External ear disorder

Disease of the external ear

• Diseases of ear pinna

• Diseases of auditory canal
Diseases of ear pinna

I. Congenital disorders
II. Trauma
III. Inflammation
IV. Tumors
I. Congenital disorders of pinna

1. ANOTIA
• complete absence
of pinna
• Treated by plastic
reconstruction or
prosthesis
2. MICROTIA

• partial absence of pinna

• rudimentary pinna
• Associated with
anomalies of external
auditory canal,middle
and inner ear
• Hearing loss is frequent
• plastic reconstruction
3. MACROTIA

• excessively large pinna

• plastic reconstruction
4. BAT EAR (LOP EAR)

• abnormally protruding
ear
• concha is large with
poorly developed
antihelix
• cosmetic surgery
II. TRAUMA OF EAR PINNA
1. HEMATOMA OF
PINNA
• collection of blood
between the auricular
cartilage and
perichondrium.
• blunt trauma in boxers
• Extravasated blood may
clot and then organise
resulting in cauliflower
ear
• Aspiration
• Pressure dressing
• incision and drainage
Hematoma to cauliflower ear
 2. LACERATION
Self inflicted : by ear bud hair
grip
Iatrogenic: ear wash or
instrumentation
Clinically:
Earache, mild bloody otorrhea
Treatment:
Antibiotics
Avoid entry of water in the ear
canal
• Suturing can be done
 3. KELOID OF AURICLE
• overgrowth of granulation
tissue at the site of a
healed skin injury
• trauma or piercing ear lobe
for ornaments
• sites-lobule or helix
• surgical excision
• steroid therapy
• Pre and post operative
radiation with total dose of
600-800 rads divided into
four doses
4. FROSTBITE

• Injury due to frostbite varies between erythema

and edema, bullae formation, necrosis of skin
and subcutaneous tissue and complete necrosis
with loss of the affected part
• Treatment
• Application of 0.5% silver nitrate for superficial
infection
• Analgesics
• Systemic antibiotics
 III. INFLAMMATION OF PINNA

1. PERICHONDRITIS
• perichondrium is infected and there is
subsequent collection of pus.
• it can cause cartilage necrosis and
collapse of auricle.
• cause: Staphylococcus aureus
• features: enlarged, thickened, red & puffy
tender & edema
• Treatment : antibiotic(erythromycin)
• Local application 4% aluminium acetate
compresses
• When abscess has formed ,drained promptly
• Culture and sensitivity of the pus to be obtained
• Incision is made to remove devitalized cartilage
• Place a catheter in the abscess and administer a
continuous drip of antibiotics for 7 to 10 days.
 IV. TUMORS

1. BENIGN TUMORS
a) periauricular sinus

• faulty union of 1 & 2

brachial arches during
the development of
pinna
• Surgery is indicated if
there is unsightly
swelling or infection
b) Dermoid cyst

• rounded mass over the

upper part of mastoid
behind the pinna
c) papilloma (wart)

• tufted growth or flat

grey plaque due to virus
• rough to peel
• surgical excision
2. MALIGNANT TUMORS

a) squamous cell carcinoma

• mostly in helix
• painless nodule or ulcer
• Otological symptoms
- Deep seated earache
- Bloody stained otorrhea
- Fleshy friable mass in the external canal
- Progressive hearing loss
• Treatment
• pinna amputation
• removal of parotid gland & cervical lymphnode
• radiation therapy
SQUAMOUS CELL CARCINOMA
Disease of Auditory canal

I. Congenital disorders
II. Inflammation
III. Tumors
IV. Miscellaneous
I. CONGENITAL

a) ATRESIA
• absence of external ear
canal opening
• due to failure of
canalisation of ectodermal
core
• unilateral/ bilateral
• surgical repair with hearing
aid
b) stenosis of ear canal

• narrow ear canal

• failure of duct to develop completely
• wax accumulation & hearing loss
• canalplasty
II) INFLAMMATION-OTTITIS EXTERNA

• acute or chronic inflammation of the skin of the

external ear canal
• types
bacterial- furuncle, diffuse
ottitis externa
infective fungal- otomycosis
viral- herpes simplex,
herpes zoster

eczema- seborrhoeic
reactive
dermatitis, neurodermatitis
FURUNCLE
Furuncle- localised acute OE

• staphylococcal infection of hair follicles

• pain, deafness, tenderness, jaw movements as
chewing cause pain in the ear
• Treatment
– ear pack of 10% ichthammol glycerine
– incision & drainage in abcess formation
b) Diffuse OE
• generalised infection of the meatal
skin which may spread to involve the pinna and tympanic
membrane
• causes- scratching with hair pins &
dirty nails, Hot and humid climate and in swimmers
• Excessive sweating changes the pH of meatal skin
• Trauma to the meatal skin
• Invasion by pathogenic organisms by staph aureus, esch.
coli
CLINICAL FEATURES

Acute phase Chronic phase

• Hot burning sensation • Irritation and strong
• Pain desire to itch
• Oozing thin serous • Scaling and fissuring of
discharge meatal skin
• Swollen meatal lining • Meatal stenosis
• Conductive hearing loss
• Enlarged regional lymph
nodes
TREATMENT

Acute phase Chronic phase

• Ear toilet • Reduction of meatal
• Medicated wicks swelling
• Antibiotics • Alleviation of itching
• Analgesics • Gauze wick soaked with
10% icthammol glycerine
inserted into the canal
• Topical antibiotic
application
• Surgical excision
c) Otomycosis

• fungal infection due to hot & humid climate

• aspergillus niger, candida albicans
• CF- intense itching, pain,discomfort, watery discharge,
ear blockage
• treatment
– ear irrigation
– antifungal- nystatin, amphotericin B
– Ear drops- 2% salicylic acid in alcohol
– Clotrimazole
III. TUMORS- BENIGN

a) osteoma

❖single, smooth, bony, hard, pedunculated

growth arising from the posterior wall of the
osseous meatus
❖surgical removal
b) exostosis

• smooth, sessile bony

outgrowth in the deeper
part of the meatus near
the tympanic
membrane.
• surgical excision
c) ceruminoma

• tumor of sweat gland which secrete cerumen

• smooth, skin covered polypoid swelling in
outer part of the meatus attached to the
posterior or inferior wall.
• surgical removal
TUMORS-MALIGNANT
a) squamous cell carcinoma
• auricular canal carcinoma resembles skin
cancer
• CF- bleeding, earache, otorrhoea, regional LN,
facial nerve palsy
• treatment
– auriculectomy
– radical mastoid operation
 IV. MISCELLANEOUS
a) impacted wax or cerumen
⮚ wax is composed of secretion of
sebaceous glands, ceruminous gland,
hair, desquamated epithelial debris and dirt.
⮚ causes
• excessive formation & desquamation
• less oily sebaceous secretions
• stiff hair in ear canal, exostosis, canal stenosis
• dusty occupation
⮚ CF
• sense of blockage, itching, irritation
• deafness,earache, tinnitus, vertigo
⮚ otoscopy- brownish
mass
⮚ treatment
✔removal of wax
• syringing or
irrigating
• instruments(Hartm
ann aural forceps)
• wax softner (5%
sodium
bicarbonate)
 b) foreign bodies in ear canal
• causes
– animate (insects, flies, maggots)
– inanimate (veg- peas, beans, seeds), non
veg- beads, stones, rubber bits
• CF- irritation, earache, deafness
• treatment
– removal by syringing or Hartmann
forceps
– suction
– microscopic removal with special
instruments
– instill chloroform water to kill maggots
 PERFORATION OF TYMPANIC
MEMBRANE
• causes
– picking ear (hair pins, match sticks, pencil)
– trauma due to foreign body
– sudden fluid comppression( diving, syringing)
– air compression (slapping, blast)
– head injury & fracture temporal bone
• CF
– deafness, tinnitus, earache, bleeding or discharge,
vertigo
• DE
– otoscopy, tuning fork test
• types
– central perforation anterior
– central perforation medium
– subtotal perforation
– total perforation
– posterosuperior marginal perforation
• treatment
– apply sterile cotton wool at the meatus
– avoid ear drops & syrnging
– avoid swimming, bathing in pool & ponds
– antibiotic (erythromycin)
– apply silver nitrate at the margin of perforation
– myringoplasty