Download - Diseases of external ear
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DISEASES OF EXTERNAL EARBy Lt Col Saeed Ullah, FCPSClassified ENT, Head and Neck Surgeon
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Anatomy
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Anatomy
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Diseases of pinna Congenital Traumatic Inflammatory Neoplastic
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Congenital Bat ear Pre auricular appendiges Pre auricular sinus Anotia Microtia Macrotia
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Bat earAbnormal protrudingPinna without land marksPoorly formed antihelix and scaphaCan be corrected surgicallyAfter 6 years of age
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Pre auricular appendiges
Skin covered tagsMay contain cartilage Removed surgically
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Pre auricular sinus/pitsRoot of the helixIncomplete fusion of tuberclesRepeated infectionAbscess may also formSurgical excision of the entire track
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Anotia
Absence of pinnaFirst arch syndrome
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Microtia
•Major developmental anomaly•Associated with other deformities•Unilateral or bilateral•Hearing loss
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Microtia
Degrees of microtia
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Macrotia
•Excessively large pinna •Can be corrected surgically
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Traumatic Laceration Avulsion Frost bite Heamatoma Keloid
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Laceration
•Sharpe trauma•Many types•Chances of avascular necrosis if perichondrium is lost •Immediate repair
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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
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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
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Heamatoma •Blunt shearing force•Boxers, wrestlers, sports injuries•Collection of blood between perichondrium and cartilage•Early Incision and drainage•Consequences
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Cauliflower ear
Consequences of non drainage or delayed drainage of heamatoma
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Keloid •Common in Black coloured personal•After trauma•Ear piercing•Surgical excision•Recurrence •Steroids/radiation
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Inflammatory Perichondritis Relapsing perichondritis Chondrodermatitis nodularis chronica
helicis
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Perichondritis •Secondary infection
• Trauma • Infection • Pseudo
monas •Red, hot, painfull pinna•Abscess formation may occur•Systemic antibiotics•I & D of abscess
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Relapsing perichondritis
•Autoimmune disorder•Any cartilage can be involved•Tender & swollen cartlige•Systemic steroids
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Chondrodermatitis nodularis chronica helicis
•Small, painfull nodules along the free border of helix•Old age•Surgical excision
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Neoplastic Benign tumors
Heamangioma Dermoid cyst Sebaceous cyst Papilloma Keratoacanthoma Neurofibroma
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Hemangioma •Benign tumor of the vessels•Detected in childhood•Bleeds frquently•Get infected•Surgical excision•Local injections of sclerosing agents
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Dermoid cyst
•Developmental cysts•Surgical excision
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Sebaceous cyst
•Cysts of sebaceous glands•Contains cheesy material•Surgical excision
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Malignant tumors of pinna SCC BCC Malignant melanoma
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SCC
•Arising from squamous epithelium•Malignant •Lymph nodes involvement •Surgical excision
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BCC
•Benign tumor of the basal layer of skin•Old age•Sun exposed areas•Surgical excision
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Diseases of external auditory canal
Congenital Traumatic Inflammatory Neoplastic
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Atresia of the canal•Congenital •Different degree of severity•Associated deformity•Ossicular and inner ear anomelies•Hearing loss•CT scan•Surgical repaire/reconstruction
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Traumatic Laceration Cotton buds Common pins Pencils Foreign bodies
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Inflammatory Infective Reactive
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Infective otitis externa Viral
Herpes zoster oticus Otitis externa hemorrhagica
Becterial Furunculosis Diffuse otitis externa Malignant otitis externa
Fungal Otomycosis
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Viral infection•Herpes zoster oticus•herpes zoster virus•Shingles•Extreme pain•Local application•Analgesics •Antifungal
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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
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Viral infection
Otitis externa hemorrhagica
Bullae formation on TM
Influenza epidemics
Pain
Blood stained discharge
Antibiotics
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Bacterial infection
Furunculosis •Hair follicles infection•Painfull•Antibiotics •Analgesics
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Bacterial infectionDiffuse otitis externa•Swimmer’s ear•Traumatic •Swelling of canal•Scanty discharge•Painfull•Antibiotics •Local drops •Packing •Aural toilet
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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
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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
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Reactive otitis externa Eczematous Seborrhoeic Neurodermatitis
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Eczematous otitis externa•Hypersensitivity reaction
• Drpos • Ornam
ents • Ear
rings •Withdrawl of the causative agents•Steroid cream
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Neurodermatitis
•Psychological disorder•Compulsive scrathing•Intense itching•Secondary infection
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Wax •Ceruminous glands•Cerumin•Itching•Blockage•Pain •Suction•Mopping out•Ear syringing
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Foreign body
•Organic •Inorganic •Position in EAC•Impaction•Removal
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Foreign body
Inorganic
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Neoplastic Squamous cell carcinoma Melagnant melanoma