diffuse infective otitis externa Malignant otitis externa FUNGAL Otomycosis Viral -Herpes zoster oticus -Myringitis bullosa hemorrhagica
Inflammation and Infection Reactive group
Eczematous otitis externa Seborrhoeic otitis externa Neurodermatitis
Inflammatory disorders Perichondritis Relapsing polychondritis.
Furuncle Staphylococcal infection. Confined to the cartilaginous part of meatus.
Furuncle -severe pain and tenderness. -movement of pinna painful. -if furuncle at post meatal wall, causes oedema over the mastoid with obliteration of retroauricular groove. -palpable periauriculat lymph nodes. TREATMENT -exclude diabetes is recurrent furunculosis. -systemic antibiotics, analgesics and heat.
Diffuse infective otitis externa Diffuse inflammation of meatal skin. Causes: -excessive sweating -trauma: scratching using pins,removal of foreign body, vigorous cleaning of ear after swimming -Invasion by pathogens : Staph. aureus, Pseud. pyocyaneus, B. protus and Esch. Coli. Clinical pictures: -pain,serous to purulent discharge, blocked ears, tenderness at surroundings. Treatment: -Ear toilet,medicated wickswith ear drops, antibiotics and analgesics.
Acute Diffuse Otitis Externa [swimmer's ear]
Otomycosis -fungal infection of ear canal due to Aspergillus niger, A.fumigatus, or Candida albicans. - also occurs as secondary fungal growth in patients using topical antibiotics for OE or OM. CLINICAL FEATURES -Intense itching,pain and ear dyscomfort,watery discharge,ear block. Colour: -A.niger:black headed filamentous growth. -A.fumigatus:pale blue or green. -Candida:white or creamy deposit.
Severe Aspergillus Niger Otitis Externa
Otomycosis
Eczematous otitis externa
-results of hypersensitivity to infective organisms or topical ear drops ex:chloromycetin or neomycin. -intense irritation,vesicle formation,oozing and crusting in the canal.
TREATMENT: -stop topical antibiotics and apply steroid cream.
Seborrhoeic otitis externa
-associated with seborrhoeic dermatitis of the scalp. -Greasy scaled seen at EAC,lobule and postauricular sulcus.
TREATMENT: -ear toilet,apply cream contains salycylic acid and sulphur,treat the dermatitis.
Myringitis bullosa haemorrhagica -formation of haemorrhagic bullae on the TM and deep meatus. Usually viral in origin. Clinical picture:severe pain and blood stained discharge when bullae ruptures. Treatment:analgesics and antibiotic.
Malignant otitis externa Caused by pseudomonas infection. Affects elderly,diabetics,those on immunosuppressive drugs. Clinical picture: -excruciating pain, granulations in the meatus,facial paralysis is common. -Infection may spread to skull base and jugular foramen,causing multiple cranial nerve palsies. -Spreads anteriorly to temporomandibular fossa,posteriorly to mastoid and medially into middle ear and petrous bone.
Malignant otitis externa
Treatment: High doses of antibiotics,6-8weeks. -Control diabetics. -Surgical debridement of devitalized tissues and bone (To do CTScan to know the extend)
Perichondritis -results from lacerations,haematoma or surgical incisions. -also due to extension of infection from diffuse OE or furuncle. Commonly caused by Pseudomonas and mixed flora. Sx: red,hot,painful pinna,stiffness of pinna. TREATMENT:systemic abx,local application of aluminium acetate compresses. -if abscess has formed,it must be drained. -devitalised cartilage must be removed.
Perichrondritis
Tumor
Exostosis Papilloma Angioma Fibroma Adenoma Osteoma
Exostoses
Is the most common benign tumor of the EAC. -they are multiple and bilateral,smooth bony swellings near TM,arise from compact bone. -Often found in swimmers who have repeated exposure to cold water. . -Treated by cleaning the ear using high speed drill. Gross bone surgery. -may damage facial nerve during surgery when exostoses lies deeply.
Exostoses
Osteoma A solitary benign bony growth. Common position in the EAC tympanomastoid suture line. -Treatment: Surgical removal
Malignant Found in elderly patients with exposure to the sun. TYPES Squamous cell carcinoma
Basal cell carcinoma (Rodent ulcer)
Squamous cell carcinoma
Common than other cancers.
-Site of occurrence: Helix
Treatment -Small lesions with no nodal mets: Excised 1cm around it. -Larger lesions:Total amputation of pinna with removal of parotid gland and lymph nodes.
Squamous cell carcinoma
Basal cell carcinoma
Found in countries with more sunlight. Common sites : helix and tragus. -ulcer looks raised,often extends circumferentially into skin. Treatment:Surgical excision.
Basal cell carcinoma (Rodent ulcer)
Miscellaneous condition of the external ear
Miscellaneous condition
Wax Sebaceous cyst Keloid Acquired atresia and stenosis of external auditory canal
Ear wax
Composed of secretion of sebaceous glands,ceruminous glands,hair,desquamated epithelial debris,keratin and dirt. Impacted ear wax causes blocked ears,tinnitus and giddiness resulting from impaction of wax against TM,and cough due to stimulation of auricular branch of vagus. TREATMENT:Remowal of ear wax.
Impect Cerumen
Sebaceous cyst
The common area behind the ear and the lobule.
Keloid
Often occur after ear piercing. . Steroid treatment of the lesion by injection every 1-2 weeks or until the clot dissolved, then excision and radiation.
Keloid of ear lobule
Acquired atresia and stenosis of external auditory canal
May be caused as follows.
Chronic otitis externa is usually found in their eczematous type Operation Perichondritis Injury after corrosive burn Idiopathic
Treatment
Polyethylene tube
Surgical treatment
