External ear disorders

External ear disordersSRIDEVI.RIntroduction A deformity, dysmorphism, or dysmorphic feature is a major difference in the shape of a body part or organ compared to the average shape of that part.Types of deformity Microtia Macrotia Anotiasmall ear large ear absent earShape of the earCup-shaped Lop-earDysplasticElfin ear (pointed)Lobe malformations

Position of the earMelotia

Low set ears Synotiaear located on the cheek due to lack of aural ascent

ears are very close to each other in the midlineAuricular fistulas

External acoustic meatus Auricular appendagesAtresia Duplication Septation

Normal earLobe earPeri auricular fistula MicrotiaDefinition: Microtia means small ears. The condition may range in severity from uncomplicated hereditary microtia transmitted as a dominant and rather harmless trait[1] to severe forms with conductive hearing loss.Etiology: Non-syndromic microtia has an autosomal dominant transmission in a minority of families[2]. Isolated microtia is uncommon. Pathogenesis: Abnormal development of the first and second branchial arches.Associates anomalies: Commonly associated with the following:

7Microtia-anotia

Definition: Deformed or absent pinna with an atretic ear canal. Most forms are associated with conductive hearing loss.

Macrotia:Definition: Macrotia means large ears. The auricle is usually very large but well shaped without other ear malformations. The most exaggerated portion is the scaphoid fossa. The condition is usually bilateral and symmetric and may cause psychological disturbance due to excessive size of the ears.Etiology: Autosomal dominant inheritance in some cases[6].Pathogenesis: unknown.Associates anomalies: Commonly associated with the following: Marfan syndrome: The cartilage is somewhat floppy in addition to the ear being large. Cerebro-oculo-facial-skeletal syndrome (COFS): (Neurogenic arthrogryposis, microcephaly, micro-ophthalmia) Large ear pinna AnotiaDefinition: Complete absence of the auricle. Skin of the cheek passes smoothly over the aural area without definite elevation or depression.Etiology: Extremely rare, sporadic and usually unilateral. Ruzic reported seven cases[10]. May be associated with facial paralysis and absence of the tonsil on the abnormal side.

10Cup-shaped earDefinition: Small auricles that grow forward over the meatus. Peterson and Schimke (1968) observed cup-shaped ears in members of 5 generations with at least 4 instances of male-to-male transmission. Their proband had Pierre-Robin syndrome[11].

Lop earDefinition: The external ear stands away from the head at a greater angle (Normal angle of the auricle to the median plane averages 25 degrees in boys and 18 degrees in girls). Lop ears are usually larger than normal ears.Etiology: Autosomal dominant inheritance in some cases. Rogers (1968) has suggested that the lop ear resembles a fetal stage of pinna development, suggesting arrest of development at that stage[12].

Dysplastic earDefinition: Abnormally shaped auricles. Usually associated with chromosomal anomalies:

Lobe malformationsAdherent lobe: frequent variation that occurs less often in men than in women. Absent lobe: seen in Seckel syndrome. Cleft lobe (coloboma): longitudinal cleft of lobe which may be partial but usually extends to but not through , the incisura intertragica.

MelotiaDefinition: Ear located on the cheek.Pathogenesis: May represent lack of aural ascent due to underdevelopment of the auricle. There is also the embryological evidence, that melotia represents extraordinary big preauricular appendages[14]Low-set earsDefinition: An ear that is set below an arbitrary line drawn between the lateral canthus of the eye and the occipital protruberance is considered low-set.Etiology: probably multifactorial.

MelotiaAuricular fistula Definition: Blind-ending narrow tubes or pits. Most are harmless, occasionally they can get infected, form retention cysts and cause chronic discharge.Etiology: Autosomal dominant inheritance with variable expressivity and incomplete penetrance. Many occur sporadically and are associated with hereditary deafness. Report of large kindreds such as that of Bhalla et al , in which there are no associated features or lateral cervical sinuses suggests that this is a distinct mendelian dominant. The pedigree was traced through seven generations indicated in the expression of the occurred bilaterally as a small pit just anterior to the crus at the root of the ascending helix. The abnormality was found to be inherited through an autosomal dominant gene with incomplete penetrance[16].Incidence: 0.9% in European populations.Locations:Anterior margin of the ascending limb of the helix. Center of the lobule natural earring hole Colloaural: from the floor of the external meatus down to the angle of the mandibleAuricular appendages

Definition: tags of skin with or without a cartilaginous base frequently located in the line of junction of the mandibular and hyoid arches. This is a common malformation occurring in approximately 1.5% of the population. May be sessile or pedunculated.Sites of location: In front of the auricle Within the ear Behind the ear On the lobuleAppendages on the cheek between the auricle and the angle of the mouth are often associated with microtia, melotia or oblique facial features. True polyotia seems to be extremely rare and has been reported by Bol and Dekleyn (Acta otolaryng 1:187,1918)Darwinian tubercle: a small projection from the descending part of the helix. Darwin regarded this variation as a remnant of the pointed ears of some External otitisIt involves inflammation of the epithelium of theInflammation of the external ear canal and/or pinnaCan be localized (associated with a furuncle) or diffuse (usually a bacterial or fungal infection or allergy)Can be acute or chronic (longer than 6 weeks)May be secondary to skin conditionsCan be serious; necrotizing otitis externa is rare and usually occurs in immunocompromised or malnourished patientsPruritus is usually the first symptomTenderness of the ear or canaldescriptionPain in the ear and also of the pinnamade worse by manipulation of the pinna and by exerting pressure on the tragus. Also pain on eatingDischarge from the earConductive hearing lossCrusting around the ear canal openingLymphadenopathypostauricular, preauricular, and lateral cervical lymph nodesInvolvement of cranial nerves (VII, IX-XII) in late stages auricle and ear canal

EpidemiologyIncidence and prevalence:Unknown, but higher in the summer and humid monthsPeople with asthma, eczema, or allergic rhinitis are three times more likely to develop otitis externaDemographics:All ages affectedOccurs equally in males and females

Causes Causes:Gram-positive organisms: Staphylococcus aureusStreptococci groups D and GGram-negative organisms: Pseudomonas aeruginosaEscherichia coliProteus mirabilisKlebsiella pneumoniaeAnaerobic bacteria: Bacteroides speciesClostridium speciesAnaerobic streptococciFungi: Aspergillus niger (these occur in 10% of otitis externa cases in the U.S.)Candida albicansSecondary to primary skin conditions (eczematous otitis externa): EczemaPsoriasisSeborrheic dermatitisAllergiesRare causes include secondary to primary skin conditions (eczematous otitis externa): Herpes simplexHerpes zosterA serious cause is P aeruginosa. Aninvasive infection may lead to necrotizing otitis externa

Risk factors:

Excess moisture (swimming, bathing, or increased environmental humidity)Trauma (scratching or foreign body)Irritants in the ear (hair spray, hair dye)Self-cleaning (pushing debris deeper into the canal)Primary skin conditionsCoexisting debilitating diseases (eg, diabetes mellitus type 1 or type 2, leukopenia, malnutrition)Associated disordersAsthmaEczemaAllergic rhinitis

Diagnostic evaluationHistory physical examinationOtoscopyCulucture & sensitivityCollaborative therapyAnalgesicsWarm compressesCleansing canalEar wickAnti biotic dropsPreventive measures Avoid swimming in polluted poolsTreat primary skin conditionsTreat underlying coexisting conditionsConsider using prophylactic agents against otitis externa; these are typically mixtures of vinegar and alcoholDecrease water entrance in earsuse of ear plugs and/or a hairdryer to dry the ear canalDecrease trauma by decreasing the insertion of foreign objectsAvoid allergens such as hair sprays and hair dyesDo not use over-the-counter ear drops for more than one weekAlways see a physician if symptoms don't resolve

What is cerumen?Cerumen, also called earwax, is made by the body to protect the ears. The earwax has both lubricating and antibacterial properties. Most of the time, the old earwax is moved through the ear canal by motions from chewing and other jaw movements. At that time, it reaches the outside of the ear and flakes off. Cerumen is produced in the outer part of the ear canal, not deep inside the ear.

What does it mean when cerumen becomes impacted?

We say that cerumen is impacted when it has built up in the ear canal to such a point that there may be signs that something is not quite right. It is important to note that, ideally, ears might never need cleaningthey are designed to clean themselves. Impaction often happens when people use items like cotton swabs or bobby pins to try to clean their ears. This only pushes the earwax farther into the ears and can also cause injury to the ear.

What are the symptoms of cerumen impaction?

A feeling of fullness in the ear Pain in the ear Difficulty hearing, which may continue to worsen Ringing in the ear (tinnitus) A feeling of itchiness in the ear Discharge from the ear Odor coming from the ear Dizziness

Who experiences earwax buildup?

Earwax buildup can happen to anyone. However, it is more likely to occur in:People who use hearing aids or earplugs People who put cotton swabs or other items into their ears Older people People with developmental disabilities People with ear canals shaped in such a way as to impede natural wax removal How is cerumen impaction diagnosed?Your health care provider can look into your ears with a special instrument, called an otoscope, to see if earwax buildup is present.How is cerumen impaction treated?Earwax removal can happen in a few ways; some of these methods can be done at home.Cleaning the outside of the ear by wiping with a cloth. Putting cerumenolytic solutions (solutions to dissolve wax) into the ear canalthese solutions include mineral oil, baby oil, glycerin, water, peroxide-based ear drops (such as Debrox), hydrogen peroxide, and saline solution. Irrigating or syringing the earthis involves using a syringe to rinse out the ear canal with water or saline, generally after the wax has been softened or dissolved by a cerumenolytic. Removing the wax manually using special instrumentsthis should be done only by a health care provider who might use a cerumen spoon or suction device. Note: Irrigation should not be done by any persons who have, or suspect they have, a perforation (hole) in their eardrum or tubes in their ear.

What are possible complications of cerumen impaction?

If left untreated, excessive earwax may cause symptoms of cerumen impaction to become worse. These symptoms might include hearing loss, ear irritation, etc. A build-up of earwax might also make it difficult to see into the ear, which may result in potential problems going undiagnosed.

How can cerumen impaction be prevented?

Do not stick anything into your ears to clean them. Use cotton swabs only on the outside of the ear. If you have a severe enough problem with earwax that you need to have it removed by a health professional more than once a year, discuss with them what the best method of prevention (if any) is for you.Getting an object stuck in the ear is a relatively common problem, especially in toddlers. The vast majority of items are lodged in the ear canal, which is the small channel that ends at the eardrum. Because the ear canal is quite sensitive, you can usually tell if there is something in your ear. Most cases of foreign bodies in the ear are not serious and can usually wait until the morning or the following day for removal. The object does, however, have to be completely removed quickly and with the least amount of discomfort and danger.

Common objects found in ears include food material, beads, toys, and insects. Children often place items in their ears out of curiosity.Although earwax (cerumen) is not technically a foreign body, it does frequently accumulate in the ear canal and can cause discomfort or decreased hearing just like other foreign bodies.

Ear Foreign Body Causes

The vast majority of objects found in ears are placed there voluntarily, usually by children, for an endless variety of reasons. A caregiver should not threaten a child when asking about this possibility, because the child may deny having put something in the ear in order to avoid punishment. This denial could easily result in a delay of its discovery and increase the risk of complications.Insects are well known to crawl into the ear, usually when you are asleep. Sleeping on the floor or outdoors would increase the chance of this unpleasant experience

AnimateIn animateVegetableMineral objectsForeign Body SymptomsFortunately, most people can tell if there is something in their ear. The ear canal, where most objects get stuck, is very sensitive. The ear canal ends at the eardrum, which is also highly sensitive. The symptoms of having a foreign body in the ear largely depend on the size, shape, and substance involved. Occasionally, a foreign body in the ear will go undetected and can cause an infection in the ear. In this situation, you may notice ongoing infectious drainage from the ear.Pain is the most common symptom. If the object is blocking most of the ear canal, you may experience a decrease in hearing on that side.Additionally, irritation to the ear canal can also make you nauseated, which could cause you to vomit.

Bleeding is also common, especially if the object is sharp or if you try to remove it by sticking something else into your ear.One of the most distressing experiences with this problem is having a live insect in the ear. The insect's movement can cause a buzzing in the ear and may be quite uncomfortable. Fortunately, dripping mineral oil into the affected ear will usually kill the insect. This is safe as long as you do not have a hole in your eardrum.managementDepending on your particular medical community, your doctor may wish to see you in the office or refer you to a local emergency department or other specialist. Do not expect any health care professional to be able to assess the situation adequately over the phone. If there is any concern for the presence of a foreign body in the ear, you should be physically examined by a qualified medical professional.Persistent pain, bleeding, or discharge from the ear could mean that the ear passages have not been completely cleared, part of the object could remain inside the ear, or an infection of the ear canal has developed. These infections generally respond well to antibiotic drops, but an exam and prescription are necessary.

A foreign body in the ear can also damage the eardrum, which may or may not affect hearing. Because you cant see the eardrum from the outside, an exam of the ear is recommended.In the majority of cases, the situation of having something in your ear will not be life threatening. Usually you will have time to call your regular doctor. The urgency of the situation primarily depends on the location of the object and the substance involved.Button batteries commonly found in many small devices and toys can decompose enough in the body to allow the chemicals to leak out and cause a burn. Urgent removal is advised.Urgent removal is also recommended for food or plant material (such as beans) because these will swell when moistened.Urgent removal is indicated if the object is causing significant pain or discomfort.Exams and TestsMost objects can be seen with good lighting and a few instruments. Occasionally, an object is discovered accidentally when x-rays are taken for unrelated reasons. It is important to realize that many materials such as food, wood, and plastic will not be visible on a routine x-ray.Do not hesitate to ask your doctor to examine the entire head and neck region. It is distinctly possible that the person has multiple foreign bodies in both ears and foreign objects in the nose.

treatmentCommonly used techniques include applying gentle suction to the object, small forceps, or instruments that have a loop or hook at the tip.If the object is metallic, a long instrument may be magnetized to assist in gently pulling the object from the ear.Another common technique involves irrigating the ear. If the eardrum appears intact, warm water can be gently squirted past the object using a small catheter. The water will turn around at the end of the ear canal and often wash the object out.

Any experienced professional can tell you that children typically struggle with these techniques. Struggling will decrease the likelihood of success and increase the chance for complications. Sedation of the child may be considered an option to allow calm and comfortable removal of the object, if necessaryMalignancy of the external earAuricle basal & sequamous cell carcinomas

melanomasThank you